Perry Ch 40-Respiratory Dysfunction

Front 1

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:

Back 1

Soothing inflamed mucous membranes

Front 2

It is important that a child with Group A beta-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent:

Back 2

Acute rheumatic fever

Acute gomerulonephritis

Front 3

When caring for a child after a tonsillectomy, the nurse should:

Back 3

Watch for continuous swallowing

**Most obvious early sign of bleeding from the operative site

Front 4

A 4-yo girl is brought to the ER. She has a frog-like "croaking" sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should:

Back 4

Notify the physician immediately and be prepared to assist with a tracheostomy or intubation

Front 5

The mother of a 20-month-old boy tells the nurse he has a "barking cough" at night. His temperature is 37 C. The nurse suspects croup and recommends:

Back 5

Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing

Front 6

An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:

Back 6

Prevent respiratory syncytial virus (RSV).

Front 7

A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:

Back 7

Assess the severity of asthma

Front 8

A 4-yr old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest he use a:

Back 8

Spacer

Front 9

One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection:

Back 9

Can trigger an episode or aggravate an asthmatic state

Front 10

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is:

Back 10

Mechanical obstruction caused by increased viscosity of mucous gland secretions

Front 11

The parents of a child with CF call the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parents to bring the child to the clinic because these symptoms are suggestive of:

Back 11

Pneumothorax

***Bronchodilation and C02 retention do not cause these symptoms

Front 12

Because the absorption of fat-soluble vitamins is decreased in children with CF, supplementation of which vitamins is necessary?

Back 12

ADEK

Front 13

An immediate intervention when an infant chokes on a piece of food would be to:

Back 13

Deliver 5 back blows between the shoulder blades with the infant in a head down, face down position

Front 14

Asthma is classified into four categories: mild-intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include:

Back 14

Lung function

Frequency of symptoms

Frequency and severity of exacerbations

Front 15

A 5-yo child is brought to the ER with abrupt onset sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions?

Back 15

Vital signs

Medical history

Assessment of breath sounds

Emergency airway equipment readily available

Front 16

Nasopharyngitis

Back 16

Common cold

Fever, irritable, decreased appetite and fluid intake, deceased activity, diarrhea and vomiting.

Older children: sneezing, chilly sensations, muscle aches, Nadal discharge and cough

Front 17

Pharyngitis

Back 17

Strep throat/sore throat

****serious complications: acute rheumatic fever (18 days after); acute glomerulonephritis (10 days after)**

Abrupt onset: fever, sore throat, headache, abdo pain, tonsils and pharynx covered in exudate, tender nodes, painful swallowing

Front 18

Diagnosis and tx for nasopharyngitis/ pharyngitis:

Back 18

Dx: throat culture

Tx: PCN

Front 19

Tonsillitis

Back 19

Inflammation of tonsils

Bacterial OR viral

Difficulty swallowing and breathing, blocked nasal passages, impaired sense of taste/smell, dry mucus membranes, nasal muffled voice.

Front 20

Tonsillitis dx/tx

Back 20

Dx: Throat culture

Tx: treat symptoms

Front 21

Influenza

Back 21

Type A or B

Deadly in infants (keep hydrated), more common in school age children, 1-3 day incubation, infectious for 24 hrs before and after onset of symptoms

Front 22

Mononucleosis

Back 22

"Kissing disease"

Transmitted by saliva

Cause by Epstein-Barr virus

S&s: 10 days-6 wks after exposure; malaise, sore throat, swollen lymph nodes, splenomegaly, fatigue, fever, skin rash, diptheria-like (grey) membrane on tonsils

Front 23

Mono dx

Back 23

Mono slot slide test

Front 24

Otitis media

Back 24

From strep, blocked eustachian tubes

Pain, irritability, pulling on ears, constant fever as high as 104F, vomiting/diarrhea, possible concurrent Resp infection, loss of appetite

Front 25

Otitis media tx

Back 25

Amoxicillin; if recurrent?

--->Augmentin. Last resort?

--->Rocephin IM

Front 26

AIR RAID

Back 26

Airway closed

Increased pulse

Restless

Retraction

Anxious

Indpiratory strider

Drooling

Front 27

Bronchitis

Back 27

Inflammation of large airways, viral cause, also bacterial in kids over 6y

Dry hacking nonproductive cough, whose at night, productive in 2-3 days

Front 28

Bronchitis tx

Back 28

Analgesics, antipyretics, humidity,cough suppressants

Front 29

RSV bronchiolitis

Back 29

Necrosis of the Resp epithelium of the small airways, peribronchiolar mononucleosis infiltration, plugging of lumens, and **hyperinflation and atelectasis**

Initial: pharyngitis, coughing, sneezing, wheezing, possible otitis media or eye infection, intermittent fever

Progressing: increased cough/wheezing, air hunger, tachypnea of >70 breaths/min, retractions, cyanosis, apneic spells, poor air exchange, poor breath sounds

Front 30

RSV dx/tx

Back 30

Testing of nasal/nasopharyngeal secretions==glow? Positive result

Tx: cool humidification 02, adequate fluids, IV fluids till after acute phase, airway management and meds:

Bronchodilators

Racemic epi

Ribavarin-***danger, alters DNA so no pregnant women or anyone at risk***

Encourage breastfeeding mothers to pump and store milk

Front 31

CF tx

Back 31

Depends on body system:

GI:Supplemental pancreatic enzymes

Pulmonary: Prevention/tx of respiratory infection

Chest physiotherapy

Front 32

CF dx

Back 32

Family hx

Absence of pancreatic enzymes

Elevated electrolytes in sweat

Chest x ray

Stool analysis- unformed; fatty

Front 33

Asthma assessments, important b tests

Back 33

PaCO2 on ABG

PEF

Pulse ox

Front 34

Inhaled corticosteroid therapy

Back 34

Raises BGL

Reflex cough

Voice change (dysphonia)

Front 35

Systemic corticosteroids

Back 35

Inc. BGL

Mood change

Round face

Acne

Front 36

Corticosteroids used for asthma?

Back 36

Prednisone (oral)

Dexsmethasone (IV)

Front 37

Antileukotrienes for asthma?

Back 37

Singulair!