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Questions and Answers
Which is the most essential guideline regarding the use of inhalers?
Which is the most essential guideline regarding the use of inhalers?
What sign or symptom following a tonsillectomy in a child requires immediate attention?
What sign or symptom following a tonsillectomy in a child requires immediate attention?
In a child admitted with acute asthma, which nursing diagnosis should be prioritized?
In a child admitted with acute asthma, which nursing diagnosis should be prioritized?
Which precautions should a nurse implement for a patient with a respiratory syncytial virus (RSV) infection?
Which precautions should a nurse implement for a patient with a respiratory syncytial virus (RSV) infection?
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What might indicate a lack of efficacy in asthma treatment?
What might indicate a lack of efficacy in asthma treatment?
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What is the likely reason for a child with cystic fibrosis experiencing loose stools with foul odor?
What is the likely reason for a child with cystic fibrosis experiencing loose stools with foul odor?
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What is the most effective way to manage asthma symptoms during an attack?
What is the most effective way to manage asthma symptoms during an attack?
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Which could signify that a child with asthma is in a state of emergency?
Which could signify that a child with asthma is in a state of emergency?
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What is a common characteristic of spasmodic laryngitis?
What is a common characteristic of spasmodic laryngitis?
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Which symptom is NOT associated with epiglottitis?
Which symptom is NOT associated with epiglottitis?
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What is the primary nursing responsibility for a child with epiglottitis?
What is the primary nursing responsibility for a child with epiglottitis?
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Which treatment is recommended for laryngotracheobronchitis?
Which treatment is recommended for laryngotracheobronchitis?
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What is a notable manifestation of laryngotracheobronchitis?
What is a notable manifestation of laryngotracheobronchitis?
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Which condition improves with positioning in a side-lying position?
Which condition improves with positioning in a side-lying position?
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What could potentially trigger spasmodic laryngitis?
What could potentially trigger spasmodic laryngitis?
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Why are antibiotics not typically prescribed for nasopharyngitis?
Why are antibiotics not typically prescribed for nasopharyngitis?
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Which symptom is NOT typically associated with acute epiglottitis in children?
Which symptom is NOT typically associated with acute epiglottitis in children?
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What is a priority nursing responsibility when examining a child diagnosed with acute epiglottitis?
What is a priority nursing responsibility when examining a child diagnosed with acute epiglottitis?
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Bronchitis treatment typically includes which of the following?
Bronchitis treatment typically includes which of the following?
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Which of the following is a symptom of bronchiolitis?
Which of the following is a symptom of bronchiolitis?
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When is the optimal time to start antiviral treatment for influenza?
When is the optimal time to start antiviral treatment for influenza?
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What is the primary cause of severe illness from RSV in children?
What is the primary cause of severe illness from RSV in children?
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Which of the following treatments is NOT recommended for pneumonia?
Which of the following treatments is NOT recommended for pneumonia?
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In the management of RSV, which action is necessary for maintaining airway health?
In the management of RSV, which action is necessary for maintaining airway health?
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What is a common physical examination finding in a child with pneumonia?
What is a common physical examination finding in a child with pneumonia?
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What characteristic cough is often present in bronchitis?
What characteristic cough is often present in bronchitis?
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What is the main route of transmission for influenza?
What is the main route of transmission for influenza?
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Which treatment is essential for symptom management in bronchiolitis?
Which treatment is essential for symptom management in bronchiolitis?
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What symptom differentiates pneumonia from other respiratory infections?
What symptom differentiates pneumonia from other respiratory infections?
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The incubation period for RSV is typically how long?
The incubation period for RSV is typically how long?
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What is the primary cause of nasopharyngitis in children?
What is the primary cause of nasopharyngitis in children?
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Which symptom is NOT associated with nasopharyngitis?
Which symptom is NOT associated with nasopharyngitis?
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What is a common treatment method for acute pharyngitis?
What is a common treatment method for acute pharyngitis?
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Which procedure is commonly used to assess respiratory disorders in children?
Which procedure is commonly used to assess respiratory disorders in children?
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What is the expected respiratory rate change in children with respiratory disorders?
What is the expected respiratory rate change in children with respiratory disorders?
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What is a characteristic feature of croup syndromes?
What is a characteristic feature of croup syndromes?
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What is the primary management strategy for nasopharyngitis?
What is the primary management strategy for nasopharyngitis?
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What is true regarding the use of antibiotics in treating nasopharyngitis?
What is true regarding the use of antibiotics in treating nasopharyngitis?
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Which of the following is NOT a manifestation of acute pharyngitis?
Which of the following is NOT a manifestation of acute pharyngitis?
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A key difference in the respiratory system of children compared to adults is:
A key difference in the respiratory system of children compared to adults is:
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Which symptom is commonly associated with pneumonia?
Which symptom is commonly associated with pneumonia?
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What is a primary prevention method for inhalation injury?
What is a primary prevention method for inhalation injury?
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Which of the following is a common manifestation of tonsillitis?
Which of the following is a common manifestation of tonsillitis?
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What should be avoided post-operatively after a tonsillectomy?
What should be avoided post-operatively after a tonsillectomy?
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Which lab test is significant in diagnosing asthma?
Which lab test is significant in diagnosing asthma?
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What is a recommended nursing intervention for children with asthma?
What is a recommended nursing intervention for children with asthma?
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Which dietary recommendation is advised for managing cystic fibrosis?
Which dietary recommendation is advised for managing cystic fibrosis?
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What is a notable manifestation of bronchopulmonary dysplasia?
What is a notable manifestation of bronchopulmonary dysplasia?
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What is a key risk factor for Sudden Infant Death Syndrome (SIDS)?
What is a key risk factor for Sudden Infant Death Syndrome (SIDS)?
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Which of the following measures is important for the prevention of SIDS?
Which of the following measures is important for the prevention of SIDS?
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Which treatment is recommended for managing cystic fibrosis?
Which treatment is recommended for managing cystic fibrosis?
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A child is experiencing respiratory arrest due to inhalation injury. What is the most critical action to take?
A child is experiencing respiratory arrest due to inhalation injury. What is the most critical action to take?
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What is true regarding the pathophysiology of cystic fibrosis?
What is true regarding the pathophysiology of cystic fibrosis?
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What is a symptom of status asthmaticus?
What is a symptom of status asthmaticus?
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Study Notes
Child With Respiratory Disorder
- Terminal learning objective: Given a pediatric patient with a respiratory disorder, provide safe and effective care by correctly responding to written, oral, and experiential assessment measures.
Respiratory System
- Frontal and sphenoid sinuses develop between 6 and 8 years of age.
- Ethmoid and maxillary sinuses present at birth.
- Nasal cavity, nares
- Oral cavity (mouth)
- Pharynx (throat)
- Larynx (voice box)
- Trachea (windpipe)
- Bronchus
- Bronchioles
- Alveoli
- Lung
- Diaphragm
Anatomic Differences
- Uses abdominal muscles to breathe.
- Uses accessory muscles (diaphragm, larynx, & trachea).
- Small airway diameter.
- Less respiratory mucus.
- Less smooth muscle.
- Nose breathers.
- Respiratory rate is attached higher.
Respiratory Procedures
- Bronchoscopy
- Lung biopsy
- ABG
- Pulse oximetry
- Pulmonary function tests
- CXR
- CT
- Radioisotope scan
- Bronchogram
- Angiogram
Upper Respiratory Disorders
- Nasopharyngitis
- Pathophysiology: cold (acute coryza), rhinovirus.
- Manifestations: inflammation and edema of mucus membranes, fever (104°F or 40°C), nasal drainage, irritability, sore throat, cough, general discomfort.
- Treatment: no cure, rest, clear airways, adequate fluid intake, prevention of fever, skin care (antibiotics are NOT effective).
- Acute Pharyngitis
- Pathophysiology: inflammation of throat structures, children 5-10 years old, group A beta-hemolytic streptococcus or Haemophilus influenzae
- Manifestations: fever (104°F or 40°C), malaise, dysphagia (difficulty swallowing), anorexia, positive throat culture.
- Treatment: acetaminophen, penicillin for 10 days
Croup Syndromes
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Pathophysiology: "Barking" cough, varying degrees of inspiratory stridor, benign vs. acute.
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Congenital Laryngeal Stridor
- Benign croup: weakness of the airway wall and floppy epiglottis, symptoms improve with prone or propped side-lying position, condition improves with growth and muscle strengthening, provide reassurance, suggest slow, small feedings and positioning
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Spasmodic Laryngitis: caused by virus, allergy, psychological trigger or GERD; Sudden onset at night with barking/brassy cough; attacks last a few hours, Increased humidity/fluid provision.
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Laryngotracheobronchitis
- Acute croup: common viral cause; mild upper respiratory infection followed by brassy or barking cough; Manifestations: edema, destruction of respiratory cilia, exudate, obstruction -Treatment varies, but may include increased humidity; hospitalization consideration; mist tent, croupette; IV fluids, cluster care; nebulized epi
Epiglottitis
- Pathophysiology: caused by H. influenzae type B, children 3-6 years, life-threatening emergency
- Manifestations: abrupt onset, orthopnea, wide-eyed, anxious, restless, frog-like croaking on inspiration, absent cough
- Treatment: never use a tongue blade to examine throat, primary nursing responsibility is tracheostomy setup, oxygen, antibiotics, H. influenzae type B vaccination recommended
Bronchitis
- Pathophysiology: infection of bronchial tree; seldom primary infection. Predisposing factors include poor nutrition, allergies, and chronic respiratory infections
- Manifestations: gradual onset, unproductive hacking cough, productive cough with purulent sputum.
- Treatment: cough suppressants (not useful during acute episodes), antihistamines, expectorants, and antibiotics.
Bronchiolitis
- Pathophysiology: viral infection of small airways, inflammation of small bronchioles, obstruction leads to atelectasis.
- Manifestations: upper respiratory infection (URI) with mild fever, serous nasal discharge, wheezing cough with signs of respiratory distress, increased respiratory rate.
- Treatment: similar treatments as croup, semi-Fowlers with slightly hyperextended neck, oral feeding with supplemental IV fluids, bronchodilating aerosol therapy, frequent vital signs, monitor oxygen saturation
Influenza
- Pathophysiology: leading cause of death in children with underlying medical conditions, spread through droplet infection, seasonal (October to March), annual vaccines
- Manifestations: like other viral infections, symptoms typically start within 48 hrs of onset.
- Treatment: started within 48 hours of first signs and symptoms, drugs like oseltamivir (Tamiflu), inhaled zanamivir (Relenza), intravenous peramivir (Rapivab), neurominidase inhibitors. Prevention includes annual flu vaccination
Respiratory Syncytial Virus (RSV)
- Pathophysiology: 50% of bronchiolitis cases, most common cause of viral pneumonia; common in infants younger than 2 years, reinfection is common.
- Manifestations: low-grade fever, cough, rhinorrhea (runny nose), progressively worsening respiratory distress
- Treatment: similar treatments as croup; semi-Fowlers with slightly hyperextended neck; oral feeding with supplemental IV fluids, bronchodilating aerosol therapy, frequent vital signs, monitor oxygen saturation.
Pneumonia
- Manifestations: preceded by URI, cough (dry then productive), fever (103-104°F or 39.5-40°C, tachypnea, shallow respirations, listlessness, poor appetite, lying on affected side, CXR confirms diagnosis .
- Treatment: depends on causative organism, antipyretics, oxygen, rest, fluids, cough suppressants, good hygiene, avoid tobacco use, H. Influenzae type b vaccine.
Inhalation Injury/CO Poisoning
- Pathophysiology: smoke inhalation, poisonous substances, 3 stages of inhalation injury (pulmonary insufficiency, pulmonary edema, bronchopneumonia), evidence of inhalation injury, carbon monoxide combines with hemoglobin (carboxyhemoglobin (COHb)).
- Treatment: oxygen administration, frequent ABGs, hyperbaric oxygenation, intubation tray readily available, respiratory arrest prevention.
Tonsillitis/Adenoiditis
- Pathophysiology: part of the body's defense mechanism, difficulty swallowing, blocked nasal passages, mouth breathing, symptoms similar to nasopharyngitis.
- Treatment: self-correcting as the child grows, surgery not performed during acute episode, tonsillectomy, persistent airway obstruction, repeated infections.
- Post-Operative Care: position on side, partly on abdomen, watch for bleeding, frequent swallowing, increased pulse/respiration, watch for restlessness, vomiting bright red blood.
Rhinitis
- Pathophysiology: inflammation of nasal mucosa due to allergic response, seasonal allergies, occurs in 10% of children, mast cells respond to antigen release histamine, nasal edema, and increased mucus production.
- Manifestations: allergic salute, darkening circles under eyes, nasal congestion (allergic shiners), clear watery nasal discharge, sneezing, itchy eyes; lab and nasal skin testing
- Treatment: symptomatic (non-sedating antihistamines, decongestants), prophylactic therapy (cromolyn inhalants, glucocorticoid nasal sprays, carbinoxamine maleate (Karbinal ER) – H-1 blocker, leukotriene antagonists).
Asthma
- Pathophysiology: bronchospasm, edema, mucus, inflammation, airway hyperactivity.
- Diagnosis: history, physical examination, response to bronchodilator therapy, elevated eosinophils, allergy skin testing, radioallergosorbent test (RAST), exhaled nitrous oxide, rarely diagnosed in infants.
- Treatment/Management: assessment, monitoring, education, environment control, medications (reduction of exacerbations, maintain normal growth and development), appropriate drug therapy, follow-up care, measurement of lung function.
- Nursing Care: control environment (avoid dander, mold, smoking, dust, humidity) remove dust collectors, mite control, don't exclude children from physical activity, identify triggers, monitor lung function with PFM, self-care aids for enhanced asthma control.
Status Asthmaticus
- Pathophysiology: severe respiratory distress not responsive to treatment, medical emergency, child admitted to ICU.
- Treatment: vital signs, IV medications, oxygen via nasal cannula, medical regimen, teach family and child—medical care, allergies, minimize exposure, medical alert bracelet, use written plan for crisis management.
Cystic Fibrosis
- Pathophysiology: inherited recessive trait, defect on gene chromosome #7—newborn screening, sweat chloride test, exocrine gland dysfunction (increased mucus viscosity, loss of electrolytes in sweat).
- Manifestations: salty tears, salty saliva, chronic cough, cyanosis, salty sweat, dyspnea, wheezing, clubbing of fingers.
- Treatment/Nursing Care: intermittent aerosol therapy, inhaler, bronchodilators, recombinant human deoxyribonuclease dornase alfa (Pulmozyme), postural drainage, pursed-lip breathing, oral pancreatic preparations, vitamin supplements (A, D, E, K, iron/zinc), CFTR modulator therapy.
Bronchopulmonary Dysplasia (BPD)
- Pathophysiology: thickening of alveolar walls and bronchiolar epithelium, in premature infants, dependent on oxygen, edema, cilia paralyzed, loss of ability to clear mucus, respiratory obstruction.
- Prevention: prevention of premature births, administer only necessary oxygen levels to avoid hypoxia, prevent tissue trauma, surfactant administration.
- Manifestations: wheezing, retractions, cyanosis, use of accessory muscles, clubbing of fingers, failure to thrive, irritability.
- Treatment: goal of therapy—reduce airway inflammation, wean infant from mechanical ventilation, noninvasive positive pressure ventilation (CPAP), fluid restriction, bronchodilators, diuretics, nutrition via NGT, education
Sudden Infant Death Syndrome (SIDS)
- Pathophysiology: unexpected death of an apparently healthy infant, peak incidence between 2-4 months, risk factors include: brain and lung issues, environmental problems, sleeping prone position, intrauterine exposures, bed-sharing.
- Manifestations: death occurs during sleep infant does not cry or show signs of distress.
- Nursing Care: convey that infant died of a disease process, parents are not responsible for death, allow time to say goodbye, encourage holding/rocking, encourage tears and emotion sharing, advise against misplaced guilt or blame.
- Prevention: firm mattress with no loose bedding, pacifier use, breast feeding, home apnea monitors for high-risk infants, CPR instruction to parents, removal of soft pillows/blankets, safe sleeping position.
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