Care of the Patient With Alteration is Respiratory Health

7/31/2019 Care of the Patient With Alteration is Respiratory Health.

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Metabolic Alkalosis

Conditions Causing Respiratory Distress

Acute

ChronicAcute Disorders of the Respiratory System

Foreign-body aspiration (FBA)

ApneaApparent Life-Threatening Event (ALTE)

Apnea plus

Most common in infants younger than 4 monthsALTE: Is It SIDS?

There is different pathophysiology

ALTE may or may not have a causeGastroesophageal reflux

Seizures

Cardiac arrhythmias

Metabolic or endocrine problemsUpper airway complications

Question #1

A child presents to the emergency department in acute respiratory distress caused by an asthmaticepisode. Which of the following drugs would the nurse plan to administer first?

Prednisone

EpinephrineTerbutaline

Cromolyn sodium

Question #2Which of the following might a child with asthma be advised to avoid?

Swimming

GymnasticsSnow skiing

Playgrounds

Question #3

Which statement by an 8-year-old child with asthma indicates that she understands the use of a peak

expiratory flow meter?

Question #3

"My peak flow meter can tell me if an asthma episode might be coming, even though I might still be

feeling okay.""When I do my peak flow, it works best if I do three breaths without pausing in between breaths."

"I always start with the meter reading about halfway up. That way I don't waste any breath."

"If I use my peak flow meter every day, I will not have an asthma attack."

Question #4

An adolescent with asthma says she heard her doctor say smoking was her trigger. The adolescent asksthe nurse what that means. The nurse explains to the adolescent that a trigger is:

Question #4


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A substance or condition that initiates an asthmatic episode.

The term for narrowing of the airways during an asthmatic episode.

Another way to describe asthma.

The rapid breathing associated with an asthma attack.

Question #5

A child in respiratory distress requires intubation. The nurse would estimate the endotracheal tube sizebased on:

_____His little finger, or Bradley tape_______

Upon admission of a patient with suspected acidosis the nurse should expect which diagnostic test to be

performed?

Pulse oximetryArterial blood gases

Acid-fast smear

Culture and sensitivity

pH 7.31 PaO2 88 PaCO2 58 H2O3 28This blood gas would be considered

Respiratory acidosis

Respiratory alkalosisMetabolic acidosis

Metabolic alkalosis

pH 7.28 PaO2 98 PaCO2 33 H2O3 14This blood gas would be considered

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosisMetabolic alkalosis

pH 7.48 PaO2 99 PaCO2 30 H2O3 22

This blood gas would be consideredRespiratory acidosis


Metabolic acidosisMetabolic alkalosis

pH 7.46 PaO2 90 PaCO2 46 H2O3 28

This blood gas would be consideredRespiratory acidosis


Metabolic acidosis

Metabolic alkalosisObstructive Sleep Apnea (OSA)

Airway obstruction (partial or complete) during sleep

Peaks between 2 to 6 years of age due to enlarged tonsils and adenoids - may be associated with obesityDiagnosis

Treatments

Sudden Infant Death Syndrome (SIDS)Unexpected death of child younger than 1 year

Diagnosed

Croup


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Broad term of upper airway illnesses examples

Affect large numbers of childrenLaryngotracheobronchitis (LTB)

Type of croup illness

LTBUsually viral cause

Most common: 3months to 4 years of age

Signs:

TreatmentA child is brought to the Emergency Department with suspected epiglottitis. Which nursing intervention

would be considered unsafe?

Allowing the child to remain in the position of choice

Placing intubation equipment at the bedsideEncouraging parents to comfort the child

Examining the throat

Epiglottitis

Usually caused by H. influenzae type B (Hib) - Hib vaccination now required for children

Signs and symptoms:

Epiglottitis: Interventions

Avoid inspecting mouth or throat

Treatment

Bacterial Tracheitis

S. aureus (most common)

Signs and symptoms:

Treatment

The mother of an infant diagnosed with bronchiolitis asks the nurse what causes this disease. The nurse's

response would be based on the knowledge that the majority of infections that cause bronchiolitis are aresult of:

Ribavirin.

Mycoplasma pneumoniae.

Respiratory syncytial virus (RSV).Hemophilus influenzae.

Bronchiolitis

Pathophysiology

Symptoms:

Treatment

Bronchitis

Unusual in childhood


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Symptoms:

TreatmentBackground

Etiology: RSV, other viruses

PathophysiologyClinical manifestations

Diagnosis: ELISA test on nasal wash specimen

Treatment: SupportiveAssessment

Diagnosis

Ineffective breathing pattern

Activity IntoleranceRisk for deficient fluid volume

Anxiety (child and parent)

Planning and ImplementationEvaluation

A child with cystic fibrosis is hospitalized for a respiratory infection. Which documentation in the chart

would indicate the need for counseling regarding nutrition and gastrointestinal complications?Frothy, foul-smelling stools

Weight unchanged from yesterday

Weight unchanged from yesterday

Eats three snacks every dayAn adolescent was diagnosed with cystic fibrosis as an infant. At this time, the adolescent will need

additional teaching related to:

Obtaining a sweat chloride test.The effect of pancreatic enzymes on the sex hormones.

Weight reduction diet.

Reproductive ability.The parents of a child with cystic fibrosis inform the nurse that they will be unable to perform postural

drainage at home because their bed does not recline like the hospital bed. The nurse's response is based

on an understanding that:Postural drainage is essential to mobilize secretions in the airways so they can be coughed out.

Postural drainage is not necessary as long as the child takes his pulmozyme to decrease the viscosity of

the mucus.

Postural drainage does not influence the pulmonary status of a child with cystic fibrosis.The parents can be referred to The Cystic Fibrosis Foundation for a flexible bed.

Background: Cystic Fibrosis (CF)

Inherited autosomal recessive disorderPathophysiology

Clinical manifestations

Cystic Fibrosis (CF)Pathophysiology


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Symptoms:

A child with a respiratory infection is scheduled to have a sweat test. The mother asks the purpose of this

diagnostic test. The nurse's response would be based on the knowledge that the test:Determines if the child is dehydrated.

Assesses if the sweat glands are functioning.

Identifies the infectious organism.Establishes a diagnosis of cystic fibrosis.

Cystic Fibrosis Evaluation

Diagnosis: Sweat test - DNATreatment

Prevent infections

Optimize nutritionAssessment

Diagnosis

Ineffective airway clearance

Risk for infectionImbalanced nutrition: Less than body requirements

Parental role conflict

Planning and ImplementationEvaluation

Question

An 18-month-old child is seen in the Emergency Department with respiratory distress and is admittedwith a diagnosis of pneumonia. Following the initial workup, the baby is still short of breath but is

rubbing his eyes as if he is sleepy. The mother wants to lay the baby down for his nap. The infant refuses

to lie down. The nurse would suggest:

The answer is?

Rocking the baby until he is asleep and then lay him down.

The mother hold him in her arms while he sleeps.The mother allow the baby to sleep in an upright position.

A sleeping pill to help the baby rest.

Pneumonia

Symptoms:

Treatment

Tuberculosis (TB)

Caused by M. tuberculosisPathophysiology

Symptoms:

Treatment

Question

An 11-month-old child is being discharged home for the first time after being diagnosed withbronchopulmonary dysplasia (BPD). She will require home oxygen therapy. Which statement by the

mother indicates that discharge teaching is incomplete?


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The answer is ?

"We will not allow any smoking at our home."

"We have several fire extinguishers, and we know how to use them."

"Her brother will blow out the birthday candles at her party.""We will return to the hospital if she seems irritable and won't play."

Chronic Disorders of the Respiratory System

Bronchopulmonary dysplasia (BPD)Triggers:

Symptoms:

Treatment

The father of a premature infant asks why oxygen concentrations are not higher to help his son breathe

better. The nurse's best response is based on an understanding of:Cystic fibrosis.

Pneumonia.

Bronchiolitis.

Bronchopulmonary dysplasia.Asthma

Most common chronic illness among children

PathophysiologyAsthma (contd)

Symptoms:

Treatment

Mechanisms of InjurySmoke Inhalation

Blunt Chest TraumaConsequences of Respiratory Distress

May lead to respiratory failure, which can be fatal if not treated promptly

Respiratory FailureBody can no longer maintain effective gas exchange

Process begins at alveoli

Results in hypoxemia and hypercapnia

Mild Respiratory Distress: Attempting to CompensateSigns and symptoms

Nursing interventionsModerate Respiratory Distress: Early Decompensation

Signs and symptoms


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Nursing interventionsSevere Respiratory Distress: Respiratory Failure/Imminent Arrest

Signs and symptoms

Nursing interventions

The nurse is teaching home tracheostomy care to the parents of a toddler. What information is essential to

include?The importance of changing the tracheostomy every day

How to recognize signs of infection and obstruction

How to remove the tracheostomy so the child can talk

Teaching the child to keep large objects away from the tube

Documents

Care of the Patient With Alteration is Respiratory Health