Lecture 3 exam 2
Card Set Information
Lecture 3 exam 2
Respiratory Vaccines Skin ENT
Over this semester!!!!
Problem with Diptheria
breathing and heart failure
Problem with Tetanus
Lock jaw....cant open mouth or swallow
Problem with Pertussis
Problem with HIB
Haemophilus Influenza B
can lead to meningitis
infections of blood, joints, brain
Problem with Hep B
liver damage and cancer
Problem with Polio
Paralysis of arm or leg
Problem with Pneumococcal disease
Problem with Rotavirus
dehydration and hospitalization
How do babies catch most disease?
contact with other people infected.
Hep B is transmitted at birth
Tetanus thru a cut or wound
If you don't want your child to get the Pertussis vaccine, you will get the
How is the Rotavirus vaccine given?
by drops that are swallowed
Prior to getting your next injection of DTap tell you doctor if after previous dose the following occurred
brain/nervous system disease within 7 days
baby cried non stop for 3+hrs
seizure or collapse
fever over 105
Don't get Polio vaccine if....
child has a life threatening allergy to antibiotics
Neomycin, Streptomycin, Polymyxin B
Don't get Hep B vaccine if
your child has a life threatening allergy to yeast
Don't get Rotavirus vaccine if child has....
Severe Combined Immunodeficiency
Weakened immune system
Had a recent blood transfusion
Don't get PCV13 or DTaP if you child has ever had a sever reaction after any vaccine containing
Difference in breathing patterns in infants and children?
nose breathers till 6 mo.
Irregular breathing is normal in infants with apnea lasting 10-15 sec.
Stuffed nose can cause problems with breathing...especially while eating
Increased airway resistance and RR causes fatigue
What's up with the cough/gag reflex in infants and kids?
it is weak and can be poor or absent with decreased neuro status and premies
Cant get mucous out....swallow it
risk for aspiration
What's the difference btwn lower airways in adults and babies/kids?
Narrow, smaller and short
Block occurs easily from inflammation/mucous, edema
things go bad fast.
Infections spread easily thru entire resp. tract
What does grunting indicate in an infant?
trying to keep lower airway open....tiring out.
What's up with the alverolar system in babies/kids?
Surfactant doesn't exist till 34 weeks gest
less and smaller amt till 5 yo
decreased surface area for gas exchange
increased atelectasis risk
What's the primary respiratory muscle until 5yo?
Infants and young children are what sort of breathers?
Increased work of breathing expends oxygen which leads to an increased risk for
respiratory fatigue and failure
What causes an increase risk of respiratory obstruction?
smaller lower airways and underdeveloped supporting cartilage
What's the major respiratory muscle for neonates?
Classic signs of respiratory distress/failure in kids
abdominal "see saw" breathing
Tripod or upright position
What causes grunting?
glottis closing which causes exhalation and alveolar stays expanded
What does a stridor mean?
Upper airway obstruction
What's the most common response to respiratory illness?
What's the most common response to acute distress?
Normal O2 sats for infants and kids
Nursing Considerations for nasal cannula
look at skin integrity around nose
Aerosol meds are used for?
blow by for infants and mask for kids
Assess, assess, assess breathing after treatment
Educate parents on proper medication protocol and info regarding triggers, rescue meds and long acting meds
Nursing considerations for a Trach
ensure all material and equipment is in the room
assess size of trach and have an extra
proper head tilt for placement
S/S of tonsilitis
S/S of pharyngitis
stomachache...refuse to eat
sore throat, hoarse, rhinitis, slight fever
Normal WBC but positive throat culture
pain relief and rest, cool bland foods
Severe sore throat, swollen red tonsils, V, headachy, high fever
WBC increased and pos. throat culture
antibiotics and pain management with saline gargle and bland foods
#1 complication of tonsillectomy/adenoidectomy?
Watch for frequent swallowing or throat clearing
bright red emesis
How do you prevent bleeding after a tonsillectomy/adenoidectomy?
don't clear throat
keep suction at bedside for emergency
What do you do if you suspect airway compromise?
lye on side
What increases the risk of otitis media?
attend day care
bottle not breast fed
What's the difference between acute otitis media and otitis media with effusion?
Acute-purulent exudate, INFECTION from bacteria or virus
Otitis with effusion-serour non purulent and NO INFECTION
S/S of acute otitis media?
pullin on ears
red tympanic membrane
S/S of otitis media with effusion
no pain just fullness
snapping sound with swallowing
Tympanic membrane-gray, yellow, translucent, air bubbles
How do you treat acute otitis media?
antibiotics for 5-10 days
How do you treat otitis media with effusion?
no antibiotics if not bacterial
don't blow nose
keep ears dry
What characterizes Croup syndromes?
inspiratory stridor and respiratory distress
S/S of epiglottitis
How do you dx epiglottitis?
lateral neck x ray....no direct visualization till pt is intubated
Nursing management for Epiglottitis
MAINTAIN a PATENT AIRWAY
S/S of Croup
gradual onset....at night
preceded by a URI
low grade fever
Nursing care for Croup
night air or shower
Aerosol Inhalant used to treat Croup.
Watch for 2-3 hrs after for rebound obstruction
When and who gets RSV?
Infants in winter months
What is the problem with RSV?
sufficient air intake, but cant passively exhale
Result of RSV?
How do you dx RSV?
Nasal Smear + for RSV
CBC is normal
When a person is having an exacerbation from RSV what will it look like?
Vaccine given to high risk infants for RSV?
How do you dx asthma?
hx of reactive airway
What sort of O2 do you give a person having an asthma attack?
low dose with NC or mask
Nursing care for a person having an asthma attack
Bronchodilators via neb.
Patient and parent ed for asthma
What meds to use and when
Peak flow meter with grn/yellow/red
tell others he/she has asthma
Breath sounds during an asthma attack
moderate-insp and exp wheezes
severe-decreased over all lung fields
LOC during an asthma attack
severe-lethargic/somnolent/min. resp to pain
How will patient be positioning themselves during an asthma attack?
mod-upright/tripod/wont lay down
O2 sats during an asthma attack
all on room air
pH for a person having an asthma attack
Blood gas for a person having an asthma attack?
severe-respiratory and metabolic acidosis
Peak flow meter results...
Grn 80-100% of personal best
Yellow 50-80% of personal best
Red <50% of predicted or personal best
What is cystic fibrosis?
general dysfunction of the exocrine gland resulting in over production of thick tenacious mucous everywhere
S/S of cystic fibrosis
failure to thrive
susceptible to infections....and antibiotic resistant one
fatty/frothy foul stools
muscle wasting cuz of malabsorption
severe productive cough
Dx tests for cystic fibrosis
Sweat chloride test
chest x ray
fecal fat-72 hr collection
Nursing care for a person with cystic fibrosis
G tube feeds at night
v. supp. of ADEK-water soluable
Pancreatic enzymes to help with digestion
How do you promote oxygenation for a person with CF?
percussion and postural drainage
vest to cough up sputum
think and mobilize secretions with fluids
steroids to decrease inflammatory response
When do you take pancreatic enzymes?
30 min. prior to meals
S/S of whooping cough
Catarrhal-1 to 2 weeks, symptoms of URI
Prodromal-2 to 4 weeks increased severity of cough during exp. followed by massive insp with a whoop
Convalescence-1 to 2 weeks, coughing spells decreasing in severity
What can trigger whooping cough spells?
Nursing care for whooping cough
admin vaccine DTaP
Antibiotics-erythromycin, azithromycin, clarithromycin
nutritional support with small frequent meals
nursing care clustered so they can sleep
Isolation for a person with whooping cough
Normal breathing for an infant
short pauses in breathing pattern lasting less than 20 seconds
pauses beyond 20 seconds or any pause with cyanosis, bradycardia or pallor
Apnea of prematurity
occurs in neonates of 24-32 weeks, but resolves by 38 weeks
occurs during feeding cuz of immaturity of breathing, sucking and swallowing coordination
How does a person manage apnea of prematurity?
gentle cutaneous stimulation so they don't stop breathing
What do you do for persistent apnea?
Drugs used to help a baby not have apnea
increase respiratory drive and improve carbon dioxide sensitivity
What causes infant apnea?
underlying conditions like:
absence of respiratory effort and air movement
apparent respiratory efforts without air movement or sound
absence of respiratory effort and nasal air movement
followed by resumption of respiratory effort without air movement
What do you track for your child on an apnea monitor?
record conditions leading up to an event, time, how long it lasted, and condition of infant after
stimulate a child when event is observed...don't wait for monitor to beep
parents trained in CPR
back up plan for power outages
If apnea monitor beeps immediately....
assess infant not machine
You see SIDS most often in babies
2-4 mo old....but happens before 6 mo
Intrinsic risk factors for SIDS
prenatal exposure to cigarettes/alcohol
Extrinsic risk factors for SIDS
prone sleeping position
infant sleeping on upholstered furniture/adult mattress
exposure to cigarette smoke
Signs of an Apparent Life Threatening Event
Near SIDS-apnea, color change, marked change in muscle tone, choking or gagging
admit for observation
*often occurs due to sepsis