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What ages react most severely to acute respiratory infections and why?
- 6 months to 3 yos
- Smaller diameter resp tract ==> higher risk of narrowing
- Immature immune system
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Main differences in pediatric lungs?
- Everything is SMALLER: so incr resistance + obstruction = trouble!
- Airway is more flexible, floppier
- Alveoli: smaller, fewer, more collapsable
- Intercostal muscles poorly developed
- Diaphragm more horizontal
- Chest wall more compliant (stretchable)
- Larynx higher and more anterior
- Infants are obligate nose breathers
- Higher RR
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S/S of Respiratory Problems?
- Incr RR
- Grunting, flaring, retraction
- Mood changes: fussy, lethargic
- Feeding problems
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S/S of Respiratory Infections?
- Fever (may be absent in newborns), may reach 103-105 even in mild cases
- Meningitis signs w/o fever
- Anorexia
- NVD, cough, sore throat
- Abd pain
- Nasal blockage/discharge (incr risk ear infection)
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Respiratory Monitoring?
- Pulse ox
- Temp
- Resp effort (use of accessory muscles, nasal flaring)
- Lung sounds
- Sputum: color, amnt, consistency
- Chest pain
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Asthma Assessment?
- Cough
- Wheeze
- Hypoxemia
- SOB
- Anxiety
- Prolonged expiration
- Use of accessory muscles
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Asthma characteristics?
- Airflow obstruction is due to...
- Constriction AND INFLAMMATION: studies show that inflammation is really the major problem in "flares"
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Asthma Triggers?
- URIs
- Environmental allergens, irritants
- GERD
- Smoking
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Asthma Mgmt by Severity?
- Mild intermittent:
- Mild persistent:
- Moderate persistent:
- Severe persistent:
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Asthma - Interventions, Nursing Care, Education
- Continuous observation and assessment to assure airway patency
- Comfort, when acute phase passed
- Educate: child and family on avoiding triggers, early ID of sx, appropriate med prophylaxis
- How to take meds: spacers, etc; metered-dose inhalers, peak flow monitoring
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Asthma Meds
- Beta Agonists: ex. Albuterol; short- and long-acting
- Inhaled Cortico-Steroids: anti-inflammatories
- Some role for leukotriene modifiers: role in asthma not established
- Oral and IV steroids: for severe flares
- NO longer a role for theophylline
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Bronchiolitis - agent, transmission, population, clinical manifestations, tx
- Viral agent: causes alveolar swelling
- Trans: droplet, contact
- Children < 2yo
- Clin Man: low grade fever, runny nose, distinctive cough (snap, crackle, pop, wheeze); up to 12 days
- Tx: small freq feeds; bronchodilators; synagis meds for preemies (inj monoclonal ab)
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Croup/Laryngeal Trachea Bronchitis - define, clinical manifestations, tx
- Swelling of mid resp tract
- Clin Man: abrupt onset, cough (barky, seal-like), up to 2-3 days, stridor at rest = signs severe swelling
- Tx: cool moist air, ensure patent airway, steroids to decr swelling
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Lower Resp Tract Infections (Pneumonia) -- ORIGINS, clinical manifestations, Tx
- ORIGINS:
- Viral - adenovirus, RSV
- Bacerial
- => infants: GBS
- => older babies: b pertussis
- => toddlers: strep pneumo
- => 5-15yo: mycoplasma
- => adult: mycoplasma
- Clin Man: cough, fever, **fatigue**, body ache
- Tx: judicious use of antibiotics, hydration
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Bronchopulmonary Dysplasia (BPD) - cause, clinical manifestations, complications
- Cause: neonatal lung injury => pulm inflam => poor wound healing => inhib lung devel => BPD
- Clin Man: lung immatur, O2 tox, ventilator dependent, typical cxr, incr minute vent and airway resistance
- Complications: pulmonary HTN, CHF; possible surgical closure of PDA early if large R=>L shunt
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Nursing POC for CF pt? Define, dx, s/s, tx
- Incr viscosity of mucuous gland secretions AND absence of pancreatic enzymes
- Dx: sweat cl test: Cl > 60meq/L
- S/S: poor wt gain, frothy smelly stool, recurrent resp illness, salty taste of skin, hemoptysis, clubbing & barrel chest late sign, hyponasal speech
- Tx: IV or PICC antibios; O2 admin (watch for CO2 tox b/c chronic retainers); chest PT (watch hemm bc rupture of cysts); pancreatic enzyme replacement; high protein/calorie diet
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