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Questions and Answers
What is gas exchange?
The movement of oxygen from the lungs into the bloodstream and the corresponding movement of carbon dioxide from the bloodstream into the lungs.
What does oxygenation refer to?
The addition of oxygen to the body’s systems.
Which groups of pediatric patients are at greater risk for respiratory complications?
Certain pediatric groups including infants and young children.
What are some common childhood respiratory complications?
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What strategies should be integrated in the care of pediatric patients regarding respiratory devices?
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Which of the following is NOT a method for clearing airways?
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Infants have fewer alveoli at birth compared to adults.
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The clinical manifestations of an asthma exacerbation include __________.
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Describe the inheritance patterns associated with cystic fibrosis.
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What is the common cause of pharyngitis?
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Identify the correct treatments for tonsillitis.
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Which of the following are manifestations of asthma?
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What is the primary goal of asthma management?
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What are common triggers of asthma?
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What test is considered the gold standard for diagnosing cystic fibrosis?
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What percentage chance is there that a child will have cystic fibrosis if both parents are carriers?
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Cystic fibrosis is an autosomal dominant disease.
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Name one long-acting asthma medication.
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The primary treatment for allergy-induced anaphylaxis includes administering _____.
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What is a common symptom of impending respiratory failure?
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What is the primary reason for performing a tonsillectomy?
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Post-operative care after a tonsillectomy includes encouraging the patient to drink dark or red colored fluids.
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What complication is associated with acute otitis media?
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One of the common symptoms of croup is a ______ cough.
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Which of the following is a treatment for bronchiolitis?
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What is the peak age for bronchiolitis?
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Match the following conditions with their descriptions:
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The presence of drooling is a classic sign of epiglottitis.
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Hand hygiene and covering your cough are key elements of ______.
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What is a recommended practice to prevent otitis media in children?
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Study Notes
Tonsillitis and Pharyngitis
- Etiology can be bacterial or viral
- Tonsils are lymphatic tissue masses in the pharyngeal area
- Tonsils filter bacteria and other germs to prevent infection
- Strep is a common cause of pharyngitis
- Rapid strep test vs. culture
- Symptoms include severe sore throat, difficulty swallowing, white patches on the back of the throat, fever, headache, and mouth odor
- Treatment includes rest, warm fluids, saltwater gargles, and antibiotics if strep positive
Tonsillectomy
- Tonsillectomy removes tonsils due to recurrent infections or obstruction caused by enlarged tonsils.
- It's usually an outpatient surgery.
- No dark or red fluids, citrus, or milk products post-op.
- Monitor for excessive swallowing, indicating potential bleeding.
- Keep a watchful eye for white patches in the throat, which may suggest bleeding.
Otitis Media
- Otitis media is a common childhood illness often following an upper respiratory tract infection (URI).
- Fluid buildup in the middle ear can occur due to Eustachian tube dysfunction.
- Factors like allergies, smoke exposure, daycare, pacifier use, and GERD increase the risk.
- It is usually diagnosed by visualization of a bulging, red, or inflamed tympanic membrane.
Croup Syndromes
- Croup describes a group of upper airway illnesses causing swelling of the epiglottis and larynx.
- It can include spasmodic laryngitis, laryngotracheitis/laryngotracheobronchitis (LTB), bacterial tracheitis, and epiglottitis.
- Symptoms often worsen at night, with tachypnea, inspiratory stridor, and a seal-like barking cough.
- Epiglottitis is a medical emergency.
- Diagnostic procedures like throat cultures and visual inspection are contraindicated due to the risk of laryngospasms.
- Humidified oxygen, cool mist, and steam inhalation can help.
Bronchiolitis
- Bronchiolitis causes inflammation and obstruction of the bronchioles.
- Peak occurrence in children aged 2-6 months.
- Respiratory syncytial virus (RSV) is the most common cause.
RSV
- Viral debris obstructs bronchioles and irritates the airway, leading to swelling and mucus production.
- Symptoms include inspiratory and expiratory wheezing, deeper cough, tachypnea, retractions, and labored breathing.
- Treatment is supportive, involving oxygen, fluids, and nasopharyngeal suctioning as needed.
Asthma
- Characterized by chronic inflammation, bronchoconstriction, and bronchial hyperresponsiveness.
- Common pediatric chronic illness.
- Symptoms include wheezing, coughing, and dyspnea.
- Triggers such as allergens, irritants, infections, medications, GI reflux, foods, stress, and exercise can cause airway obstruction.
Status Asthmaticus
- A life-threatening asthma episode unresponsive to treatment.
- Intubation and admission to a pediatric intensive care unit (PICU) may be required.
- Complications include respiratory failure.
Asthma Medications
-
Rescue Medications:
- Short-acting beta-2 agonists (e.g., albuterol): Used for immediate relief.
- Intravenous corticosteroids (e.g., methylprednisolone): Used for more severe cases.
- Oral corticosteroids (e.g., prednisolone): Used for inflammation.
- Anticholinergics (e.g., ipratropium bromide): Relax airway muscles.
- Epinephrine (racemic): Used in emergencies.
-
Maintenance Medications:
- Inhaled corticosteroids (e.g., fluticasone propionate): Reduce inflammation.
- Long-acting beta-2 agonists (e.g., formoterol fumarate): Provide prolonged bronchodilation.
- Anti-immunoglobulin E antibodies (anti-IgE) (e.g., omalizumab): Block IgE antibodies involved in allergic reactions.
- Mast cell inhibitors (e.g., cromolyn): Stabilize mast cells, preventing histamine release.
- Leukotriene modifiers (LM) (e.g., montelukast sodium): Block leukotrienes, inflammatory mediators.
- Methylxanthines (e.g., theophylline): Relax airway muscles.
Cystic Fibrosis
- A chronic lung disease affecting the respiratory system and other organs.
- Caused by a genetic mutation leading to thick mucus buildup in the lungs and other organs.
- Treatment involves managing symptoms and complications, and preventing infections.
Asthma
- Asthma exacerbations are worsened by triggers
- Asthma triggers can cause airway inflammation and narrowing
- Short-acting medications like albuterol quickly relieve symptoms
- Long-acting medications like salmeterol help prevent symptoms
- Teaching patients about asthma triggers and how to avoid them is essential for prevention
Cystic Fibrosis
- Cystic Fibrosis (CF) is an autosomal recessive genetic disease
- CF affects the transmembrane conductance regulator (CFTR) protein
- CFTR regulates the hydration of epithelial cells, impacting many organs
- This results in thick, sticky mucus that can clog airways, pancreas, and other organs
- CF is a progressive illness and can worsen over time
- Early diagnosis is possible via newborn screening
- However, newborn screening isn't a definite diagnosis
CF: Increased Sweat Electrolytes
- Sweat chloride test is the gold standard for diagnosis
- Sodium and chloride levels are 2-5 times higher than in controls
- Parents often can taste the salt on their child's skin
CF: Pathophysiology
- CF gene causes a defective form of a protein in epithelial cells
- Defective protein disrupts the movement of chloride across cell membranes, leading to thick mucus
- Thick mucus hinders movement of air and digestive enzymes
- CF is considered an "orphan disease", meaning it is rare and research funding is often limited
CF: Complications
- Thick mucus in lungs traps germs leading to recurrent and chronic infections
- Thick mucus in pancreas blocks important enzymes that help digest food, causing malabsorption issues
- CF can also affect the reproductive system, leading to decreased sperm count or blocked fallopian tubes
CF: Treatment
- Chest physiotherapy techniques such as percussion, vibration, and postural drainage help clear mucus from airways
- CPT vest provides mechanical vibration for mucus clearance
- Bronchodilators like albuterol, salmeterol, and ipratropium help open airways
- DNase (dornase alfa) helps break down thick mucus
- Hypertonic saline helps thin out mucus
- Mast-cell stabilizers like cromolyn help prevent airway inflammation
- Digestive enzymes like Creon, Zenpep, and Pancreaze help digest food
CF: Family Education and Management
- Teaching families about CF triggers, infection prevention, nutrition, and medication compliance is crucial
- Encouraging adherence to therapies is key for managing symptoms and improving quality of life
- Regular follow-up care with a CF specialist is essential
CF: Genetics
- If both parents are carriers of the CF gene, there’s a 25% chance their child will have CF
CF: Body Systems Affected
- CF affects the respiratory, digestive, reproductive, and integumentary systems
CF: Diagnosis
- Newborn screening is done to identify potential CF cases
- Sweat chloride test is the gold standard for confirming a diagnosis
CF: Non-Pharmacological Interventions
- Chest physiotherapy
- CPT vest
- Maintaining physical activity to improve lung function
Respiratory Emergencies
- Difficulty breathing can progress to respiratory distress and failure
- Respiratory failure occurs when the body can't maintain effective gas exchange
- Signs of impending respiratory failure include irritability, lethargy, cyanosis, and increased respiratory effort
- Nursing role in respiratory distress is critical for early identification, escalation of care, and preventing respiratory failure
Anaphylactic Shock
- Severe allergic systemic reaction
- Key assessment findings include: bronchial edema, laryngeal spasms, wheezing, chest tightness, hypotension, rapid and weak pulse, altered consciousness, rash, nausea, vomiting, swollen tongue, and itchy lips
- Treatment includes rapid identification, epinephrine administration, IV fluids and medications, airway and cardiopulmonary support, and transfer to intensive care unit
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