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Pediactrics ch 32
child with respiratory dysfunction exam 1
132
Nursing
Undergraduate 4
05/16/2012

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Cards

Term
Why are healthy full term infants presumed to have a lower infection rate?
Definition
d/t the protective function of the maternal antibodies
Term
Is viral infection rate high during the toddler and preschool years?
Definition
yes
Term
Respiratory tract infections are less frequent when a child reaches the age of 5. But the incidence of what two infections increase during this time?
Definition

strep

&

mycoplasma pneumoniae

Term
Why does the size of the respiratory tract have to do with risk of infections in children?
Definition
the diameter is smaller and is subject to narrowing and edematous mucous membranes and increased secretions
Term
Why are infants and young children subject to middle ear infections?
Definition
d/t the short and open eustachian tube
Term
The most common respiratory tract pathogens appear in epidemics during what months?
Definition
Spring and winter
Term
Assessment for respiratory system should include?
Definition

heart rate

respiratory rate/depth/rhythm

hydration status

Term
What technique could the nurse do to ease respiratory efforts?
Definition

-warm or cool mist

-the moisture soothes inflamed membranes 

-beneficial when there is laryngeal involvement or hoarseness

Term
Would you recommend that parents use a home vaporizer to ease respiratory efforts?
Definition
No, hazardous and no evidence to support this
Term
If your baby is congested, what should be done before feedings to promote comfort?
Definition
use nasal aspirator or rubber ear syringe to remove secretions before feeding
Term
What can be done to provide relief in a patient with painful cervical adentitis?
Definition
hold or cold applications
Term
Ideally, when should a child be isolated?
Definition
at the first sign of illness
Term
Why should parent be cautious when using OTC combo cold remedies?
Definition
they often contain acetaminophen
Term
Factoid: To reduce the temperature and minimize the chance of dehydration, encourage COOL LIQUIDS
Definition
;)
Term
High cal liquids, such as, colas, fruit juice drinks, water flavored and sweetened with corn syrup can help prevent catabolism and dehydration, BUT should be avoided when what is present ?
Definition
diarrhea
Term
Your pediatric pt who is at risk for dehydrations is asleep. do you wake them up to drink fluids, or let them sleep?
Definition
Never force children to drink unless the practitioner advises it
Term
How would you as the nurse assess a child's level of hydration?
Definition
observe the frequency of voiding and notify nurse or doc in their is insufficient voiding
Term
how is urinary outout calculated in an infant who weighs 30 kg or less
Definition
1 ml/kg/hr
Term
Group A beta-hemolytic strep can cause skin manifestations such as?
Definition
impetigo and pyoderma (pus-producing)
Term
Beside rheumatic fever and acute glomerulonephritis, what other disease may develop?
Definition
scarlet fever
Term
what are the clinical manifestations of scarlet fever?
Definition
pharyngitis and a erythematous sandpaper-like rash
Term
Factoid: GABHS is generally a brief illness and varies from subclinical(no sx) to severe toxicity
Definition
:)
Term
The onset of GABHS is often abrupt and characterized by what ?
Definition

pharyngitis

HA

fever

ab pain

Term
Your pt with GABHS opens his mouth and says "aaahhh", what would you expect to observe?
Definition
tonsils and pharynx inflamed and covered in exudate
Term
when does the inflamed tonsils and pharynx usually manifest in strep?
Definition
by the second day of illness
Term
When would the complications of acute nephritis and rheumatic fever occur after the onset of GABHS?
Definition

nephritis: about 10 days

RF: about 18 days

Term
Although 80-90% of acute pharyngitis is viral, what should be done to rule out GABHS?
Definition
throat culture
Term
Your pt has a positive strep throat culture. Do they have an active disease?
Definition
No, some children normally have strep in their throats.
Term
Your pt has a negative rapid diagnostic test response for strep. Do they still need the culture?
Definition
Yes, they need a culture regardless. The sensitivity in these tests are questionable.
Term
For a pt with a strep sore throat infx present, how is it treated?
Definition
oral penicillin for at least 10 days
Term
Does the penicillin prevent the development of acute glomerulonephritis in children?
Definition

-nope

but it may prevent the spread of a nephrogenic strain of GABHS

Term
IM penicillin G benzathine is appropriate therapy for strep and ensures adequate blood concentration. But why may pt not what this done?
Definition
very painful
Term
If your pt with step is allergic to penicillin, then what may be given?
Definition
oral erythromycin
Term
If children are old enough to cooperate, what may provide throat relief?
Definition
warm saline gargles
Term
Never give pencillin IV !!!!!!
Definition
:/
Term
How is strep spread?
Definition

close contact with afftected persons

large droplet

physical transfer of secretions

Term
when is the child with strep non-infectious?
Definition
24 hrs after initiation of antibiotics
Term
when should the pt with strep replace their toothbrush?
Definition
after taking antibiotics for 24 hrs
Term
The two viruses most likely to precipitate OM are?
Definition
RSV and influenza
Term
Is there a correlation with children who have siblings or parents with chronic OM?
Definition
Yes, they have a higher incidence of OM
Term
What are some significant risk factors for OM?
Definition

Daycare

being around smokers

 

Term
How does passive smoking increase the risk of persistent middle ear infx?
Definition
enhances attatchment of the pathogens that cause otitis to the resp epithelium in the middle ear space, thus prolonging inflammatory response and impeding drainage through the eustachian tube 
Term
What are the two most identifiable risk factors for the occurrence of OM?
Definition

family socioeconomic status

&

extent of exposure to other children

Term
AOM is frequently caused by what three pathogens?
Definition

Streptococcus pneumoniae

H. Influenzae

Moraxella catarrhalis

Term
Breast feeding may protect infants from resp viruses and allergy because it contains what Ig?
Definition
IgA
Term
IgA does what in terms of OM prevention?
Definition
limits the exposure of the eustachian tube and middle ear to pathogens and foreign protein
Term
OM is promarily the result of _ eustachian tube (fill in the blank)
Definition
dysfunctioning
Term
What are the three functions of the eustachian tubes?
Definition

1.protect middle ear from nasopharyngeal secretions

2. drain secretions made in the middle ear to the nasopharynx

3. ventilation to equalize pressure and replenish O2 that has been absorbed

Term
Example of intrinsic obstruction causing OM?
Definition
Infx or allergy
Term
Extrinsic obstruction causing OM?
Definition
enlarged adenoids and nasopharyngeal tumors
Term
what causes hearing loss in OM? (3)
Definition

negative middle ear pressure

effusion

damage to eardrum

Term
What is the most feared consequence of hearing loss?
Definition
development of speech, language, and cognition
Term
Hearing loss is a functional complication to OM, but what is a structural complication?
Definition
tympanic membrane retraction caused by continuous negative pressure
Term
Chronic suppurative OM, inflammation of the middle ear and mastoid, is evidenced by what?
Definition
perforation and discharge for up to 6 weeks duration
Term
What are clinical signs of cholesteatoma?
Definition

foul smelling grayish yellow discharge

pain

permanent, progressive hearing loss

Term

 

What is the treatment for cholesteatoma?

Definition
surgical excision of the entire cholesteatoma
Term
what would you assess in the behavior of an infant with accumulated purulent drainage in the middle ear?
Definition
holding or pulling at their ears and rolling head from side to side
Term
A temperature as high as _ is common, and _ and _ glands may be enlarged. (fill in the blank) OM
Definition

104 degrees

postauricular

cervical

Term
Factoid: in OM, loss of appetite typically occurs, and sucking or chewing tends to aggravate pain
Definition
:)
Term
When the eardrum ruptures, is the pain relieved?
Definition
yes
Term
What happens in result of eardrum rupture?(3)
Definition

relief of pain

gradual decrease in temp

purulent discharge in external canal

Term
Is there severe pain or fever in OME?
Definition
it's usually absent
Term
If your pt can verbalize the feelings of having OME, what would they say? (3)
Definition

feeling of fullness in the ear

popping sensation when swallowing

feeling of "motion" in the ear

Term
Dioagnosis of AOM is made on visual inspection if?
Definition

eardrum has purulent, discolored effusion

bulging full, opacified, or reddened immobile eardrum

Term
On visual inspection, what would indicate OME?
Definition

immobile eardrum

orange-colored membrane

Term
Because fever and ear pain is usually not present in OME, what nonspecific sx may occur?
Definition

rhinitis

cough

diarrhea

Term
Factoid: waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants over 6 monthsand children
Definition
Term
for a child under 2 yrs who has sx of ear pain and fever, would the watchful eye method still comply?
Definition
no
Term
how is an infant under 6 months treated for OM?
Definition
antibiotics d/t immature IS
Term
When antibiotics are needed for OM, what is given?
Definition
oral amoxicillin is high doses
Term
If the child is non-compliant or if the causitive organism is resistant pneumococcus then what is given for treatment of OM?
Definition
IM ceftriaxone
Term
Supportive care for OM is treating pain and fever. How would you do this?
Definition

acetaminophen or ibuprofen (if older than 6 months) for fever

topical pain relief with cold or warm application

benzocaine drops

Term
What surgery may be needed to alleviate severe pain from AOM?
Definition
myringotomy ( surgical incision of eardrum)
Term
What is the therapy for recurrent AOM?
Definition

chemoprophylaxis with:

long term antibiotics

immunotherapy

surgery

Term
Why should a child undergoing long term antibiotic therapy visit the doc once a month?
Definition
to detect evidence of effusion
Term
what two surgical procedures are done to treat recurrent AOM?
Definition

tympanostomy tube placement

&

adenoidectomy

Term
When would antibiotics be indicated for OME?
Definition
persistent effusion for more than 3 months
Term
Is OME associated with mild to moderate hearing impairment?
Definition
yes,and the major goal of therapy is to have the middle ear be fluid free and restore normal hearing
Term
tympanostomy tubes are recommended after how many months of bilateral effusion and bilateral hearing deficit?
Definition
4-6 months
Term
What vaccine has reduced the incidence of AOM in some infants and children?
Definition
pneumococcal conjugate vaccine PCV 7 (Prevnar)
Term
Prevnar is administered as a four dose series beginning at the age of?
Definition
2 months
Term
what would you recommend to the family with a child with an URI going onto an airplane?
Definition
nasal mucosa shrinking spray or oral decongestant before the trip
Term
What is the simple most effective method for inflating the middle ear on descent in an airplane?
Definition
swallowing: a pacifier or feeding would benefit an infant
Term
What is the predominant sx of external ear infx, or swimmer's ear?
Definition
ear pain accentuated by manipulation of the pinna, esp pressure on the tragus
Term
Conductive hearing loss in otitis externa d/t what ? (3)
Definition

edema

secretions

accumulation of debris in canal

Term
What appears in ear as infx progresses?
Definition

edema

erythema

cheesy blue-green discharge

tenderness

Term
What causes otitis externa?
Definition
normal flora that assume pathogenic characteristics under conditions of excessive dryness or wetness
Term
to prevent recurrent ear infx, how long should children be allowed to swim and what care should be done afterwards? 
Definition
less than an hour, if possible, and ears should dry completely (1-2 hours) before entering the water again
Term
What two cleaning products per say can you combine to prevent ear infx?
Definition
50:50 white vinegar and rubbing alcohol
Term
what does croup result from?
Definition
swelling or obstruction in the larynx
Term
Most cases of croup are attributed to what type of diseases?
Definition
viruses
Term
What are the key difference b/t LTB and epiglottitis?
Definition

absence of cough

presence of dysphagia

high degree of toxicity

(all in epi)

Term

FACTOID

Children with epiglottis look worse than they sound and children with LTB sound worse than they look

Definition
;))
Term
Parents with a chiuld experiencing epiglottitis may say what about the childs condition at bedtime?
Definition
went to bed asymptomatic to awaken later with a sore throat and pain upon swallowing. The child has a fever and looks sicker than clinical findings suggest
Term
You have been told that your pediatric pt in the er has epiglottitis, how would you expect them to appear when you see them?
Definition

sitting in tripod position

chin thrust out

mouth open & tongue protruding

drooling d/t pain on swallowing and excessive secretions

frightened expression and extremely restless

voice is thick and muffled

froglike croaking sound on inspiration

!!!!!!!!!THE CHILD IS NOT HOARSE !!!!!!!!!!

Term
how does the throat appear in pt's with epiglottitis?
Definition

red and inflamed

distinctive, large, cherry red, edematous epiglottis is visible

Term
Progressive obstruction d/t epiglottits will do what to oxygen levels?
Definition

hypoxia

hypercapnia

acidosis

decreased muscular tone

reduced level of consciousness

sudden death

Term
When a child with epi is being transported, what is the best means for transportation to reduce distress?
Definition
sitting on the parents lap
Term
what is considered for the child with epi with severe resp distress?
Definition
nasotracheal intubation or tracheotomy
Term
How can a parent help prevent acute epi?
Definition
beginning at two months receive the H. influenzae type b conjugate vaccine
Term

what organisms are responsible for LTB? (5)

 

Definition

parainfluenza virus 1,2 and 3

influenza types A & B

measles

M. pneumoniae

Term
What is LTB characterized by?
Definition

gradual onset of low grade fever

child woke up with a barky, brassy cough and at times inspiratory stridor

 

Term
SX of LTB are typically worse during what time of day?
Definition
at night, and agitation and crying tend to exacerbate the sx
Term
What is the major objective in medical management of infectious LTB?
Definition
maintaining an airway and providing adequate respiratory exchange
Term
Why does cool temperature therapy provide relief in pt's? (ie standing in front of a freezer, cool mist, standing outside during a cool night)
Definition
constricts edematous vessels
Term
If LTB is not relieved by cool mist, then what will be used?
Definition
nebulized epinephrine, causes mucosal vasoconstrictionand subsequent decreased subglottic edema
Term
When pt is given racemic epinephrine, it is the nurses responsibilty to observe what every 2-3 hours?
Definition
respiratory distress
Term

FACTOID

The use of corticosteroids is beneficial because of the antiinflammatory effects decrease subglottic edema.

IM dexamethosone for those who cannot tolerate oral steroids

Definition
:))
Term
In severe cases of LTB, a mixture of what may be used to reduce the work of vreathing and relieve the airway obstruction?
Definition
helium and oxygen (heliox)
Term
For a pt with LTB, the nurse will vigilantly monitor what three things?
Definition

cardiac

respiratory status

pulse ox

Term
What are early signs of an impending airway obstruction?
Definition

increased pulse and RR

substernal and intercostal retractions

nasal flaring

increased restlessness

Term
By age 3, most children have been affected by what respiratory illness ?
Definition
bronchiolitis
Term
The antibody response to RSV is inadequate and nearly 3/4's of children are reinfected
Definition
fact
Term
Severe RSV in the first year of life represent a significant risk factor for the development of?
Definition
asthma up to age 13
Term

FACTOID

It is important to note that not all infants and children with RSV will develop a lower resp tract infx

Definition
Term
RSV is a paramyxovirus containing what ?
Definition
a single strand of DNA and is related to parainfluenza virus
Term
what is the pathphys for RSV?
Definition

cilia in resp swell and protrude into the lumen and close their cilia->fusion of infected cell membrane with adjacent epi cells->forming a giant cell with multiple nuclei

->bronchiolar mucosa swells and fill with mucus and exudate-> hyperinflation, patchy areas of atelectasis

Term
What are classical manifestations of RSV?
Definition

altered air exchange, such as:

wheezing

retractions

crackles

dyspnea

tachypnea

diminished breath sounds

Term
what tests are done on nasal secretions to identify RSV?
Definition

DFA

ELISA

Term
Uncomplicated bronchiolitis are treated symptomatically with?
Definition

oxygen

adequate fluid intake

airway maintenance

meds

Term
Supplemental O2 is used if infant fails to maintainconsistent oxygen sat of _ after nasal suctioning and repositioning
Definition
90%
Term
why would fluids by mouth be contraindicated in some pt's with RSV?
Definition

tachypnea

weakness

fatigue

Term
Approx 50% of pt's with RSV respond to what med?
Definition
short acting beta-agonist
Term
The only product in the US for prevention of RSV is ?
Definition

palivizumab

given monthly in an IM injection

Term
who are good candiates for palivizumab prophylaxis?
Definition

infants born before 32 wks who required medical therapy

younger than 2 with bronchopulm dysplasia who recieved med att 6 months before RSV

severe bronchopul dysplasia

congenital heart dx

Term
Prophylaxis should be initiated at the onset of RSV and terminated at the end of the season
Definition
Term
What type of precautions are children with RSV ?
Definition
contact and standard
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