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healthy people 2010
Reduce hospitalization rates for thre ambulatory care sensitive conditions : pediatric asthma and immunization -preventable pneumonia and influenza
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Newborns are obligatory nose breathers until what age?
4 weeks
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Which sinuses are present at birth and which are not? At what age are the absent sinuses developed?
- Maxillary and ethmoid are present
- Frontal and sphenoid sinuses are not present and develop by age 6-8 years
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What factors related to a child's throat leads to an increased incidence of airway obstructions?
- children tend to have enlarged tonsillar and adenoidal tissue even in the absence of illness.
- Tongue is large in relation to oropharynx
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How large is the infant trachea? adult trachea?
- infant 4 mm wide
- adult 20 mm wide
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Why is the larynx funnel shaped in infants and children under 10 years of age?
the cricoid cartilage is underdeveloped
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Why is there an increased chance of aspiration in infants and children?
the larynx and glottis are located higher in the neck which increases the chance of aspiration of foreign material into the lower airways.
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What is congenital laryngomalacia?
- very common condition of infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction
- inspiratory stridor present
- suprasternal retractions may be present w/o other signs of resp distress
- generally benign that improves by 1 year of age
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Lower respiratory structures in children
- bifurcation of trachea at level of third thoracic vertabra in chilren; level six in adults; contributes to risk of aspiration
- alveoli develop at approx. at 24 weeks gest
- term infants born with 50 million alveoli
- adult number of alveoli of 300 million by the age of 7-8
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Chest Wall of children
tidal volume of infants and toddlers almost completely dependent upon movement of diaphram
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Metabolic rate and oxygen need in children
- higher metabolic rate than adults
- adult consume 3-4 L per minute
- infants consume 6-8 L per minute
- infants and children develop hypoxemia more rapidly
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circumorally
just around mouth
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acrocyanosis
blue hands and feet
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In which children would you not use the degree of cyanosis as an indicator of hypoxemia.
children with low red blood cells
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what is the first sign of respiratory illness in infants and children (most often)?
tachypnea
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A slow or irregular respiratory rate in an acutely ill infant or child is an ominous sign.
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What is the action of an Expectorant (guaifenesin)?
Reduces viscostiy of thickened secrections by increasing respiratory fluid
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What are the indications for expectorant (guaifenesin)?
- common cold
- pneumonia
- conditions requiring mobilization and subseqent expectoration of mucus
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What is the action of cough suppressants such as
dextromethorphan
codeine
hydrocodone
relieves irritating, nonproductive cough by direct effect on the cough center in the medulla, which suppresses the cough reflex
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What is the nursing implication of using cough suppressants?
use only with nonproductive coughs in the absence of wheezing
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What is the action of brochdilators such as
(short acting)
albuterol (Provent)
levalbuterol
(long acting)
salmeterol
Relax airway smooth muscle, resulting in brochodilation
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Indications for use of beta2-adrenergic agonists (bronchodilators)?
- acute and chronic treatment of wheezing and brochospasm in asthma
- brochiolitis
- cystic fibrosis
- chronic lung disease
- prevent wheezing in exercise induced asthma
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What are the actions of racemic epinephrine?
- Produces bronchodilation
- indicated for croup
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What are the nursing implications for racemic epinephrine?
- assess lung sounds and work of breathing
- observe for rebound brochospasms
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What is the action of anticholinergic (ipratropium)?
Produces brochodilation in asthma or chronic lung diease
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What are the nursing implications of using anticholinergic (ipratropium)?
in children, generally used as an adjuct to beta2-adrenergic agonists for treatment of bronchospasm.
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What are the actions of corticosteroids (inhaled) ?
anti-inflammatory effect to decrease the fequency and severity of asthma attacks. May also delay pulmonary damage that occurs with chronic asthma ; also used for chronic lung disease and croup syndrome
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What are the nursing implications of inhaled corticosteroids?
dexamethasone (decadone)
Fluticasone (Flovent)
- not for treatment of wheezing
- rinse mouth after inhalation to decrease incidence of fungal infections, dry mouth, and hoarseness
- treatment of choice for asthma maintenance program
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What is the action of Corticosteroids (oral, parenteral)?
- suppress inflammation and normal immune response
- used for acute asthma exacerbations, wheezing with chronic lung disease, and severe croup
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What are the nursing implications of the use of corticosteroids (oral, parental)?
- may cause hyperglycemia
- may suppress reaction to allergy tests
- consult physician if vaccinations are ordered during course of treatment
- long term can result in peptic ulceration, altered growth, and numerous other side effects.
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What are the actions of leukotriene receptor antagonists (montelukast, zafirlukast, zileuton)?
decrease inflammatory response by antagonizing the effects of leukotrienes to control asthma in children age 1 year and older
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Action of montelukast ?
for allergic rhinitis in chldren 6 months and older.
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What is the action of Methylzanthines such as
theophylline
aminophylline
- 10-20 therapeutic blood level
- provide for continuous airway relaxation in moderate or severe asthma in order to achieve long-term control
- apnea of prematurity
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Nursing implications of Methylxanthises ( theophylline, aminophylline).
- monitor drug level routinely. Report signs of toxicity immediately:
- tachycardia,
- nausea
- vomiting
- diarrhea
- stomach cramps
- anorexia
- confusion
- headache
- restlessness
- flushing
- increased urination
- seizures
- arrythmias
- insomnia
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Healthy people 2010
reduce the proportaion of children who are regularly exposed to tobacco smoke at home
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