Pediatric Respiratory

  1. 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
  2. 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
  3. S/S of Respiratory Problems?
    • Incr RR
    • Grunting, flaring, retraction
    • Mood changes: fussy, lethargic
    • Feeding problems
  4. 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)
  5. Respiratory Monitoring?
    • Pulse ox
    • Temp
    • Resp effort (use of accessory muscles, nasal flaring)
    • Lung sounds
    • Sputum: color, amnt, consistency
    • Chest pain
  6. Asthma Assessment?
    • Cough
    • Wheeze
    • Hypoxemia
    • SOB
    • Anxiety
    • Prolonged expiration
    • Use of accessory muscles
  7. Asthma characteristics?
    • Airflow obstruction is due to...
    • Constriction AND INFLAMMATION: studies show that inflammation is really the major problem in "flares"
  8. Asthma Triggers?
    • URIs
    • Environmental allergens, irritants
    • GERD
    • Smoking
  9. Asthma Mgmt by Severity?
    • Mild intermittent:
    • Mild persistent:
    • Moderate persistent:
    • Severe persistent:
  10. 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
  11. 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
  12. 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)
  13. 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
  14. 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
  15. 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
  16. 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
Card Set
Pediatric Respiratory
Nursing assessment, evaluation and treatment of pediatric respiratory conditions