Lecture 3 exam 2
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Problem with Diptheria
breathing and heart failure
Problem with Tetanus
Lock jaw....cant open mouth or swallow
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
- blood infection
- ear infections
- brain damage
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
- Digestive problems
- 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.
- Increased RR
- 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
- frightened look
- LOC change
- abdominal "see saw" breathing
- Nasal Flaring
- 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
- mouth odor
- difficulty swallowing
- mouth breathing
- red tonsils
S/S of pharyngitis
stomachache...refuse to eat
- gradual onset
- 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?
- no straws
- don't clear throat
- keep suction at bedside for emergency
What do you do if you suspect airway compromise?
What increases the risk of otitis media?
- attend day care
- bottle not breast fed
- paci use
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?
- acute pain
- pullin on ears
- red tympanic membrane
S/S of otitis media with effusion
- no pain just fullness
- snapping sound with swallowing
- decreased hearing
- balance disturbances
- Tympanic membrane-gray, yellow, translucent, air bubbles
How do you treat acute otitis media?
- antibiotics for 5-10 days
- pain control
How do you treat otitis media with effusion?
- no antibiotics if not bacterial
- don't blow nose
- keep ears dry
- hearing test
What characterizes Croup syndromes?
inspiratory stridor and respiratory distress
S/S of epiglottitis
- Sudden onset
- Distressed inspiration
- High fever
How do you dx epiglottitis?
lateral neck x ray....no direct visualization till pt is intubated
Nursing management for Epiglottitis
- MAINTAIN a PATENT AIRWAY
- humidified O2
- Calm Environment
S/S of Croup
- gradual onset....at night
- preceded by a URI
- inspiratory stridor
- respiratory distress
- low grade fever
Nursing care for Croup
- night air or shower
- Aerosol Inhalation
- IV fluids
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?
- air trapping
How do you dx RSV?
- recent URI
- Nasal Smear + for RSV
- CBC is normal
When a person is having an exacerbation from RSV what will it look like?
- tachypnea >60
- nasal flaring
Vaccine given to high risk infants for RSV?
How do you dx asthma?
- hx of reactive airway
- frequent URI
- Nasal smeal-+eosinophils
- RAST-IgE antibody
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
- IV fluids
- Patient/parent education
- Bronchodilators via neb.
- Relaxation...nose breathing
Patient and parent ed for asthma
- What meds to use and when
- Peak flow meter with grn/yellow/red
- avoid triggers
- tell others he/she has asthma
Breath sounds during an asthma attack
- mild-exp. wheezes
- 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?
- mild-resp. alkalosis
- 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
- extreme fatigue
- failure to thrive
- delayed puberty
- impaired digestion
- resp. issues
- 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
- Promote oxygenation
- prophylactic antibiotics
- 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?
- getting scared
Nursing care for whooping cough
- admin vaccine DTaP
- Antibiotics-erythromycin, azithromycin, clarithromycin
- cardiopulmonary monitor
- pulse ox
- 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?
- admin O2
- cardiorespiratory monitor
Drugs used to help a baby not have apnea
- oral theophylline
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?
- respiratory movement
- cardiac rate
- 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
- genetic predisposition
- prenatal exposure to cigarettes/alcohol
Extrinsic risk factors for SIDS
- prone sleeping position
- bed sharing
- soft mattress
- 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
What would you like to do?
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