Lecture 3 exam 2

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  1. Problem with Diptheria
    breathing and heart failure
  2. Problem with Tetanus
    Lock jaw....cant open mouth or swallow
  3. Problem with Pertussis
    • PNA
    • Seizures
    • brain damage
  4. Problem with HIB
    Haemophilus Influenza B
    • can lead to meningitis
    • pna
    • infections of blood, joints, brain
    • deafness
  5. Problem with Hep B
    liver damage and cancer
  6. Problem with Polio
    Paralysis of arm or leg
  7. Problem with Pneumococcal disease
    • meningitis
    • blood infection
    • ear infections
    • pna
    • deafness
    • brain damage
  8. Problem with Rotavirus
    dehydration and hospitalization
  9. How do babies catch most disease?
    contact with other people infected.

    • Hep B is transmitted at birth
    • Tetanus thru a cut or wound
  10. If you don't want your child to get the Pertussis vaccine, you will get the
    DT vaccine
  11. How is the Rotavirus vaccine given?
    by drops that are swallowed
  12. Prior to getting your next injection of DTap tell you doctor if after previous dose the following occurred
    • brain/nervous system disease within 7 days
    • baby cried non stop for 3+hrs
    • seizure or collapse
    • fever over 105
  13. Don't get Polio vaccine if....
    • child has a life threatening allergy to antibiotics
    • Neomycin, Streptomycin, Polymyxin B
  14. Don't get Hep B vaccine if
    your child has a life threatening allergy to yeast
  15. Don't get Rotavirus vaccine if child has....
    • Severe Combined Immunodeficiency
    • Weakened immune system
    • Digestive problems
    • Had a recent blood transfusion
  16. Don't get PCV13 or DTaP if you child has ever had a sever reaction after any vaccine containing
    diphtheria toxoid
  17. Difference in breathing patterns in infants and children?
    • nose breathers till 6 mo.
    • Irregular breathing is normal in infants with apnea lasting 10-15 sec.
    • Increased RR

    • Stuffed nose can cause problems with breathing...especially while eating
    • Increased airway resistance and RR causes fatigue
  18. What's up with the cough/gag reflex in infants and kids?
    it is weak and can be poor or absent with decreased neuro status and premies

    • Cant get mucous out....swallow it
    • risk for aspiration
  19. What's the difference btwn lower airways in adults and babies/kids?
    Narrow, smaller and short

    • Block occurs easily from inflammation/mucous, edema
    • things go bad fast.
    • Infections spread easily thru entire resp. tract
  20. What does grunting indicate in an infant?
    • trying to keep lower airway open....tiring out.
  21. What's up with the alverolar system in babies/kids?
    • Surfactant doesn't exist till 34 weeks gest
    • less and smaller amt till 5 yo

    • decreased surface area for gas exchange
    • increased atelectasis risk
  22. What's the primary respiratory muscle until 5yo?
  23. Infants and young children are what sort of breathers?
  24. Increased work of breathing expends oxygen which leads to an increased risk for
    respiratory fatigue and failure
  25. What causes an increase risk of respiratory obstruction?
    smaller lower airways and underdeveloped supporting cartilage
  26. What's the major respiratory muscle for neonates?
  27. Classic signs of respiratory distress/failure in kids
    • tachypnea
    • desaturation
    • frightened look
    • LOC change
    • Pallor/Cyanosis
    • abdominal "see saw" breathing
    • Nasal Flaring
    • Tripod or upright position
    • Retractions
  28. What causes grunting?
    glottis closing which causes exhalation and alveolar stays expanded
  29. What does a stridor mean?
    Upper airway obstruction
  30. What's the most common response to respiratory illness?
  31. What's the most common response to acute distress?
  32. Normal O2 sats for infants and kids
  33. Nursing Considerations for nasal cannula
    look at skin integrity around nose
  34. Aerosol meds are used for?
    Nursing considerations?
    relaxing bronchioles...bronchodilators

    blow by for infants and mask for kids

    • Assess, assess, assess breathing after treatment
    • Educate parents on proper medication protocol and info regarding triggers, rescue meds and long acting meds
  35. Nursing considerations for a Trach
    • ensure all material and equipment is in the room
    • assess size of trach and have an extra
    • proper head tilt for placement
  36. S/S of tonsilitis
    • mouth odor
    • difficulty swallowing
    • mouth breathing
    • red tonsils
    • snoring
    • apnea
    • otitis
  37. S/S of pharyngitis
    stomachache...refuse to eat
  38. Viral Pharyngitis/Tonsilitis
    • gradual onset
    • sore throat, hoarse, rhinitis, slight fever
    • Normal WBC but positive throat culture

    pain relief and rest, cool bland foods
  39. Bacterial pharyngitis/tonsilitis
    • Sudden
    • Severe sore throat, swollen red tonsils, V, headachy, high fever
    • WBC increased and pos. throat culture

    antibiotics and pain management with saline gargle and bland foods
  40. #1 complication of tonsillectomy/adenoidectomy?
    • Watch for frequent swallowing or throat clearing
    • tachy
    • pallor
    • bright red emesis
    • restlessness
  41. How do you prevent bleeding after a tonsillectomy/adenoidectomy?
    • no straws
    • don't clear throat
    • keep suction at bedside for emergency
  42. What do you do if you suspect airway compromise?
    • raise HOB
    • lye on side
  43. What increases the risk of otitis media?
    • attend day care
    • bottle not breast fed
    • paci use
    • smoke
  44. What's the difference between acute otitis media and otitis media with effusion?
    Acute-purulent exudate,  INFECTION from bacteria or virus

    Otitis with effusion-serour non purulent and NO INFECTION
  45. S/S of acute otitis media?
    • acute pain
    • pullin on ears
    • fever
    • unconsolable
    • red tympanic membrane
  46. S/S of otitis media with effusion
    • SUBTLE
    • no pain just fullness
    • snapping sound with swallowing
    • decreased hearing
    • balance disturbances
    • Tympanic membrane-gray, yellow, translucent, air bubbles
  47. How do you treat acute otitis media?
    • antibiotics for 5-10 days
    • pain control
  48. How do you treat otitis media with effusion?
    • no antibiotics if not bacterial
    • don't blow nose
    • keep ears dry
    • hearing test

  49. What characterizes Croup syndromes?
    inspiratory stridor and respiratory distress
  50. S/S of epiglottitis
    • Sudden onset
    • Drooling
    • Dysphagia
    • Dysphonia
    • Distressed inspiration
    • High fever
  51. How do you dx epiglottitis?
    lateral neck x ray....no direct visualization till pt is intubated
  52. Nursing management for Epiglottitis
    • humidified O2
    • NPO
    • Calm Environment

    • Intubation?
    • Antibiotics?
  53. S/S of Croup
    • gradual onset....at night
    • preceded by a URI
    • inspiratory stridor
    • respiratory distress
    • low grade fever
  54. Nursing care for Croup
    • night air or shower
    • Aerosol Inhalation
    • IV fluids
  55. Aerosol Inhalant used to treat Croup.
    Racemic Epinephrine

    Watch for 2-3 hrs after for rebound obstruction
  56. When and who gets RSV?
    Infants in winter months
  57. What is the problem with RSV?
    sufficient air intake, but cant passively exhale
  58. Result of RSV?
    • Hyperinflation
    • air trapping
  59. How do you dx RSV?
    • recent URI
    • Nasal Smear + for RSV
    • CBC is normal
  60. When a person is having an exacerbation from RSV what will it look like?
    • tachypnea >60
    • nasal flaring
    • retractions
  61. Vaccine given to high risk infants for RSV?
    Respigam (Immunoglobulin)
  62. How do you dx asthma?
    • hx of reactive airway
    • frequent URI
    • Nasal smeal-+eosinophils
    • CBC-+eosinophilia
    • RAST-IgE antibody
    • PEFR
    • CXR-airtrapping/hyperinflation
  63. What sort of O2 do you give a person having an asthma attack?
    low dose with NC or mask
  64. Nursing care for a person having an asthma attack
    • IV fluids
    • rest
    • humidifier
    • Patient/parent education
    • Bronchodilators via neb.
    • Steroids?
    • Relaxation...nose breathing
  65. Patient and parent ed for asthma
    • What meds to use and when
    • Peak flow meter with grn/yellow/red
    • avoid triggers
    • tell others he/she has asthma
  66. Breath sounds during an asthma attack
    • mild-exp. wheezes
    • moderate-insp and exp wheezes
    • severe-decreased over all lung fields
  67. LOC during an asthma attack
    • mild-alert
    • moderate-irritable/agitate/combative
    • severe-lethargic/somnolent/min. resp to pain
  68. How will patient be positioning themselves during an asthma attack?
    • mild-relaxed/recumbant
    • mod-upright/tripod/wont lay down
    • severe-passive
  69. O2 sats during an asthma attack
    • mild->95%
    • moderate-90-95%
    • severe-<90%

    all on room air
  70. pH for a person having an asthma attack
    • mild-elevated
    • moderate-7.35-7.45
    • severe-decreased
  71. Blood gas for a person having an asthma attack?
    • mild-resp. alkalosis
    • moderate-physiologic
    • severe-respiratory and metabolic acidosis
  72. Peak flow meter results...
    Grn Zone
    Yellow Zone
    Red Zone
    • Grn 80-100% of personal best
    • Yellow 50-80% of personal best
    • Red <50% of predicted or personal best
  73. What is cystic fibrosis?
    general dysfunction of the exocrine gland resulting in over production of thick tenacious mucous everywhere
  74. S/S of cystic fibrosis
    • extreme fatigue
    • failure to thrive
    • delayed puberty
    • infertility
    • impaired digestion
    • clubbing
    • resp. issues
    • susceptible to infections....and antibiotic resistant one
    • fatty/frothy foul stools
    • muscle wasting cuz of malabsorption
    • severe productive cough
  75. Dx tests for cystic fibrosis
    • Sweat chloride test
    • DNA
    • chest x ray
    • fecal fat-72 hr collection
  76. Nursing care for a person with cystic fibrosis
    • G tube feeds at night
    • v. supp. of ADEK-water soluable
    • Promote oxygenation
    • prophylactic antibiotics
    • Pancreatic enzymes to help with digestion
    • immunizations-pneumococcal
    • bronchodilators
  77. How do you promote oxygenation for a person with CF?
    • percussion and postural drainage
    • vest to cough up sputum
    • think and mobilize secretions with fluids
    • hydration
    • exercise
    • steroids to decrease inflammatory response
  78. When do you take pancreatic enzymes?
    30 min. prior to meals
  79. S/S of whooping cough
    • Catarrhal-1 to 2 weeks, symptoms of URI
    • Prodromal-2 to 4 weeks increased severity of cough during exp. followed by massive insp with a whoop
    • Convalescence-1 to 2 weeks, coughing spells decreasing in severity
  80. What can trigger whooping cough spells?
    • yawning
    • sneezing
    • eating
    • drinking
    • getting scared
  81. Nursing care for whooping cough
    • admin vaccine DTaP
    • Antibiotics-erythromycin, azithromycin, clarithromycin
    • cardiopulmonary monitor
    • pulse ox
    • nutritional support with small frequent meals
    • nursing care clustered so they can sleep
  82. Isolation for a person with whooping cough
  83. Normal breathing for an infant
    short pauses in breathing pattern lasting less than 20 seconds
  84. Apnea
    pauses beyond 20 seconds or any pause with cyanosis, bradycardia or pallor
  85. Apnea of prematurity
    occurs when?
    occurs in neonates of 24-32 weeks, but resolves by 38 weeks

    occurs during feeding cuz of immaturity of breathing, sucking and swallowing coordination
  86. How does a person manage apnea of prematurity?
    gentle cutaneous stimulation so they don't stop breathing
  87. What do you do for persistent apnea?
    • admin O2
    • cardiorespiratory monitor
    • CPAP
  88. Drugs used to help a baby not have apnea
    • caffeine
    • oral theophylline

    increase respiratory drive and improve carbon dioxide sensitivity
  89. What causes infant apnea?
    • underlying conditions like:
    • GERD
    • seizures
    • hyperglycemia
  90. Central apnea
    absence of respiratory effort and air movement
  91. obstructive apnea
    apparent respiratory efforts without air movement or sound
  92. Mixed apnea
    • absence of respiratory effort and nasal air movement
    • followed by resumption of respiratory effort without air movement
  93. What do you track for your child on an apnea monitor?
    • respiratory movement
    • cardiac rate
    • record conditions leading up to an event, time, how long it lasted, and condition of infant after
    • stimulate a child when event is observed...don't wait for monitor to beep
    • parents trained in CPR
    • back up plan for power outages
  94. If apnea monitor beeps immediately....
    assess infant not machine
  95. You see SIDS most often in babies
    2-4 mo old....but happens before 6 mo
  96. Intrinsic risk factors for SIDS
    • genetic predisposition
    • male
    • premie
    • prenatal exposure to cigarettes/alcohol
  97. Extrinsic risk factors for SIDS
    • prone sleeping position
    • bed sharing
    • soft mattress
    • infant sleeping on upholstered furniture/adult mattress
    • exposure to cigarette smoke
  98. Signs of an Apparent Life Threatening Event
    Near SIDS-apnea, color change, marked change in muscle tone, choking or gagging

    • CPR
    • admit for observation
    • *often occurs due to sepsis
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Lecture 3 exam 2
Over this semester!!!!
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