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O2 Deviations
Oxygenation Deviations of the Child
| Question | Answer |
|---|---|
| How does increased cartilage on children's ribs effect respiratory distress? | More cartilage helps to compensate for respiratory distress with increased rate rather than depth; retractions. |
| Nursing Diagnoses for Respiratory Distress | Ineffective Airway Clearance or Ineffective Breathing Pattern |
| Nursing Outcomes for Respiratory Distress | Ease respiratory effort; promote hydration/nutrition; facilitate temperature reduction; promote rest/comfort; promote development. |
| What are the three (3) types of Croup Syndromes (The big "3")? | Acute Laryngotracheobronchitis (LTB); Acute Epiglottitis; and Tracheitis |
| What is Acute Epiglottitis? | It is a medical emergency. You should NEVER try to examine throat with tongue depressor and NEVER use a culture swab. |
| What causes wheezing? | Constriction |
| How is Acute Epiglottitis diagnosed? | Lateral neck x-ray. |
| What causes crackles? | Fluid in the lungs. |
| What is Tracheitis? | Progression of infection and patient should be admitted to PICU. |
| What does Bronchi sound like? | Low pitch sound that will usually clear with coughing. |
| What is Stridor? | Indicates upper airway edema. High Pitch. |
| What is normal childhood pH? | 7.35 - 7.45 |
| What would be important to assess for following a tonsillectomy? And for how long? | Assess for bleeding during the first 24 hours, for the first 7-10 days after surgery and with any excessive swallowing. |
| How would you control pain after a tonsillectomy? | Acetaminophen and use of an ice collar. |
| What should you tell your patient or patient's parents not to use after a tonsillectomy? | Straws |
| What type of pain is common when clearing of the throat after a tonsillectomy? | Ear pain. |
| What would you give to and/or have your patient avoid in terms of hydration after a tonsillectomy? | Patient can start with cool liquids and move to soft solids but should avoid citrus juices. |
| What should patients who have just had a tonsillectomy avoid for at least one week? | Vigorous activity. |
| What are some alternatives to deep breathing for children? | Blowing bubbles. |
| Respiratory Childhood differences from adults. | Maternal antibodies diminish between 3-6 months; they have a smaller airway diameter; shorter, more horizontal eustachian tube; right bronchus is straighter than left; ribs more cartilaginous and they are obligatory nose breathers up until about 1 month. |
| What are S/S's of Acute Otitis Media? | Acute onset of ear pain (tugging) and redness of tympanic membrane. This can occur with or without effusion. |
| What is effusion? | Escape of a fluid into a part |
| What is Otitis Media with Effusion? | Otitis media with effusion (OME) is when there is thick or sticky fluid behind the eardrum in the middle ear, but there is no ear infection. |
| What can Otitis Media with Effusion lead to? | Hearing loss. |
| What are signs of Otitis Media with Effusion? | Rhinitis and cough. |
| Why may Dexamethasone (Decadron) administered for respiratory distress? | To help decrease upper airway edema. |
| Is Croup viral or bacterial? | Viral |
| Is Epiglottitis viral or bacterial? | Bacterial |
| What is Otitis Media? | Inflammation with or without infection of middle ear. |
| When is peak incidence for Otitis Media? | Within the first two years of life. |
| What is the cause of Otitis Medis? | Dysfunction of eustachian tube. |
| How is Otitis Media Diagnosed? | Diagnosis is based on visualization and pneumatic otoscopy. |
| What are some Risk Factors for Otitis Medis? | Recurrent URI, exposure to tobacco smoke, attendance at daycare, use of pacifier (after 10 months), absence of infant breastfeeding, bottle propping. |
| Why should tylenol with codeine be used with caution after a tonsillectomy? | Because it can cause lethargy and respiratory distress and even death in children if not monitored properly. |
| How is Otitis Media treated? | Antibiotic therapy for 10 days in children < 6years of age and for 5-7 days in children > 6 years of age. |
| Types of medications used to treat Otitis Media? | Amoxicillin, augmentin, cefdinir, azithromycin and ceftriaxone. |
| What is the most common cause of Bronchiolitis? | RSV is most common cause. |
| What are common symptoms of Bronchiolitis? | Tachypnea, retractions, wheezing, nasal flaring, crackles, and apnea (may precede other RSV symptoms in young infants). |
| How should retractions be described/charted? | Should be described according to their location. |
| How would you administer ear drops in a child under three (3) years? | Pull pinna down and back. |
| How would you administer ear drops in a child over three (3) years? | Pull the pinna up and back. |
| How is Chronic Effusion treated? | With myringotomy and PE tubes. |
| What is Myringotomy? | A surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. |
| What are ways to prevent Bronchiolitis? | Palivizumab (Synagis) in high risk infants; HAND HYGIENE, and limit exposure to tobacco smoke. |
| What is the nursing care/treatment you should provide in patients with Bronchiolitis? | Racemic epinephrine/albuterol via nebulization, O2 therapy & monitoring, hypertonic saline, IV therapy & nutrition, SUCTION BEFORE FEEDING AND PRN, contact/droplet precautions and Ribavirin for select patients with potentially life-threatening infection. |
| What is the most common chronic disease of childhood? | Asthma (Reactive Airway Disease - RAD). |
| Who is Asthma most prevalent in? | Boys 0-17 years of age, non-hispanic black children and peurto ricans and children from poor families. |
| What disease is the primary reason for school absences/hospitalizations? | Asthma. |
| List the clinical symptoms of Asthma. | Cough, wheeze, shortness of breath, chest pain, quick reliever medication use (SABA), diurnal variation (worsens at night), limited exercise tolerance. |
| What are some triggers of asthma? | Upper respiratory infections, irritants in the air, exercise, weather changes, medications, hereditary factors. |
| What are the four (4) components of Asthma management? | Assessment and monitoring; education for a partnership in asthma care; control of environmenal factors and co-morbid conditions that affect asthma; and pharmacological therapy. |
| What is intermittent asthma? | Symptoms 1-2 times/week with nighttime symptoms 1-2 times/month. |
| What is mild persistent asthma? | Symptoms more than twice/week with nighttime symptoms 3-4 times/month. |
| What is moderate persistent asthma? | Daily symptoms with nighttime symptoms > once weekly. |
| What is severe persisitent asthma? | Symptoms throughout the day with nighttime symptoms 7 times/weekly. |
| What does SABA stand for? | Short-acting beta 2-agonists. |
| What type of pharmacalogical intervention is used in acute asthma episodes? | Usually a short-acting beta 2-agonist (SABA). |
| How should Albuterol be used? | May be taken/given every 20 minutes x3 for quick relief. Effect lasts 4-6 hours and can be used 4-6 times per day. |
| What are types of inhaled cotricosteroids (ICS)? | Fluticasone (Flovent), Budesonide (Pulmicort), Beclomethasone (QVAR, Beconase), Mometasone (Asmanex). |
| What is considered the "Gold standard for asthma management"? | Inhaled Corticosteroids |
| What are some adverse effects of cotricosteroids? | Oral candidiasis (thrush), hoarse voice (dysphonia) and high doses effect linear growth. |
| What types of physical affects can Inhaled Corticosteroids have? | Easy bruisability and should avoid exposure to eyes. |
| What do Long-acting Beta Agonists (LABAs) do? | Relax bronchial smooth muscle. |
| What are long-acting beta agonists NOT recommended for? | Monotherapy. |
| What are two types of long-acting beta agonists? | Salmeterol (Serevent) and Formoterol (Foradil). |
| How many times a day can long-acting beta agonists be used? | Twice |
| Long-acting beta agonists are most effective when combined with what? | Inhaled steroids. |
| What are the two types of Asthma combination therapy? | Fluticasone and Salmeterol (Advair Diskus) and Budesonide and Formoterol (Symbicort). |
| What do Leukotriene modifiers do? | They block chemicals that start airway inflammation. |
| What is Omalizumab (Xolair) used for? | Used for severe asthma, children > 12 years, and risk of anaphylaxis. |
| What are types of Leukotriene modifiers? | Singular (Montelukast) - Daily tablet; Accolate (Zafirlukast)- BID; Zyflo (Zukeuton)- BID extended release tablet. |
| What is Theophilline? | Provides continuous airway relaxation; sustained release for control of nocturnal symptoms. |
| What is Cromolyn Sodium (MDI)? | Anti-inflammatory: May be used for inavoidable allergen exposure. |
| What is the Stepwise Approach? | It is used to assist, not replace, clinical decision making. |
| What activities are usually tolerated well with people who have exercise-induced bronchospasms? | Swimming, baseball, gymnastics. |
| What other considerations can help prevent bronchospasms? | Warm-up before exercise, pre-treatment before exercise, wearing scarf or mask over nose/mouth in cold weather and avoiding activities such as soccer, and basketball. |
| What helps to reduce both asthma and allergic rhinitis symptoms? | Intranasal Corticosteroids. |
| What are spacer devices for? | Used for people who have difficulty with technique and can reduce potential side effects. |
| What is Cystic Fibrosis? | It is thick mucous blocks pancreatic ducts which lead to pancreatic enzyme deficiencies. |
| What kind of things can Cystic Fibrosis lead to? | Can lead to malabsorption - poor growth and failure to thrive, vitamin (A,D,E,K) deficiencies, steatorrhea (bulky, frothy, pale floating stools). |
| What are the symptoms of GI malabsorption related to Cystic Fibrosis? | Failure to thrive and general malnutrition, vitamin deficiencies, steatorrhea, protuberant abdomen and poor weight gain. |
| What are GI symptoms related to Cystic Fibrosis? | Constipation, rectal prolapse from the large difficult-to-pass stools, meconium ileus in newborn, or late/difficult passage of meconium is one of the earliest symptoms. |
| What are respiratory symptoms related to Cystic Fibrosis? | Frequent URIs with increased risk of Pseudomona Aeruginosa or Burkholderia Cepacia, chronic moist cough, nasal polyps, clubbing of fingers/toes and barrel chest. |
| What are the treatments for Cystic Fibrosis? | Respiratory therapy and the prevention of infection. |
| What does the respiratory therapy treatment consist of in regards to Cystic Fibrosis? | Chest Pt (1 hour ac or 2 hours pc); aerosol therapy with bronchodilators, Dnase Oscillating vests; hypertonic saline via nebulization in older children. |
| How do you go about preventing infection in patients with Cystic Fibrosis? | Antibiotic therapy (oral, inhaled, IV routes); Monitor renal function with high dose antibiotics. |
| What are the reproductive issues that can be cause by CF? | Increased infertility but women can conceive and genetic implications (children will be carriers). |
Created by:
nglidden
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