Test 1

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Author:
amber1026
ID:
32308
Filename:
Test 1
Updated:
2010-09-01 22:20:32
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Peds
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Description:
Resp Assessment
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  1. Upper Respiratory Tract
    • - Oronasopharynx
    • - Pharynx
    • - Larynx
  2. Lower Respiratory Tract
    • Trachea
    • ◦ Bronchi
    • ◦ Bronchioles
    • ◦ Alveoli
  3. Respiratory Infection most often caused by
    • RSV
    • ◦ β- hemolytic streptococci
    • ◦ Staphylococci
    • ◦ Haemophilus influenzae
    • ◦ Chlamydia trachomatis
    • ◦ Mycoplasma
  4. can be vaccinated against
    • RSV - only those who qualify
    • H Influenzae
  5. Pediactric Anatomy
    - diameter of airway
    - distance bewtween structures
    - easy access to
    • - smaller in children
    • - is shorter
    • - middle ear
  6. Predisposing Factors for Respiratory Infections
    • Poor nutrition
    • Anemia
    • Fatigue
    • Asthma
    • Allergies
    • Cardiac anomalies
    • Cystic Fibrosis
  7. Chest and lungs
    - inspection
    Chest wall is thinner, infant chest is rounded,>2yrs becomes more oval, head and chestcircumference are about equal until 1 year ofage. Infants and young children are abdominalbreathers.
  8. chest and lungs
    - palpation
    • Used to evaluate chest movement, respiratory effort, deformities, tactile fremitus
    • ◦ Increased fremitus?◦ Decreased fremitus?
  9. chest and lungs
    - ausultation
    • Use an infant or pediatric stethoscope
    • ◦ Compare sounds between sides
    • ◦ Listen to an entire inspiratory and expiratory phase
  10. Expected Findings
    - no excessive
    - nares
    - nasal mucosa
    - mucous membranes
    - tonsils
    - chest
    • - drainage from the ears
    • - patent w/out flaring
    • - pink and moist, no excessive d/c
    • -moist and pink
    • - barely visible or prominent
    • - more round, transverse to AP 2:1 by childhood
  11. Expected Findings
    - chest movement
    - breathing in infants
    - children under 6 are what kind of breathers
    - breath sounds in infant
    - children and adolescents, vesicular sounds over
    • - symetrical, no retractions
    • - irregular is common
    • - abdominal
    • - harsher
    • - lung fields
  12. Expected findings
    - S1 and S2
    - sinus arrhythmias associated with respirations
    - infants pulses
    - children and adolescents pulses
    • - clear and crisp
    • - common
    • - brachial, temporal and femoral pulses full
    • - pluse locations and finding same as adult
  13. Unexpected Findings - abnormal breath sounds
    - absent or diminished suggests
    - crackles suggest
    - rhonchi suggest
    • - pneumothorax or airway obstruction
    • - air passing through watery secretions in small airways
    • - air passing through thick secretions in bronchi and trachea
  14. unexpected findings - abnormal voice sounds
    - stridor
    - wheezing
    - hoarsness
    • - results from air moving throughnarrowed trachea and larynx
    • - results from passage of airthrough mucus or fluids in a narrowedlower airway
    • -suggests inflammation
  15. Early signs of REsp complications
    • Earache
    • Respirations > 50-60- (never a good sign)
    • Fever > 101 degrees
    • Listlessness
    • confusion
    • Irritability/ crying
    • Persistent cough/ wheezing
    • Refusal to take fluids
  16. basic interventions for resp complications
    • Positioning
    • Airway patency
    • Oxygen administration
    • Calm, quiet environment
    • Coughing
    • Incentive spirometry
    • CPT
  17. Respiratory Distress
    • Tachypnea/Inc HR
    • ◦ Retractions
    • ◦ Nasal Flaring
    • ◦ Grunting
    • Stridor◦
    • Seesaw resp
    • ◦ Diminished breathsounds
    • ◦ PaO2 less than 50
    • ◦ PCO2 above 60
    • ◦ Restlessness
    • ◦ Fatigue
  18. REspiratory Failure
    • ◦ Cyanosis
    • ◦ Bradycardia
    • ◦ Bradypnea
    • Low Blood pressure
    • confusion
  19. prep for Dx procedure
    • Recognize prior knowledge
    • include the parents and the child
    • Use concrete words
    • Provide teaching to child based ondevelopmental age (when?)
    • Explain what child will feel, see, hear, smell and touch
    • be honest
  20. During the procedure or dx test
    • Avoid delays, set the room up before childgets there
    • not done in patient room
    • Be confident that the child can besuccessful and do well
    • Involve the child
    • Provide distraction
    • Allow expression of feelings
  21. after procedure
    • Encourage expression of feelings
    • Positive reinforcement- (whether theywere good or not!)
  22. Respiratory Diagnostics
    - Respiratory secretion specimens–required for diagnosis of respiratoryinfections such as
    - throat culture
    - chest
    - CT
    - CBC
    • - TB and RSV
    • - swab tonsils and pharynx
    • - xRay
    • - of chest - with or without contrast
    • - other lab test
  23. Albuterol
    - admin how
    - monitor what
    - think
    - SE
    • - with nebulizer, sometimesliquid form used po
    • - heart rate very closely
    • - SBAR
    • - palpitations, tremors, insomnia,nervousness, HA
  24. Racemic Epinephrine
    - if given monitor for how long
    - mucosal vasoconstriction decreases
    - watch what in frequent dosing
    • - at least three hours
    • - subglottic edema
    • - heart rate
  25. Prednisolone
    - usually administered how
    - reduces
    - SE
    - Taper...
    • - as a syrup: Pediapredor Orapred
    • - inflammation in lungs
    • - mood changes, seizures, hyperglycemia,GI bleeding
    • - slowly, watch for increased healing time, cushingoid effects
  26. Solumedrol
    - given how
    - decreases
    - SE
    - Taper...
    • - IV
    • - inflammation in lungs
    • - HTN, hyperglycemia, Cushingsyndrome, GI bleeding
    • - slowly, watch for increased healingtime, cushingoid effects
  27. Oxygen
    - increases
    - potent
    - high levels contraindicated in
    - evidence of toxicity
    - if pt shows signs of confusion, diaphoresis always think about
    • - amount of O2 in bloodstream
    • - vasodilator
    • - COPD, sickle cell anemia
    • - convulsions, difficultybreathing, chest pain
    • - effect of oxygen
  28. Xopenex
    - relaxes
    - treats
    - administer how
    - SE
    - don't give with
    - given less often than albuterol....
    • - bronchial smooth muscle,
    • - bronchospasms
    • - nebulizer
    • - dizziness, nervousness, tachycardia,increased cough
    • - with other bronchodilators or epi
    • - effect canlast up to 8 hours

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