Pediatric Exam 3 Study Guide PDF

**Keanu Omar Meléndez** **[1. Please review the normal anatomy of the Respiratory system]** **Upper Respiratory Tract Anatomy & Function** - **Components**: Nose, pharynx, larynx. - **Air Pathway**: Enters through nostrils or mouth → nasal cavities → pharynx. - **Pharynx Divisions**:...

**Keanu Omar Meléndez** **[1. Please review the normal anatomy of the Respiratory system]** **Upper Respiratory Tract Anatomy & Function** - **Components**: Nose, pharynx, larynx. - **Air Pathway**: Enters through nostrils or mouth → nasal cavities → pharynx. - **Pharynx Divisions**: - Nasopharynx (behind nasal cavity) - Oropharynx (behind mouth) - Laryngeal pharynx (leads to larynx) - **Larynx**: Contains vocal cords; above trachea. Protected by epiglottis during swallowing. - **Function**: Filters, warms, and humidifies air. Ciliated mucous membranes trap foreign materials. Tonsils (palatine, lingual, adenoids) aid in bacterial filtering. **Lower Respiratory Tract Anatomy & Function** - **Components**: Trachea, bronchi, lungs. - **Trachea to Lungs**: Trachea connects larynx to lungs → splits into right/left main bronchi → smaller bronchi and bronchioles → alveoli for gas exchange. - **Lung Lobes**: Right lung (three lobes) left lung (two lobes). - **Pleurae**: Two-layered membranes surrounding lungs, ensure stability and facilitate gas diffusion. - **Function**: Conducts air to alveoli for oxygen-carbon dioxide exchange. The alveolar walls and adjacent capillaries facilitate this process. **[2. Understand the differences between children and adults- and why children are at a higher risk for respiratory aliments]** - **Premature infants lack sufficient surfactant, increasing the risk of Respiratory Distress Syndrome (RDS).** - **Smaller, less developed airways make children more prone to obstruction from mucus, swelling, and foreign bodies.** - **Neonates have a significantly smaller airway size, a more compliant chest wall, and weaker respiratory muscles.** - **Infants breathe primarily through their nose, making nasal congestion a significant problem for breathing.** - **The diaphragm is the main respiratory muscle in infants, with underdeveloped intercostal muscles, leading to more frequent retractions.** - **Apnea (brief periods of not breathing) and irregular breathing patterns are common in newborns.** - **Children have a higher respiratory rate and increased oxygen needs due to a higher metabolic rate.** - **Less for younger children Alveoli number increases significantly by age 3, with lung growth continuing into adolescence.** - **Anatomical features such as horizontally oriented Eustachian tubes, larger tonsillar tissue in early school age, and a flexible larynx that\'s susceptible to spasms, further contribute to the risk.** - **Children rely on abdominal muscles for inhalation until about age 5 or 6.** **[3. Nursing interventions when caring for an infant/young child with impaired gas exchange]** - **Assess Respiratory Status:** - **Check respiratory rate and look for distress signs (e.g., grunting, nasal flaring).** - **Oxygenation:** - **Administer prescribed oxygen therapy and monitor saturation levels.** - **Airway Management:** - **Perform gentle suctioning as needed and encourage position changes for secretion clearance.** - **Support Effective Breathing:** - **Keep the environment smoke-free and promote deep breathing exercises for older children.** - **Nutrition and Hydration:** - **Ensure adequate fluid intake and coordinate nutritional support.** - **Medication Administration:** - **Provide prescribed medications like bronchodilators and monitor for side effects.** - **Educate Parents/Caregivers:** - **Teach signs of respiratory distress and proper medication or oxygen use at home.** - **Positioning:** - **Use upright or semi-Fowler's position to facilitate easier breathing.** - **Infection Control:** - **Implement strict hand hygiene and reduce exposure to infections.** - **Provide Emotional Support:** - **Offer support to the child and family, addressing any concerns.** **[4. Signs of Respiratory distress in infants/children as well as nursing interventions]** **Signs of Respiratory Distress in Infants/Children** - **Increased Respiratory Rate: Breathing faster than normal for their age.** - **Nasal Flaring: Widening of nostrils with each breath.** - **Retractions: Indrawing of the chest wall, especially around the ribs and sternum, during breathing.** - **Grunting: A grunting sound at the end of each breath.** - **Cyanosis: A bluish color of the skin, indicating low oxygen levels.** - **Wheezing or Stridor: High-pitched whistling or harsh sounds when breathing.** **Nursing Interventions** - **Assess and Monitor: Regularly check respiratory rate, effort, and oxygen saturation. Look for changes in behavior or alertness.** - **Maintain Airway Patency: Position to keep the airway open; consider gentle suction if necessary for infants.** - **Oxygen Therapy: Administer supplemental oxygen as prescribed to maintain adequate oxygen saturation.** - **Fluid Management: Ensure proper hydration to help thin secretions, making them easier to clear.** - **Position for Comfort and Efficacy: Positioning in a way that eases breathing, such as elevating the head of the bed.** - **Support for Breathing: Assist with nebulizer treatments or administer prescribed inhalants to open airways.** - **Reduce Anxiety: Provide comfort and reduce anxiety for the child and family, as stress can worsen respiratory distress.** - **Educate Caregivers: Teach caregivers how to recognize signs of distress and when to seek immediate care.** **[5. What is RSV, nursing interventions when caring for a child with RSV]** **[No antibiotics!]** **RSV (Respiratory Syncytial Virus) is a common respiratory virus that causes mild, cold-like symptoms in most people, but can lead to serious lung infections, especially in infants and young children.** **Nursing Interventions for a Child with RSV:** **Monitor respiratory status, Support oxygenation, Ensure hydration, Maintain clear airways, Positioning, Infection control, Symptom management, Educate caregivers, Nutritional support, Emotional support.Top of Form** **[6. Teaching you would provides to the parents of a child with RSV]** **Recognize signs of respiratory distress, Practice good hand hygiene, Keep the child hydrated, Use a cool-mist humidifier, Manage fever with appropriate medications, Avoid smoke exposure, Understand the use of nasal saline drops and suctioning, Know when to seek medical attention, Isolate the child from people with colds or crowds, Encourage rest and provide a comfortable sleeping position.** **[7. Understand CF- who is it transmitted and what is the percentage of transmission with each pregnancy]** **Cystic Fibrosis (CF) is the most common lethal genetic disorder in Whites, characterized by thick, sticky mucus that obstructs organs like the bronchioles, small intestine, and pancreatic and bile ducts. The condition, stemming from mutations in the CFTR gene, affects the chloride channels in epithelial cells, altering mucus production and causing chronic issues across multiple systems.** **Transmission:** - **CF is an autosomal recessive disorder, requiring both parents to be carriers for their child to be affected.** - **If both parents carry the CF gene, each pregnancy has a 25% chance of resulting in a child with CF.** **Incidence:** - **In White children, CF occurs in about 1 in 3,500 live births.** - **The prevalence is lower in Blacks, Hispanics, and Asians compared to Whites.** - **Over 30,000 people in the United States live with CF.** - **Approximately 1 in 29 people in the United States are CF carriers.** - **Early diagnosis is common, with over three-quarters of children diagnosed by age 2.** **Manifestations and Outcomes:** - **Symptoms and the extent of organ involvement vary widely, worsening over time.** - **No cure exists, and the disease is fatal, with around 90% of child deaths due to lung disease.** - **The life expectancy for someone with CF has increased, now at 44 years, reflecting advancements in understanding and managing the disease.** **[8. Earliest sign of CF in an infant]** **Meconium ileus in the neonate is the earliest clinical manifestation of CF.** **Meconium ileus (MI) is a bowel obstruction that occurs when a baby\'s first stool, ** **[9. Which finding confirms CF]** **A sweat chloride level greater than 60 mEq/L, confirmed through the sweat test on two separate occasions, is diagnostic for CF. This finding, especially when coupled with positive DNA testing identifying two CF mutations, definitively confirms the diagnosis of Cystic Fibrosis.** **[10. Education to parents regarding administration of Pancreatic enzymes]** **Need to make sure child is taking their enzyme medication with first bite of food, if not can have impaired absorption and cause failure to thrive.** **Need D.E.K.A** **What They Do: Aid digestion. Necessary when the pancreas is underperforming.** **When to Take:** - **With meals and snacks.** - **Right before eating or during the first bites.** **How to Administer:** 1. **Dosage: As prescribed, varies with food amount.** 2. **Method:** - **Pills: Swallow with water.** - **For kids who can\'t swallow pills: Sprinkle on soft, acidic food like applesauce. Don't mix with milk. Consume immediately.** **Monitoring:** - **Check stool consistency for effectiveness.** - **Look out for abdominal pain or allergies as side effects.** **Storage:** - **Room temperature, away from moisture.** - **Use before expiration date.** **Extra Tips:** - **Balanced diet enhances enzyme function.** - **Stay hydrated.** - **Regular check-ups for dosage adjustments.** **[11. Look at Medications for this exam]** Albuterol (Proventil, Ventolin) (pg. 1058 & 1060)- short acting, emergency only. Bronchodilator for resp clients. **Side effects** tachycardia, tachypnea, agitation, Pancrelipase (Creon) (pg. 1070)- Pancreatic enzymes. Take with the **first bite of food**. They aid in giving over and grabbing the fat and protein to allow the body to use if not then the body can't absorb it an end up with a fatty stool. Doransealfa (Pulmozyme) (pg. 1070)- used for **CF patients**. Breaks down mucus in lungs which Helps with decreasing bacterial infections and decrease trauma to lungs because we get fibrosis on the lungs from recurring infections. Prednisolone (Orapred)/ Methylprednisone (Solumedrol) (pg. 947)- reduce inflammation. For cf, asthma. Long term use causes immunocompromise. Fluticasone propionate and salmeterol oral inhaler (Advair HFA) (pg. 1062)- Long term. Has both steroid and bronchodilator. Daily maintenance. Budesonide/Formaterol Fumate Dihydrate (Symbicort)LABA (pg. 1062)- long term. Daily maintenance **Cystic Fibrosis Medications: Doransealfa (Pulmozyme) and Pancrelipase (Creon)** - **Dornase alfa (Pulmozyme)**: - **Use**: Reduces mucus viscosity in the lungs, improving respiratory function. - **Administration**: Inhaled via a nebulizer. - **Teaching Strategies**: Ensure proper nebulizer use, daily administration, and hygiene to prevent contamination. - **Pancrelipase (Creon)**: - **Use**: Aids in digestion of fats, proteins, and carbohydrates. - **Administration**: Oral, with each meal or snack. - **Infant Administration**: Open capsules, mix granules with acidic soft food (not milk/formula), and feed immediately. - **Teaching Strategies**: Adjust dose based on dietary fat content, monitor stool consistency, and maintain hydration. **Corticosteroids: Solumedrol vs. Prednisolone** - **Solumedrol (Methylprednisolone)**: - **Routes**: IV or IM. - **Use**: Anti-inflammatory or immunosuppressant used in acute asthma exacerbation. - **Prednisolone**: - **Route**: Oral (PO). - **Use**: Anti-inflammatory used in chronic conditions like asthma. - **Teaching for Both**: - Importance of adherence, potential side effects (weight gain, mood changes, increased blood sugar), and tapering protocol to avoid withdrawal. **Albuterol: Use and Side Effects in Children** - **Use**: Bronchodilator for relief of asthma symptoms. - **Side Effects**: Tremors, nervousness, increased heart rate, headache, nausea. - **Teaching**: Correct inhaler use, understanding of \"rescue\" medication role, and recognition of side effects. **Inhaler Medications: Advair HFA & Symbicort** - **Fluticasone Propionate and Salmeterol (Advair HFA)**: - **Use**: Long-term asthma control; combines steroid and long-acting beta agonist (LABA). - **Administration**: Inhaled via HFA inhaler. - **Budesonide/Formoterol Fumate Dihydrate (Symbicort)**: - **Use**: Asthma and COPD management; combines steroid and LABA. - **Administration**: Inhaled via aerosol inhaler. - **Rationale**: Both medications reduce inflammation and relax airways, improving breathing and controlling symptoms. - **Teaching**: Proper inhalation technique, daily use for control, not rescue, and mouth rinsing post-inhalation to prevent oral thrush. **[12. Priority nursing DX for respiratory, children with CF, Asthma and RSV]** - Impaired gas exchange - Ineffective breathing - Risk for failure to thrive. - At risk for fat soluble vitamin deficiency A, D, E, and K **[13. Otitis Media- signs, treatment ]** Reoccurring ear infections can lead to hearing issues and even worse problems if infections spread. If at risk for resp infection more at risk for ear infections. Effusion: Fluid behind the ear Diagnosis made through observation. Most ear infections are viral. **Signs and Symptoms** - **Ear Pain (Otalgia): Especially in young children, may manifest as tugging or pulling at the ear.** - **Hearing Loss: Fluid in the middle ear can muffle sounds.** - **Fever: Particularly in Acute Otitis Media (AOM).** - **Irritability and Restlessness: Common in children due to discomfort or pain.** - **Fluid Drainage from the Ear: Indicates a ruptured eardrum (more common in AOM).** - **Difficulty Sleeping: Due to ear pain and pressure.** **Otitis Media: Treatment** - **Pain Management** - **Over-the-counter pain relievers: Acetaminophen or ibuprofen for pain and fever.** - **Warm compress: Applied to the affected ear for comfort.** - **Observation** - **\"Watchful waiting\" for 48-72 hours for mild cases, especially in children over 6 months, as many cases resolve without antibiotics.** - **Antibiotics** - **Indicated for:** - **All cases of AOM in children under 6 months.** - **Severe cases in older children: High fever, severe pain, or symptoms lasting more than 48-72 hours.** - **Amoxicillin is often the first choice, with alternatives for those allergic or with treatment failure.** - **Follow-up** - **Reevaluation if symptoms persist or worsen to assess the need for further treatment or referral to an otolaryngologist.** - **Prevention** - **Pneumococcal and influenza vaccines can reduce the risk of AOM.** - **Avoid exposure to tobacco smoke and manage allergies.** **[14. What are signs of tachypnea ]** - **Increased Respiratory Rate: Above the normal range for the patient\'s age. In infants, a rate of over 60 breaths per minute is considered tachypneic. For children, rates over 40 breaths per minute can indicate tachypnea.** - **Shallow Breathing: The breaths may appear more superficial or less effective.** - **Nasal Flaring: Widening of the nostrils during breathing, especially noted in infants and young children.** - **Retractions: The inward movement of the chest wall during inhalation. Look for skin sucking in around the ribs and neck, which indicates increased effort to breathe.** - **Use of Accessory Muscles: Muscles in the neck, shoulders, and chest may be used to help with breathing, indicating respiratory distress.** - **Cyanosis: A bluish color of the skin, especially around the lips and fingertips, suggesting oxygen deprivation.** - **Audible Breathing Sounds: Such as wheezing or grunting, may accompany tachypnea.** **[15. Teaching you would provide to the parent of a child with asthma in regards to reducing exposure to allergens]** **Asthma is a leading cause of acute and chronic illness in children and the most frequent admitting diagnosis in children's hospitals.** **Environmental Irritants: Avoid cigarette smoke, wood smoke, strong fumes, high humidity, and strong scents.** **Allergenic Triggers: Control exposure to animal dander, cockroaches, dust mites, pollens, and molds.** **Get rid of carpet.** **Control Measures:** - **For mild asthma: Ban smoking indoors and clean house frequently.** - **If symptoms persist: Implement additional measures to reduce trigger exposure.** **Immunotherapy:** - **Suitable for unavoidable allergen exposure.** - **Complements, but doesn't replace, other asthma treatments.** **[16. Nursing interventions for an infant who has become apnea]** - **Stimulate Breathing: Gently rub back or flick foot.** - **Clear Airway: Position, suction if needed.** - **Administer Oxygen: If indicated by oxygen saturation.** - **Monitor: Use apnea monitors for heart rate and breathing.** - **Educate Parents: On safe sleep and monitoring.** - **Document: Time, duration, interventions, and infant\'s response.** **[17. Which type of infant is at highest risk of hypothermia]** - **Body temperature below 36.2° C DON'T BRING BODY TEMP UP FAST** - **Preterm Infants: INCREASED BODY SURFACE AREA AND NO BROWN FAT Their underdeveloped thermoregulatory systems and lower amounts of body fat make it difficult for them to maintain body temperature.** - **Low Birth Weight Infants: Infants weighing less than 2,500 grams (about 5.5 pounds) at birth have less body fat for insulation and energy stores, increasing their risk of hypothermia.** - **Infants with Perinatal Asphyxia: Conditions that lead to compromised oxygen delivery at birth can disrupt the normal thermoregulatory processes.** - **Infants in Environments with Inadequate Warming Practices: Those not provided with adequate warmth immediately after birth, including skin-to-skin contact or appropriate warming devices, are at increased risk.** **All individuals, regardless of age, gender, or race, are potentially at risk.** **Populations at greatest risk for problems with thermoregulation are** **Very young persons** **Very old persons** **Poor persons** **Persons living in very hot or cold climates.** - **Remove the person from cold.** - **Provide external warming measures.** - **Provide internal warming measures.** **[18. What is the most appropriate measure to assess core body temperature]** **RECTAL** **[19. Signs/symptoms of hyperthermia]** - **Body temperature above 37.6° C ABOUT 99 degrees greater than 101 is when we treat.** **Hyperthermia (Elevated Body Temperature)** - **Body Temperature: Above 37.5°C (99.5°F) when measured rectally.** - **Skin: May feel hot and appear flushed or red.** - **Sweating: Infants may sweat excessively in an attempt to cool down.** - **Irritability: Increased fussiness or discomfort.** - **Dehydration Signs: Dry mouth, crying without tears, fewer wet diapers.** - **Rapid Heart Rate: Heart may beat faster than normal.** - **Increased Breathing Rate: Breathing may be faster to attempt to release excess heat.** **Hypothermia (Low Body Temperature)** - **Body Temperature: Below 36.5°C (97.7°F) when measured rectally.** - **Skin: Cold to the touch, especially on extremities like hands and feet.** - **Lethargy: Decreased activity or response to stimuli.** - **Weak Cry: Cry may be weaker than usual or difficult to hear.** - **Feeding Difficulties: Trouble nursing or taking a bottle due to low energy.** - **Bradycardia: Slower than normal heart rate.** - **Poor Tone: Floppy or poor muscle tone.** - **Pale or Blue Skin: Pale skin can indicate reduced circulation, and bluish skin, particularly around the lips, can indicate low oxygen levels.** **[20. Signs of adequate ventilation and inadequate ventilation ALREADY STATED ABOVE]** **Adequate ventilation** **Normal respiratory rate, regular breathing pattern, adequate chest expansion, normal skin color, absence of accessory muscle use, clear breath sounds, adequate oxygen saturation, appropriate capnography readings (ETCO2 within 35-45 mmHg), patient comfort, effective cough, and ability to clear secretions.** **Inadequate ventilation** **Early stage - apprehension, irritability, confusion, tachypnea, dyspnea, tachycardia, mild hypertension\ Late stage - confusion, accessory muscles, hypotension, cyanosis, cool clammy skin\ both: diaphoresis, decreased urine output and fatigue, dyspnea.** **[21. Specific triggers of an asthma attack]** **Allergens (pollen, dust mites, pet dander), irritants (tobacco smoke, pollution, perfumes), respiratory infections, cold air, exercise, stress, certain medications (aspirin, NSAIDs), and food additives.** **[22. Nursing interventions to improve oxygenation] THIS IS BASICALLY ALREADY SAID 3 TIMES ON HERE.** **Positioning (elevate head of bed, prone position), deep breathing exercises, incentive spirometry, suctioning airways, administering prescribed oxygen therapy, monitoring oxygen saturation, encouraging hydration, and providing respiratory medications as ordered.** **[23. Education regarding administration of pancreatic enzymes to a young child ]** - **Timing: Take with meals and snacks.** - **Dosage: Follow prescribed amount.** - **For Young Children:** - **Mix granules with soft, acidic food (e.g., applesauce); consume immediately.** - **Don't mix with milk/formula.** - **Capsules: Swallow whole; don't crush or chew.** - **Monitoring: Observe digestion improvement.** - **Storage: Keep cool and dry.** - **Diet: Maintain balanced nutrition.** - **Hydration: Ensure good fluid intake.** - **Check-ups: Regular dosage adjustments and growth monitoring.** **3-2 math problems and 4-5 select all that apply.** **125mg ordered from doctor.** **I have 200mg/2ml.** **Answer 1.25mL** **Dose range.** **Baby is 6.2 kg.** **Dose range is 50-75mg/kg/day.** **310mg-465mg** **STUDY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!**