Pedi respiratory part 2

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Prittyrick
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290818
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Pedi respiratory part 2
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2014-12-06 20:00:09
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  1. Pharyngitis (sore throat)
    • def- inflammation of throat
    • cause- virus, bacteria, allergy

    • Viral Pharyngitis- mild symptoms, sore throat, fever, malaise, 
    • PE: vesicles (viral),  regional LAD, red pharynx/palate 
    • Treatment: analgesics/antipyrectics, warm pack to neck, warm salt water gargles, increase fluids, liquid or soft diets

    • Streptoccocal pharyngitis- cause GABHS (group A beta hemolytic strep) (worry about this bc it could go into rheumatic fever) serious, can lead to cardiac and kidney damage, 
    • S/s erythamatous throat, enlarged tonsils with white exudate
    • - palatial petechiae (caused by bacteria)
    • - high fever 104
    • - headache, stomach ache (comes on quickly) 
    • DX: rapid strep or throat culture
    • Treatment: PO penicillin VK x 10 days
  2. Tonsillitis/adenitis
    • Definitions
    • - tonsillitis: infection/inflammation of palatine tonsils
    • - adenoiditis: inflammation of adenoids (u cant see them)
    • - most common in 4-7 years old child. < 3 years of age usually viral

    S/S fever, legarthy, sore throat, edema in mouth, Adenoiditis (nasal talking like liv and lex), mouth breathing, difficulty breathing, halitosis, sleep apnea, 

    • most common cause of this is strep (bacterial organism + GABH, virus)
    • DX throat culture
  3. Tonsillectomy
    • surgical removing of tonsils and adenoids
    • indicated for massive tonsil hypertrophy that causes problems with breathing or eating. Also for chronic infections

    • Nursing S/P surgery:
    • - Gentle oral care- encourage popsicles and ice chips
    • - Monitor for hemmoraging frequent VS check
    •    - subtle signs: increase RR, HR
    •    - frequent swallowing, throat clearing, anxiety

    position child on abdomen or side lying on pillow to promote drainage or secretions. 

    Remember: a nurse who recognizes subtle sign of hemmoraging is a childs 1st defense against hemorrhage and possible shock
  4. Sinusitis or Rhinosinusitis
    • bacterial infection of sinuses
    • rare in children < 6 yrs old frontal sinuses not fully developed

    usually a secondary infection: due to strep, staph, or h. influenza (what happens kids will have URI for about 7-10 days before this happens)

    SX: tenderness over affected sinus, purulent nasal discharge, fever, headache

    DX: nose and throat cultures

    Treatment: anti-pyretic, analgesics, antibiotic x 10 days, warm compress

    Complication: acute otitis media, osteomyelitis (bone infection)
  5. Acute Otitis Media (AOM)
    • def: inflammation of middle ear or ear infection
    • most common: 6 month- 3 yr old children
    • (eustachian tube is prone and str8) most common bottle feed babies
    • causes: bacterial and viral

    • S/s:
    • - sudden onset of ear pain, irritability, fever, decr hearing, headache, V/D
    • - infants: rub or pull at ears, roll head to side to side
    • - older child: hearing loss, nasal congestion, cough
    • - PE: tympanic membrane inflamed red and bulging, perforation with drainage, light reflex diminished, landmarks poorly visualized or not seen, fluid bubbles (no cone of light at 5 or 7)
  6. Otitis media DX, complication, treatment, nursing intervention
    • DX: u would not necessarily dx.
    • - Hx of recent symptoms
    • - presence of fluid in middle ear
    • - s/s of inflammation

    Complication: effusion, hearing loss, spontanenous rupture of the TM and mastoiditis 

    • Treatment: may resolved spontaneously (viral so we may watch and wait)
    • -antibiotics given to avoid complications (amoxillian, azithromycin)

    Nursing interventions: finish all meds. analgesics and antipyretics
  7. Epiglottitis: medical emergency
    • def: acute rapidly progressing inflammation of the larnynx and epiglottis. life threaten affects 2-8 yrs
    • Cause: bacteria or virus
    • Prevention: haemophilus influenzae type B vaccine (Hib)
    • SX: triad- respiratory distress, dysphagia, drooling and tongue profusion, stridor, stridor, hoarsness, tongue sticking out, look very sick, high fever, severe sore throat irriablity

    • Nursing: do not inspect the throat and mouth without emergency equipment
    • never leave unattended
    • provide a calm enviroment
    • allow position of comforts
    • keep emergency equipment available 
  8. Epiglottitis therapeutic management, reminders
    • Medical Emergency
    • - swollen epiglottitis cant rise to allow airway to open 

    • Therapeutic management: 
    • - intensive care unit: moist air O2, antibiotics, IVF, intubation or tracheostomy
    • - treat siblings with prophylactic antiobiotics

    • Reminders
    • - do not inspect the mouth of throat
    • - do not use tongue depressor
    • - do not collect a throat culture
    • - keep emergency equipment at bedside
    •    - tracheostomy or endotrachial intubation kit
  9. Croup (larngotraheobronchitis)
    • Def: rapid, acute, upper airway obstruction
    • cause: virus
    • affects children between 3m-3yrs
    • young children illness
    • most common in winter and fall

    • Assessment:
    • starts with mild URI symptoms, rhinitis, conjuctivitis, all prior to onset of stridor/ 
    • - at night child will developed the hoarse coupy barking cough, inspiratory stridor, marked restractions
    • Awaken in extreme respiratory distress due to laryngeal obstruction. usually subside by morning
    • danger of glottal obstruction from laryngeal inflammation very real
  10. Croup thera management/nurse
    • Therapeutic management: symptomatic relief at home
    • - continuous monitoring of respiratory status by caregiver
    • Efforts to decrease/stop laryngospasm 
    • - calm environment to decre agitation
    • - steam from hot shower x 15mins
    • - cool mist humidifer or cool night air
    • - if not working tell pt to take pt to ER
    •     - corticosteroids via nebulizer and cool moist air
    •     - IVF to maintain hydration
    •     - tracheostomy endotrachial intubation with O2 therapy 

    • Nursing Supportive
    • - monitor closely for worsening respiratory symptoms
    • - VS Q 15 min with continuous pulse oximetry 
    • - strict I&O
  11. Respiratory Syncytial Virus (RSV) Bronchiolitis
    • Def: acute inflammation of bronchioles. most common lower respiration tract illness children < 2 yrs old
    • causes: RSV- most commons. peak at 6 months
    • other causes: adenovirus, parainfluenza virus, bacteria, 
    • Occurs: winter and spring
    • s/s: 1-2 days cold symptoms, then sudden onset cough, wheeze, retraction with nasal flaring, incr RR, incre HR, fever, poor feedings, grunting, cyanosis, apnea chest sounds clogged but these pt usually have good O2 stat
    • Studies show- triad of cough, wheezing, and retractions is predictive of RSV
    • - can progress to severe respiratory distress
  12. RSV bronchilitis
    treatment/meds
    • Treatment: supportive, antipyretics, hydration, monitor closely
    • - hospitalization: incr retraction, tachypnea, seems listless, poor feedings
    • - for severe symptoms: 
    •   - humidified O2
    •   - IVF to maintain hydration if not feeding well
    •   - ventilatory assistance if necessary

    • Medications
    • - antivirals controversial 
    • - prevention: palivizumab (synagis), given monthly during RSV season (Northeast Nov-April)- prevention for kids at risk
  13. RSV Bronchiolitis nursing/risk factors
    Nursings: cardiorespiratory monitoring, humidified O2, contact precautions, hydration, administer medications, pulmonary hygiene 

    • Risk Factors:  for severe RSV bronchiolitis 
    • - premature birth > 4 weeks
    • - chronic lung disease (asthma)
    • - Born heart disease
    • - low birth weight
    • - older siblings (incr exposure)
    • - daycare (incr exposure)
    • - family hx of asthma
    • - mulitple births (twins often low birth weight)
  14. Asthma lower respiratory tract disorders
    def: reversible airway obstruction caused by chronic inflammation and airway is hyperresponsive to a varierty of stimuli

    • S/S: recurrent wheezing, breathlessness, chest tightness, and non productive cough 
    • Albuterol (rescue inhaler)
    • incre school absences and hospitalization
    • Pathophysiology: affects small airways
    • involves 3 separate processess:
    • 1. bronchoconstriction (smooth muscle tighten) 
    • 2. inflammation/edema
    • 3. incre mucus production
    • All three causes narrow airway and increase work of breathing. can lead to respiratory distress, respiratory failure and possible death

    acute complication: status astmaticus (symptoms don't stop despite of aggressive treatment) and respiratory failure
  15. Asthma triggers
    allegens: pets/animals, dust mites, cockroach droppings, molds, foods etc

    irritants: smoking, fire wood, cigarette smoke on clothes, bleach, strong odors

    excerise 

    common cold or viral infections rhinitis, sinusitis

    strong emotions: prolonged laughter or crying, anxiety, fear, anger or excitment

    GERD/heartburn

    certain meds
  16. Asthma symptoms
    • Symptoms vary from severity of disease:
    • Mild episode- breathless with walking
    • moderate severe episode: breathless while talking, infants- feedings difficulties with shorter softer cry
    • severe episode- breathless at rest, no interest in feeding, sit upright, talks in words not sentences
    • imminent respiratory arrest: in addition to the above. drowsy and confused. adolescents may not show advance symptoms until in frank respiratory arrest (stoic) 
  17. Asthma Physical symptoms
    • bnoctunal cough- at night
    • chest tightness/pain
    • wheeze- most common, musical high pitched whistling sound
    • mainly expiratory severe disease- inspiration and expiration
    • exercise induced asthma- heard during and after activity
    • cough- maybe the only symptoms non productive
    • chest tightness or pain- especially in excerise induce, nocturnal cough
    • other non specific symptoms- recurrent bronchitis, bronchiolitis, or pneumonia, persistent cough with colds, reccurrent chest rattling, chest congestion

    quiet chest omnius sign- u should hear moving...bc lungs can be so tight so they can move air..so this is alarming
  18. Asthma Nursing assessment
    Hx/subjective: onset, activities when symptoms began, associated symptoms, medications, home remedies, SOB, wheeze, known allergies, fam hx, pets, stress

    • PE assessment
    • general: color, anxious, legarthic/irritiable, sits up right for comfort
    • VS: incr RR, incr HR, decre O2 stat
    • Lung/chest- expiratory wheeze, I & E wheeze, prolonged expiratory phase, decr peak flow and restractions. barrel chest, tight breath sounds, quiet chest is ominous sign
    • skin: cyanosis clubbing
  19. Asthma common lab and dx test
    • peak expiratory flow rate
    • pulse oximetry
    • chest x-ray
    • pulmonary function studies
    • allergies testing
    • blood gases
  20. Asthman therapeutic management
    Goals:

    • 1. environmental control to avoid allergens and exposures to irritants
    • 2. reduction control of inflammatory episodes
    • 3. relieves symptoms by pharmacologic agents
  21. Asthma Action Plan
    • Green: Go > 80% personal best
    • Yellow: cautions 50-79% of personal best
    • Red: stop danger <50% personal best
  22. Asthma Nursing intervention
    • assess and monitor respiratory and cardiovascular status
    • - tachyapnea, quiet breath sounds and tachycardia
    • - assess cough: hacking, productive to non productive, especially at night without infection
    • - MOnitir VS: track changes and complications
    • admins meds: rescue and controller
    • - rinse child's mouth- prevents irritation and thrush
    • modify environments to avoid allergic reaction- identifies or remove allergens or triggers
    • forbid smoking in the home or around the child
  23. Asthma Rescue and controller meds
    • Albuterol: rescue/quick relief med- bronchodilator
    • albuterol 2-4 puffs via nebulizer or MDI q 4-6 hr PRN
    • long term control med act on lung tissue to decr inflammation
    • inhaled corticosteroids: flovent, pulmicort 1-2 puffs daily
    • rinse mouth after
    • systemic corticosteriouds: suppress inflammation. used in severe asthma exacerbation
    • PO prednisone, predinsolone
    • IV solumedrol
  24. Asthma Maintenance medication
    • leukotriene modifers: decre frequency and severity of asthma excerbation by decre airway edema and smooth muscle constriction
    • singulair availability
    • infants: granules
    • children: chewables
    • older children/adults: tablets
  25. Common Nursing Dx asthma
    • impaired gas exchange
    • ineffective airway clearance
    • ineffective breathing patterns
    • risk for infection
    • ineffective tissue perfusion: cardiopulmonary 
    • anxiety
  26. Asthma nursing intervention during acute attack
    • allow child to sit upright for comfort
    • humidify oxygen to mobilize secretions
    • monitor VS closely
    • administer inhaled medication thru MDI or nebulizer
    • monitor peak flow rates
    • maintain calm environment
    • monitor effectiviness of drug therapy
  27. Status Asthmaticus Emergency
    • respiratory distress continues despite attempt to controll it
    • emergency treatment
    • - provide continious albuterol nebulizer as ordered
    • - admins IVF and IV corticosteriods
    • - provide humidified O2
    • - Monitor I&O
    • Concurrent infection: obtain sputum cultures, administer broad spectrum antibiotics
    • keep emergency equipment available for intubation
  28. Lower respiratory tract disorders Pneumonia
    • def: infection and inflammation of the lower respiratory tract
    • usually self limited
    • types: nosocomial or community acquired
    • cause: virus, bacteria, fungus or aspiration
    • symptoms: cough, sharp chest pain, blood streaked or brownish sputum, high fever and chills, incr HR and RR, nasal flaring, restractions, dyspnea, wheezing, fine crackles, decre breath sounds
  29. Pneumonia dx, med management, nursing interventions
    Dx: chest x-ray, sputum cultures, cbc

    Medical management: antibiotics

    • Nursing interventions
    • supportive: bed rest, anti pyretics, incre hydration, encourage cough and deep breathing, allow position for comfort, chest PT, and postural drainage, VS q 4hrs, O2 and universal precautions
    • lie on the side of inflitrate to decre pain
    • family education: antibiotics, course of illness: bacterial vs viral. prevention: pneumoccoccal vaccine
  30. Pneumonia Types
    Pneumococcal- abrupt onset, acutely ill, high fever, respiratory distress fine crackles

    Chlamydial pneumonia

    • viral pneumonia- rsv, adenoviurs, supportive treatment
    • mycoplasma pneumonia- seen in > 5 yrs old children, winter months

    lipid pneumonia: aspiration of lipid substance (popcorn or peanut)

    hydrocarbon pneumonia: ingestion of household products such as funiture polish, gasoline, kerosene, insect sprays- irritation/inflammation or respiratory tract with GI symptoms N/V
  31. Cystic Fibrosis: CF
    • def: genetic disease especially effects the lungs, digestive and reproductive systems of the exocrine glands
    • complications: pneumonia, actelectasis hemoptysis, pneumothorax, Giand reproductive tract dysfunction
    • inherited autosomal recessive trait
    • cause: deletion in chromosome 7 at CF transmembrane regulator
    • cause problem with water flow and salts in and out of the body cells which leaves to excessive thick sticky mucus and abnormal secretion of sweat and saliva
    • affects lungs and GI tract of 30,000 children and adults
    • approx 50% now live > 30 but still die young
  32. How does CF presents in the body
    • Neonatal
    • - 1st sign in newborn- no meconium meconium ileus
    • - prolonged jaundice
    • - bowel proforation

    • Infancy
    • - pancreatic insuffiency with excess fat in feces (steatorrhea) greasy stools
    • - failure to thrive

    • Childhood
    • - anemia hypoproteninemia, hyponatremia
    • - heat intolerance
    • - wheezing or chronic cough
    • - recurrent chest infections
    • - coughing up blood ( hemoptysis)
    • - nasal polyps 
    • - distal intestinal obstruction syndrome, rectal prolapse
    • - clubbing of fingers

    • Older patients
    • - chronic obstruction pulmonary disease
    • - infertility esp in males
  33. CF: organ involvment
    • GI: thick mucous blocks the pancreatic ducts- which is blocking our enzymes- amylase, lipase, trysin (helps to break down food)
    • - results unable to digest fats, protein, carbs, which causes malabsorption and malnutritution 
    • - decre fat sol vitamins absorption 
    • - childhood steatorrhea
    • need: pancreatic enzyme to help disgest food and fat sol vitamins

    respiratory: excess mucous in lungs leads to hypoxemia and secondary bacterial infection, chronic infections lead to tissue damage and respiratory failure over time

    Reproductive: ovary ducts and vas deferens are blocked with mucus causing female reproductive diffculty and make infertility 
  34. CF nursing assessment
    • hx and recurring respiratory infection
    • newborn meconium ileus or difficult passing meco
    • slow to regain birth weight
    • feedings difficulties
    • salty taste to skin
    • colicky
    • early respiration infection and chronic cough, crackles, wheeze or decr breath sounds

    • Child: stool hx, bulky or large greasy stools
    • clubbing
    • barrel chest, protruding abdomen "pot belly"
    • known cf children: frequent hosp admissions for pulmonary exacerations or other complications
  35. CF dx
    • prenatal: dna testing aminiotic fluid
    • newborn screening
    • sweat chloride test: test shos 2-5 times normal level of Na and Cl, repeat test to confirm
    • norm 20 mEq/L dx > 60
    • stool specimen: incre fat content
    • CXR: hyperinflation, bronchial wall thickening
    • atelectasis, infiltrates
    • Pulmonary function test: decrease vital capacity and expiratory volume , increased residual volume
  36. CF therapeutic management
    • includes measures to reduce pancreatic, lung and sweat gland involvment
    • - inhaled aerosol medications via nebulizer: dornase alpha. bronchodilation, antibiotics, anti inflammatory, mucoytics
    • PO pancreatic enzymes with meals
    • fat soluble vitamins supplements (vit ADEK)
    • pulmonary hygiene- chest pt, vest, posteral drainage
    • breathing excerises
    • increa calore and protein diet or high protein formula (probana)
    • for pulmonary infections antibiotc broad spectum O2 prn, no antihistamine
  37. CF: Nursing care plan/interventions
    • teach not to restrict salt, give sodium supplements in hot weather if necessary 
    • admins pancreatic enzymes with all meals and snacks
    • provide high calorie, protein foods, continuous breast feeding and supplement with high calorie formula
    • multivitamin BID, especially fat- soluble ADEK
    • maintain patent airway: chest PT and postural drainage 3-4 times daily after mucolytic, bronchodilators or antibiotic nebulizer treatments
    • prevent GI blockage: incr fluid, fiber and give stool softener
  38. CF Nursing intervention
    • complete pulmonary hygiene
    •  - CPT
    •  - Breathing excerises and incentive spirometry
    • administer aerosolized medications 
    • provide low flow humidified O2
    • monitor respiratory status
    • administer antibiotics for infections
    • individual dietary modifications 
  39. CT patient/family education
    • Teach:
    • critical importance of chest PT 3-2 times daily
    • - avoid CPT immediately after meals
    • - vest therapy: correct positioning and use
    • - postural drainage
    • Avoid exposures to infections
    • daily physical activity
    • how to perform nebulizer treatments and use inhalers correctly, use of low flow humidifed O2
    • PO medications: encourage consistent admins
    • review daily supplement regimen: fat sol vitamins
    • - high calorie high protein foods
    • - pancreatic enzymes with all meals and snacks
    • Encourage hydration do not restrict salk and provide salt supplements in hot weather
    • avoid cough suppressant and antihistamines
    • annual flu vaccine
    • genetic counseling
    • promote normal G&D and family coping: referral to mental health PRN support resources
    • lung transplantation
    • can be used to replaced the diseased lung tissue andimprove the child's life span

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