PEDS Exam 2

• Anatomical Differences
• Smaller, narrowed airways smaller nares- less than 6mo nose breathers
• Enlarged tonsil tissue and epiglottis is more posterior and longer
• Larynx is higher in the neck
• Softer tracheal cartilage-prone to collapse
• Less alveoli- born with 20mil
• Underdeveloped respiratory muscles- fewer functional muscles
• Abdominal breathers
• Irregular Breathers

respiratory failure and shock

• air passing through a narrowed lower airway
• musical sound, high pitched

• air passing through a narrowed upper airway
• without stethoscope usually harsh noise

• air passing through watery secretions. Pneumonia, CF.
• High pitched noncontinuous sound.

obstruction of airflow, collapsed lung

• Retractions
• Result of pliable chest wall
• Mild/Moderate/Severe-Nasal flaring, grunting, head bobbing (later sign)
• Use of abdominal accessory muscles

• Restlessness
• Tachypnea
• Tachycardia
• Diaphoresis
• Increased WOB
• (early decompensation)

• Severe Hypoxia
• Dyspnea
• Bradycardia
• Cyanosis
• Stupor

• Tachypnea and increased Work of breathing (WOB)
• Tachycardia and diaphoresis
• Changes in LOC and comfort: easy fatigability, restlessness progressing to irritability, decreased responsiveness
• Color changes/changes in peripheral perfusion
• Decreased O2 saturation and need for supplemental O2

• Rest= cluster care
• Elevate head of bed
• Hydration/Humidity
• RR>60/min—no PO because of risk for aspiration
• Monitor resp rate and effort
• Assess breath sounds
• O2 sats
• Contact or C/D Isolation
• Suctioning

• Albuterol
• Racemic Epinephrine
• Corticosteroids (Decadron)
• Antibiotics (Azithromycin)
• Analgesics (Tylenol/Ibuprofen)
• Chest physiotherapy

• bronchodilator. Relaxes smooth muscle,
• AE: Shaky, increase HR.

• short acting vasodilator opens them up and reduces edema
• AE:Increased HR.

decrease inflammation, obstruction edema. IV or nebulizer.

• related to what they are sick for
• make sure they finished doses watch for allergies

comfort or fever

(RSV) (ICU) loosen secretions. One hour before meals or two hours after to prevent vomiting. Room air 20%. 100% out of wall.

• Helps with our respiratory kids because we can give objective data
• lower score is better

• Upper Airway Illness: swelling of the epiglottis and larynx
• Bacterial Epliglottitis/ Tracheitis
• Acute Laryngotracheobronchitis (LTB)
• Acute Laryngitis
• Acute Spasmodic Laryngitis
• Dx: clinical symptoms, x-ray

• respiratory distress symptoms
• inspiratory stridor
• supra-sternal retractions
• harsh “barking cough”
• low grade fever

• Albuterol
• Racemic epinephrine
• Steroids
• systemic or nebulized

• LTB/ acute spasmodic croup
• patent airway
• Improve respiratory effort
• high humidity - cool mist
• oral fluids—if RR < 60/min and not increased WOB

• Caused by haemophilus influenza type B or streptococcal pneumoniae
• diagnosed via Xray

• Drooling
• Dysphagia
• Dysphonia
• Distressed resp

• high fever above 39
• sore throat
• stridor on inspiration

• maintain airway patency
• important you dont want to agitate the airway so dont use tongue depressor to look into the airway because it can cause laryngeal spasms

• Lower respiratory illness causing inflammation and obstruction of the bronchioles
• RSV (season is oct-march) vs. Non-RSV

• NP culture
• Inflammation of bronchioles on x-ray
• Highly contagious—Respiratory isolation

• URI, serous nasal drainage
• Tachypnea
• Wheezing
• Crackles
• Respiratory distress

• Apnea
• Bacterial Pneumonia
• Respiratory Failure

• Fluids/IVF
• Oxygen/Humidification
• Rest
• Patent airway
• NPO or TF if RR >60/min
• Chest physiotherapy
• mostly treating symptoms

• avoid if possible to avoid edema
• good rule of thumb every 3-4 hours

• Ribavirin (only approved treatment)
• RespiGam
• Steroids
• Bronchodilators

• an antiviral that can be given to kids that have life threatening cases of RSV
• teratongenic med so pregnant RN or parent cannot administer it

• RSV immunization for high risk patients
• premature less than 32 weeks
• chronic lung or congenital heart disease
• immunocompromised
• CF kids

• Infancy >37 weeks gestation:
• Brief resolved unexplained event for 20 seconds or longer OR
• A respiratory pause of shorter duration but that is associated with the following:
• Bradycardia
• Cyanosis
• Pallor and/or marked hypotonia.

• GERD with aspiration—pH study
• Seizures- cause them to lose respiratory drive and dsat. so they do an EEG to rule it out
• Metabolic or Endocrine dysfunction – electrolyte imbalance.
• Infection
• 50% go home unexplained

• History of the event and what was the resolution.
• Education
• Monitor—respond—document.
• Assessment skills: color, resp. rate
• CPR class prior to discharge.
• Support for the anxiety
• respite
• resource person

• home monitoring
• pharmacologic respiratory stimulants: theophylline, caffeine
• Family must have infant CPR training prior to discharge from hospital.

• Sudden and unexpected death of an infant less than one year of age which is unexpected by history and is unexplained by thorough postmortem exam
• Often the exact cause is unknown.
• Remains a leading cause of death for infants 1 month to 1 year - 90% of cases occur before 6 months.
• SIDS is not preventable, but risks can be reduced.
• Highest risk 2-4 months.

• Lower socioeconomic level
• overheating
• prone sleeping
• bottle propping
• smoking in home
• soft bed or surface
• co-sleeping with others

Severe anemia, cigarette smoking, substance abuse, age (<20 years of age.) low weight gain during pregnancy, STDs and UTIs

• Premature
• multiple births
• low Apgar score
• CNS or respiratory disorder
• male gender more common
• SGA or history of SIDS

• sleeping on their back (sleep sac recommended)
• Sleep in crib or bassinet no co-sleeping
• Use a pacifier
• prevent overheating
• Avoid tobacco exposure

• support family and offer resources
• allow parents to view/hold baby
• encourage expression of feelings
• Home monitoring-follow-up

it is an inherited autosomal recessive disorder which means both parents must be carriers of the gene

• Defect on chromosome 7 that changes mucous
• Defects of the Exocrine Glands
• Abnormal mucus secretion and obstruction
• Multiple Systems are affected.
• Pulmonary
• GI
• Reproductive Organs
• is terminal illness

Salty taste increase of NaCl in sweat and saliva

• Meconium Ileus- where the newborn does not pass the meconium
• Damage to pancreas can result of CF related diabetes
• Abnormal stools described as like foul smelling, frothy and they float

• Initial signs- wheezing respirations and nonproductive dry cough
• Eventually will lead into increased dyspnea, obstructive emphysema and atelectasis
• Progressive Involvement- years of decrease oxygenation you'll see clubbing of the fingertips, barrel-shaped chest cyanosis

• Males- typically sterile vas deference doesnt form correctly
• Females- normal structure but secretions are so thick it is difficult for the sperm to get to and fertilize the egg

they are smaller than other kids- so watch weight gain and growth chart closely- failure to thrive

• Family history of disease
• DNA testing
• Prenatal diagnosis
• Fecal fat 72 hour stool analysis
• CXR, Pulmonary function tests (PFTs)
• Sweat Chloride tests
• > 60mEq/L is a positive
• >40mEq/L is suggestive in infants less than 3 months.

• Prevent or minimize pulmonary complications
• Ensure adequate nutrition for growth
• Encourage appropriate physical activity- but they dehydrate faster so make sure they have enough electrolytes and water
• Promote a reasonable quality of life for the child and family.

• Respiratory Therapy
• CPT- chest physiotherapy can be done 2-5 times per day and want it done one hour before meals or 2 hours after meals to avoid throwing up

• Antibiotics- if sick
• bronchodilators- opens up the bronchi
• aerosol DNase- mucolytic that breaks down mucus and helps them cough it up
• anti-inflammatories- for inflammation of the lungs

• High cal, hi pro diet (150%)
• Pancreatic enzymes (don’t give with hot foods) but take with any sat or meal
• Vitamins in water soluble form (ADEK)- not drug store has to be prescribed

• Chronic hypoxia—small, fatigues easily
• Insulin-dependent diabetes mellitus (CFRD)
• Multiorgan Failure: Liver, Heart, Lung
• Always terminal

• Elexacaftor + tezacaftor + ivacaftor (Trikafta TM)
• Approved for people with CF ages 12 and older who have at least one copy of the F508del mutation
• Study shows 10% increase in lung function
• Ttrikafta TM in children with CF ages 6-11 years old is currently underway

• Frequent Assessments WOB
• Cough and deep breath- huff cough taught by RT
• Nutrition
• Pancreatic enzymes
• Chest physiotherapy
• Anticipatory guidance

• Ineffective airway clearance related to thick mucous in the lungs.
• Imbalanced Nutrition: less than body requirements related to the inability to digest nutrients.
• Parental role conflict related to interruptions in family life due to the home care regimen and child’s frequent exacerbations.
• Risk for Infection related to the presence of mucous secretions conducive to bacterial growth.

• Sudden discomfort.
• Can be caused by trauma or surgery.
• Can be accompanied by anxiety or emotional distress.
• Acute pain can turn into chronic pain.

• Lasts over a longer period of time.
• Can be made worse by environmental and psychological factors.

• Vital Signs
• Pupil dilation
• Sweating
• Actions wont want you to touch them
• uncooperative
• anxious

• Children are often grossly under medicated
• The long and short term consequences of pain in children is unknown
• Children are often too young or non-verbal, unable to be their own advocates

• BEST INDICATOR-changes in facial expression
• Increased BP and HR
• Decreased O2 saturations
• High pitched, tense cry
• Thrashing, tremors, guarding

• Loud crying, longer than infant
• Verbalization of discomfort
• “ouch, it hurts”
• Delaying behaviors
• Clings to parent
• Regression

• Cry, Kick
• Thinks he is being punished
• Regression
• Withdrawal
• Deny pain to avoid “shot”
• Begs for it to end
• Can indicate location of pain

• Able to describe pain
• Fears bodily harm
• Stiff or withdrawn body posture
• Procrastinates (“wait a minute”)

• Describes pain
• Understands cause and effect
• Increased muscle tension
• Withdrawal and decreased activity
• May suppress manifestations of pain and then expect nurse to know that he/she has pain

• Same tool should be used each time pain assessed
• Ideally, child is taught about the tool prior to time of pain.
• Use of assessment tool is imperative in the clinical setting
• Provides method of documenting effectiveness of pain management or need to change pain management

Uses numbers to describe increasing pain, use with school age child with understanding of numbers and ordering

May be too abstract for young school-agers

• Pain is scored by observation of behaviors identified to be indicative of pain
• IPS-Infant Pain Scale-27 weeks gestation-7 months
• FLACC (faces, legs, activity, cry, consolability)
• 2months-7years
• FLACCr for developmentally delayed kids

Children as young as 3 years old, number under face is recorded

Is available with pictures of children from different ethnic backgrounds, used with children 3-13 years

• Character- what is it like dull or sharp
• Onset- when did it start
• location
• Duration- how long has it been going on
• Severity- rating pain level
• Pattern- does it come and go or follow anything that you do
• Associating factors- what makes it better, what makes it worse

• preferred choice for most forms of acute, severe pain and chronic, severe pain
• Fentanyl- if pushed too fast causes chest wall rigability
• Methadone
• Morphine
• Codeine
• Dilaudid
• Oxycodone
• Placebo

aspirin, ibuprofen, naproxen, Ketorolac- need to check urine output because it causes urinary retention

medically controlled state of decreased consciousness, maintains gag reflex, airway and responsiveness

• Patient controlled analgesia- kids over 5
• Nurse controlled analgesia- under 5 or developmentally delayed

• Titrate dosage until optimum pain relief is achieved without excessive sedation
• The amount of the drug can be increased or the interval of dosages can be decreased

• Should use route that is most effective and least traumatic
• IV or oral are preferred routes
• IM should be last choice-”treating pain with something painful”

• Continuous pain should be managed with a preventive schedule of “around the clock (ATC) or reverse PRN
• If pain is expected, then it should be treated without waiting until it becomes unbearable
• Painful procedures should be timed for peak effectiveness from the pain med
• Topical Lidocaine for IV and lab sticks

• Side effects of opioids include: sedation, respiratory depression, itching, nausea, and vomiting, cough suppression, urinary retention, constipation
• ***Why should Narcan be available when giving opioids?*

• Distraction
• refocus child, not for severe pain, does not mean child does not have pain
• Relaxation
• Deep breathing
• Imagery
• Think of favorite place and then go there

Silvery white, yellow or darker 1 mm teardrops, found commonly behind the ears and at the base of the head

Highly contagious spread by skin to skin contact. Highest prevalence is under 2 yrs

Permethrin(Nix)

Severe pruritus, restlessness, rash with various types of lesions

intense pruritus (sensation to itch), and complaints of dandruff.

Removing crusts and applying antibiotic ointment for 5-7 days

Erythema, red streak, edema of face or infected limb, painful/tenderness at site, warmth, hx of trauma

honey colored crusts covering an ulcerative base on the skin

A highly contagious superficial infection caused by streptococci, staphylococci, or both. The most common sites are the face, around the mouth, the hands, the neck and the extremities

Fungal infection of the skin. Usually acquired from infected humans, cats, dogs, or horses. Pink scaly circular patch with expanding border

(Strong acids and alkaline products) batteries, household cleaners, bleach, toilet bowl cleaner, denture cleaner

Swelling of mucous membranes; edema of lips' tongue and pharynx

Treatment reserved for children with CNS depression, diminished or absent gag reflex

A form of highly porous carbon commonly used to filter contaminants Given to absorb and removed any remaining particles of toxic substance

Airway assessment and measurement of respirations(breathing)

Antipruritic medication such as Benadryl, aveeno/oatmeal baths, short fingernails

White strawberry tongue

A communicable disease that may cause severe defects in the fetus

Koplik's spots (white spots in the oral buccal mucosa)

Intensely red rash on the cheeks giving a "slapped face" appearance after one week

History of severe anaphylactic reaction to a vaccine and encephalopathy within seven days of administration of DTaP

Allergy to Neomycin

MMR and Varicella vaccines

Every 10 years

Dtap, IPV and HIB