Peds Module 6 PowerPoint PDF

Managing the Care for Pediatric Patients with Alterations in Gas exchange · & Oxygenation M OD ULE 6 NU RS 4 4 5  Recall the concepts of gas exchange and oxygenation. (CO7) Apply knowledge of interrelated concepts...

Managing the Care for Pediatric Patients with Alterations in Gas exchange · & Oxygenation M OD ULE 6 NU RS 4 4 5  Recall the concepts of gas exchange and oxygenation. (CO7) Apply knowledge of interrelated concepts of acid-base balance, nutrition, mobility, fatigue, perfus ion, inflammation, and anxiety. (CO7) Identify the pathophysiology, etiology, clinical manifestations, treatment strategies, and nurs ing cons iderations for patients with viral and bacterial illnesses in the pediatric population. (CO1, CO7) Adapt focused respiratory asses sment strategies based on the age and developmental level of the patient. (CO1, CO5, CO7) Module 6 Dis cuss why certain pediatric groups are at greater risk for respiratory complications. (CO1, CO7) Des cribe common childhood res piratory com plications. (CO1, CO7) objectives Identify the diagnostic s trategies for alterations in gas exchange. (CO1, CO7) Integrate knowledge of respiratory devices to the care of the pediatric population. (CO7) Apply knowledge of gas exchange to the nursing care for patients with viral and bacterial illness es, including bronchiolitis (respiratory s yncytial virus , acute laryngotracheobronchitis, and epiglottitis.) (CO1, CO7) Des cribe the methods for managing viral respiratory infections in infants and children Dis cuss m ethods of clearing airways such as s uctioning and chest physiotherapy. Des cribe the perioperative nursing care for pediatric patients who have undergone tonsillectom y or adenoidectomy. (CO1, CO7) Des cribe the pathophysiology, clinical manifestations, diagnostic procedures, treatment options, and nursing care for a pediatric patient with cystic fibrosis. (CO1, CO7)  Identify medications used to manage cystic fibrosis. Connect non-pharmacological interventions with management of care. Discuss the inheritance patterns and associated screenings for cystic fibrosis. Describe how the differing body systems are affected by cystic fibrosis. Describe the genetic screenings available for all infants prior to leaving the hospital for Cystic Fibrosis. (CO4) Describe the pathophysiology, clinical manifestations, diagnostic procedures, treatment Module 6 options, and nursing care for a pediatric patient with asthma. (CO1, CO7) Integrate previous knowledge of short acting asthma medications, long-acting asthma medications. objectives Describe the clinical manifestations of an asthma exacerbation. Explain the role triggers play in asthma exacerbation. Connect the home and hospital plan of care for asthma management and asthma exacerbation. Discuss the nurse’s role in the early identification and emergent care associated with respiratory emergencies. (CO1, CO2, CO7) Apply knowledge of emergent care to pediatric patients experiencing anaphylaxis or respiratory distress/failure. Discuss the role of the interdisciplinary team in providing quality outcomes for children with alterations in oxygenation and gas exchange. (CO1, CO2 , CO7)  Gas exchange- The movement of oxygen from the lungs into the bloodstream, and the corresponding movement of carbon Gas exchange dioxide from the bloodstream into the and lungs. oxygenation Oxygenation- The addition of oxygen to the body’s systems. Gas exchange  Interrelated concepts TEST CONCEPTS Acid base balance So, who has an increased risk of Nutrition respiratory illness and Mobility complications? Fatigue Perfusion Does age and size of patient play a Inflammation role? Anxiety  Differences between pediatric and adult oxygenation and respiratory system momisgivea 36wks. glungs underdeveloped Shorter and Produce less Fewer alveoli at Respiratory rate more narrow surfactant at birth is higher airways birth Chest muscles Eustachian tubes Obligate nose less developed are shorter and breathers for the which leads to more horizontal first few months retractions S breath through only theirnose ↓ does not signal > - body EVEN IF CONGESTED !! to breath through mouth  Respiratory assessment Respiratory rate Color Effort Auscultation Cough Behavior-anxiety ↓ ↓ is bad sign ↓ ↓ nasal flaring ↓ count for a darker skin babies will grunting, , Wet , dry ? ANXIETYiS full minute head bob be grey/green due to not being With ↓ 02 able to breathe How would your assessment differ? will let assess with you NO PROBLEM , if I N FAN T TODDLER in respiratory distress - ↳ usually will fight against assessment  Pulse oximetry Oxygen and Oxygen therapy (O2 hood, nasal cannula, face mask, high flow) inhalation Metered dose inhaler (MDI) with spacer therapy helps to break up Chest physiotherapy (CPT) & any secretions Suctioning (orally, nasally, and endotracheal) ROOM AIR O2 : 21 % high flow Oxygen (vapaderm) & Oxygen delivery devices  It takes a team (interdisciplinary care) Practitioner-Doctor, Nurse Nurse Respiratory therapist practitioner, and/or Physician’s Assistant  Diagnostic tools blow into : measures how lungs are working (Syrs old) &. Pulmonary function test X-ray CT (PFTs) MRI Bronchoscopy Common Acute Alterations (Linnard-Palmer, pg. 281, table 16-1) Nasopharyngitis (common cold) Tonsillitis and Pharyngitis Otitis Media Croup syndromes Bronchiolitis (RSV) COUCH MEDICINE DOES NOT WORK < Pylo Nasopharyngitis RUNNY NOSE, COUGH, COMMON COLD- SELF LOW GRADE FEVER, ETIOLOGY IS VIRAL LIMITING VIRUS HEADACHE, NASAL CONGESTION SYMPTOMATIC TREATMENT-TYPICALLY AVOID COUGH SYRUP DURATION 4-10 DAYS ESPECIALLY IN YOUNGER CHILDREN Tonsillitis and pharyngitis  - Etiology is bacteria or viral Inflammation of tonsils or pharynx Tonsillitis and Tonsils are to filter out bacteria and other germs to prevent infection pharyngitis Strep is common cause of pharyngitis (AT I pg. 94) Rapid strep test vs. culture-how do we do this for kids? Symptoms: severe sore throat, difficulty swallowing, white patches on back of throat, fever, HA, mouth odor GHA-headache Treatment- rest, warm fluids, saltwater gargles (depending on age); if Strep + antibiotics Tonsillitis : inflammation of the palatine tonsils e masses of tissue lymph-type ↳ caused by : 4 SK FACTORS : found in the pharyngeal area VIRAL INFECTION filter pathogens from entering 4 S-15 yo : Pharyngitis S · rhinovirus and G tract. respiratory · adenovirus environment sore · crowded y throat · poor hand ENLARGED TONSILS : RSV hygiene · · MEDICATIONS : corona immature block nose and · can immune antipyretics/analgesics · · throat · HIV system ↳ acetaminophen epstein-barr ↳ hydro cod one ↓ RR , a sinus · drainage, early winter/spring and · antipyretics ↓ sleep swallowing · · ↳ (infectious , mononucleosis) Speaking antibiotics the function AB TESTS : disrupt · · can BACTERIAL INFECTION : Y for strep infection (GABHS) of the eustachian tube , - penicillin throat culture media and group A strep otitis · causing · (strep throat) for A impede hearing group - beta strep !!! TREATMENT : POST-OP CARE : EXPECTED FINDINGS : - clearing , throat t swallowing - for & bleedingred - · asses , fever headache · supportive restlessness emesis , HR pallor bright · · ↳ rest , , cough mouth assess airway vitals · · · + · rhinorrhed breathing ↳ fever meds ↳ warm fluids comforte analgesics/tetracaine lollipops , ice · collar/chips white patchesa gargle salt water fluids AFTER return of gag reflex sneezing encourage · · on throat antibiotics -NO red liquids, milk-based · trus, · sore throat N/V (if bacterial) , or =tonsillectomy · NO coughing throat clearing noseblowing or strasa , · ·dysphagiBeing drooling , - , tonsils obstructed abscesses hemorrhage adymophagia · · · airway !! Adenoidectomy COMPLICATIONS:R · mouth odor ↳ removal of pharyngeal dehydration infection tonsils · chronic  & Tonsillectomy Removal of tonsils d/t recurrent infections or upper airway obstruction caused by large tonsils Generally, outpatient surgery-often performed at surgery centers with nurses and staff who primarily care for adults thick and will coat area e Post-op care: no dark or red colored fluids, no citrus, no milk products Will look like blood need to notice - , Encourage fluids to keep mouth moist and maintain hydration bleeding Monitor for excessive swallowing = Indicator of bleeding *could see this even if you’re not a pediatric nurse  Otitis Media - ear infection (AT I pg. 239, Linnard-Palmer, pg. 352) - Acute Otitis Media (AOM) is a complication of Eustachian tube dysfunction that generally occur during an acute viral upper respiratory tract infection. Risk factors for OM- age, allergies, exposure to smoke, day care, pacifier use, URI, GER, not breastfed Physical exam- Erythema and bulging tympanic membrane Prevention No bottle propping, avoid passive smoke exposure, immunizations ’ Observation vs Antibiotic therapy ’ Severe otalgia or lasting >48 hrs, fever >102 Tympanostomy  Otitis Media infection of the middle ear. One of the most common acute illnesses in URI e. childhood (AOM), can be viral or bacterial Preceded by an upper infection. ↳ 24 months old. Y INFLAMMATION !!. respiratory yus infection !! Otitis media with effusion COME) e collection of fluid in middle ear, no RISK FACTORS : DIAGNOSTIC : MEDICATIONS : · pneumatic otoscope : · Shorter/horizontal & visualize acetaminophen tympanic · & Ustachian tubes in children membrane will be bulging, · ibuprofen school age yellow/red orange or , · antibiotics 6 months yo drainage · or ↳ po · STREP!! ↓ - /M 3 Conce RSV , y/o DOWN allergies pull pinna · = and back · topical anesthetics haemophilus · Up - benzocaine · NOT breastfed < 3ylo-pulland pinna back lidocaine - ear drops Winter/spring · · cleft lip/palate MANAGEMENT : down syndrome · · recommend waiting PROCEDURES : EXPECTED FINDINGS : 2 3. days before antibiotics IMERAPEUTIC prescribing myringotomy ·recent historyofupa · for children 2-12. yrs tube tympanoplasty · acute behavior · changes crying irritable fussy · , , · inconsolable tugging ear, turning head · ear pain I , appetite · N/V · fever Child vs. adult anatomy · Otitis will fall out on their own Media 12-18 months & Tube treatment Acute Otitis Media  Croup syndromes (ATI pg. 96) Croup is a term applied to a broad classification of upper airway illnesses that result from swelling of the epiglottis and larynx. Such as spasmodic laryngitis (spasmodic croup), laryngotracheitis/laryngotracheobronchitis (LTB), and bacterial syndromes, such as bacterial tracheitis and epiglottitis. The swelling usually extends into the trachea and bronchi. Croup  at Croup syndromes gets worse night Acute spasmodic laryngitis Viral invasion of the upper airway that extends throughout the larynx, trachea, and bronchi. Common presenting signs are tachypnea, inspiratory stridor, and a seal-like barking cough. Croup - > just LISTEN to not make throat Diagnosis is made by clinical presentation. close off e Throat cultures and visual inspection of the inner mouth and throat are contraindicated in children with LTB and epiglottitis. These procedures can cause laryngospasms NO tongue blade. * could see this in any ED Keep resuscitation equipment at bedside. ↳ steam helps Interventions: Humidified oxygen and Cool mist to moisten - cold air helps secretions MEDICAL EMERGENCY !! & Epiglottitis need to likely Will > - intubate !! Etiology is bacterial-Haemophilus influenza, Group A beta-hemolytic streptococcus, staphylococcus Intense sore throat, dysphagia*, drooling*, S prefers upright position (tripod position with neck extended)*, barking cough is absent* Diagnosis is often based on a lateral neck x-ray Immediate ET tube placement usually needed *Classic signs that distinguish the condition Lateral neck x-ray with epiglottitis Bronchiolitis Inflammation and obstruction of the small airways, the bronchioles. The peak age for bronchiolitis is 2 to 6 months Infection with respiratory syncytial virus (RSV) is the most common cause, but other viral, bacterial, and mycoplasmal organisms may also be responsible. RSV occurs in annual epidemics from October to March in the Southeastern United States  RSV Viral debris clogs and obstructs the bronchioles and irritates the airway. the airway lining swells and produces excessive mucus.  this leads to partial airway obstruction and bronchospasms. Inspiratory and expiratory wheezing; a deeper, more frequent cough; tachypnea; retractions; and more labored breathing. Treatment is supportive care Oxygen, fluids, nasopharyngeal or nasal suctioning PRN RSV Prevention…Education Hand hygiene Cover cough Immunizations Education Medication administration (full course of antibiotics) Correct dose Tell parents what to expect  Application of acute illnesses Describe interventions for What are your red How can you tell if a acute respiratory flags for child is bleeding alterations (i.e., epiglottitis? post-tonsillectomy? croup, RSV)  Link to practice videos Chest retractions e lift head up !! https://youtu.be/XJ-ON24aO9s https://youtu.be/XJ-ON24aO9s https://www.youtube.com/playlist?list=PL7DDE01506E03B5ED https://www.youtube.com/playlist?list=PL7DDE01506E03B5ED Chronic Alterations Asthma - DO NOT out of asthma grow Cystic Fibrosis  Asthma (ATI pg. 99, Linnard- Palmer pg. 274) Respiratory illness characterized by chronic inflammation, bronchoconstriction, and bronchial hyperresponsiveness. Most common pediatric chronic illness Manifestations- GOAL : Wheezing use rescue inhaler < 2x Coughing a week Dyspnea Asthma Triggers: Antigens, irritants, infection, medications, GI reflux, foods, stress, exercise Causing cascade of events that affect the entire respiratory tract Results in bronchoconstriction, edema, and mucus production causing airway obstruction and air trapping which lead to increased WOB, hypercapnia, and hypoxemia Diagnostic- Pulmonary function test, peak expiratory flow rates  Short-acting asthma medications (Linnard-Palmer pg.278) & RESCUE ONLY Short-acting beta-2 agonists (e.g., Intravenous Oral corticosteroids (e.g., albuterol)-only short corticosteroids (e.g., prednisolone) acting med used outside methylprednisolone) of emergent treatment Anticholinergics (e.g., Epinephrine (racemic) ipratropium bromide) Long-acting Inhaled corticosteroids (e.g., fluticasone propionate) Long-acting beta-2 agonists (e.g., formoterol fumarate) asthma Anti-immunoglobulin E antibodies (anti-IgE) (e.g., omalizumab) medications Mast cell inhibitors (e.g., cromolyn) Leukotriene modifiers (LM) (e.g., montelukast sodium) Methylxanthines (e.g., theophylline)  & Severe asthma Status asthmaticus &xacerbation (ATI pg. 101) Life threatening episode causing airway obstruction unresponsive to treatment Intubation PICU Complications- respiratory failure Therapy and Goal of treatment Primary goal is to keep it under control Maintain pulmonary function Maintain normal activities How do we control asthma? Avoid triggers -> roach droppings Daily maintenance Family education  Check your asthma knowledge Callergies , excema , asthma What does an asthma exacerbation look like? Explain the role triggers play in asthma exacerbation. What are short- and long-acting treatment medications for asthma? What should be included when teaching about asthma exacerbation prevention? Cystic fibrosis  Autosomal recessive genetic disease- dysfunction of transmembrane conductance regulator (CFTR) CF This regulates the hydration of epithelial cells (AT I pg. 105, of many organs Progressive illness GET WORSE !! Linnard- > - WILL Wide variation of disease Palmer pg. 279) Earlier diagnosis d/t newborn screening, however, this is not definite diagnosis Genetic inheritance of CF Increased Sweat Electrolytes Sweat chloride test is the gold standard of diagnosis. Sodium and chloride will be 2-5 times greater than in the controls Parents often can taste the salt when they kiss their child Pathophysiology of CF CF gene directs body's epithelial cells to When the protein is defective, epithelial This disrupts the essential balance of salt produce a defective form of a protein cells can't regulate the way chloride (part of and water needed to maintain a normal found in cells that line the lungs, digestive the salt called sodium chloride) passes thin coating of fluid and mucus inside the tract, sweat glands, and reproductive across cell membranes. lungs, pancreas, and passageways in other system. organs. The mucus becomes thick, sticky, and hard to move.  Thick mucus results in mechanical obstruction "Orphan disease" ↑ In patients with CF, the thick, sticky mucus and the germs it has Cystic fibrosis trapped remain in the lungs, which become infected. this is why we do percussive treatments twice daily In the pancreas, thick mucus blocks the channels that would normally ↓ carry important enzymes to the intestines to digest foods. Kids with CF have problems gaining weight, even with a normal diet and a good give pancreatic appetite. This is why we give pancreatic enzymes Ozymes EVERY TIME YOU GIVE Reproductive- decreased or absent sperm or potentially blocked FOOD !! fallopian tubes CPT vest Medications for CF Bronchodilators (e.g., albuterol, Antibiotic prophylaxis (aerosol, oral salmeterol) or IV) Anticholinergics (e.g., ipratropium Vitamins A, D, E, & K bromide [Atrovent]) Ivacaftor (Kalydeco)* DNase (e.g., dornase alfa) This is a med that targets the genetic mutation itself-many new Hypertonic saline (7%) drugs like it to come Mast-cell stabilizers (e.g., cromolyn) Digestive enzymes (e.g., Creon, Zenpep, Pancreaze)  Prevent Maintain good Comply to therapies Family exacerbations nutrition and interventions Teaching Infection Prevention Follow up care  What are the chances of a child being born with CF when both parents are carriers? 25 % or 1 in 4 Which body systems are affected by CF? CF knowledge respiratory digestive reproductive, integumentary , , check What screening is done prior to leaving the hospital that might indicate a patient has CF? Sweat test What is the gold standard for CF diagnosis? newborn screen (genetics) What non-pharmacological interventions should be included in caring for a CF patient? ↳ Chest PT Vest BE ACTIVE + ,  Pediatric respiratory emergencies  Many respiratory conditions associated with difficulty breathing can progress to respiratory distress. If the condition is not managed properly, it can lead to respiratory failure. Distress vs Respiratory failure occurs when the body can no longer - Failure maintain effective gas exchange. The physiologic process that ends in respiratory failure begins with hypoventilation (body’s O2 needs exceed actual O2 intake) of the alveoli. Signs of impending respiratory failure include irritability, lethargy, cyanosis, and increased respiratory effort such as dyspnea, tachypnea, nasal flaring, and intercostal retractions. Nursing role in identification of respiratory distress Assessment findings Escalation process Levels of care Nursing should support child during respiratory distress to prevent respiratory failure Main reason young children have cardiac failure is due to respiratory failure allergy test done 2 weeks after Anaphylactic shock-nursing role S (Linnard-Palmer pg. 440) Severe allergic systemic reaction Assessment findings- bronchial edema, laryngeal spasms, wheezing and feeling of tightness of the chest, hypotension, poor perfusion and rapid, weak pulses, rapid change in level of consciousness, body rash, nausea & vomiting, swollen tongue & itchy lips Treatments-rapid identification onset, administer SQ or IM epinephrine, need two large bore IVs for fluids and medications, administer antihistamine, airway and cardiopulmonary support (oxygen, intubation, etc.), transfer to ICU