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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
Respiratory alkalosis
Metabolic acidosisMetabolic alkalosis
pH 7.46 PaO2 90 PaCO2 46 H2O3 28
This blood gas would be consideredRespiratory acidosis
Respiratory alkalosis
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