NSG 4800: Pediatrics
Study online at https://quizlet.com/_jnvd8x
1. Respiratory Distress: S/S: grunting, nasal flaring, retractions, cyanosis (late sign), tachypnea, fever,
anorexia, vomiting, nasal blockage, nasal discharge (thin & watery vs thick & purulent), and agitation/excessive
fussiness.
- cardinal signs: restlessness (early signs), increased pulse, respirations, and diaphoresis.
• interventions: ease respiratory efforts, promote rest, promote comfort, prevent spread of infection, reduce temper-
ature, promote hydration/nutrition, provide family support, and pharmacological therapy, if age is appropriate.
2. Croup (laryngotracheobronchitis): • a group illnesses cause by parainfluenza and RSV that affects
the larynx, trachea, and bronchi and described as epiglottis, supraglottitis laryngitis, laryngotracheobronchitis, and
bacterial tracheitis.
• risk factors: males, ages 3 months-5 years (more common in 2 year olds), and winter months.
• causes: S. pyogens, S. pneumoniae, S. aureus, haemophilus influenza, and corynebacterium diphtheriae.
- can lead to obstruction because child have a narrow airway diameter.
• symptoms: acute onset, hoarseness, barky cough, inspiratory stridor, purulent sputum, toxic appearance marked
distress, and high fever 102.2ºF.
3. croup medical: • medications: corticosteriods (mainstay treatment), dexamethasone, nebulized epineph-
rine is an accepted treatment in patients with moderate to severe croup, and adrenaline reduces respiratory distress
in less than 10 minutes.
• interventions:
1. patent airway
2. monitor for respiratory distress
3. elevated HOB and provide rest.
4. cool air humidified oxygen
5. fluids: IV if child cannot swallow
6. avoid cough syrups: thicken secretions
7. resuscitation
4. epiglotititis: • medical emergency characterized by high fever, sore throat, dyspnea, and progressing respi-
ratory obstruction that requires immediate attention,
• risk factors: ages 2-8
• symptoms: rapid onset, sore throat, dysphagia, anxiety due to inspiratory distress, drooling, muffled speech, toxic
appearance, tripod positioning (classic sign), marked distress, high fever (101.8ºF-104ºF), and inspiratory stridor
• diagnosis: "steeple sign" or subglottic narrowing, blood cultures, absence of thumb sign on radiograph, elevated
, NSG 4800: Pediatrics
Study online at https://quizlet.com/_jnvd8x
WBC's (leukocytosis with a left shift)
• prevention: Hib immunization, hand washing, covering cough, and proper tissue disposal.
5. epiglottis: • nursing care: in mild croup, a child will have a croupy cough and only need parental guidance,
reassurance, given alertness, baseline minimal respiratory distress, proper oxygenation, and stable fluid status.
maintaining airway and adequate oxygen exchange are the goals. maintain airway, provide rest and humidification,
monitoring fluid balance, administer medications, and assess LOC.
- patients who receive nebulized epinephrine, needs to be observed for 3 hours because of concerns of returning
bronchospasm, worsening respiratory distress, and persistent tachycardia.
• medical care:
1. cool mist for mild cases (O2 hoods for infants and O2 tents for toddlers),
2. nebulizer epinephrine: mucosal vasoconstriction decreases subglottic edema that's indicated for children with
moderate-severe stridor does not respond to cool mist.
3. corticosteroids: decrease edema and has anti-inflammatory effects.
4. antibiotics (ampicillin and sulbactum)
• education/discharge: instructions on cool-mist and steamy bathroom for distress, medication compliance and
administration, potential side effects and symptoms of worsening condition.
- do not place in supine and do not take oral temperature.
- provide heliox
6. Bronchiolitis (RSV) respiratory syncytial virus: • inflammation of the bronchioles and small
bronchi that is common in children ages 2 and younger that is highly contagious and spreads by direct contact.
• symptoms: URI (cough, coryza, and rhinorrhea), respiratory distress marked by noisy, raspy breathing, and cyanosis.,
audible wheezing, intercostal retractions (hallmark sign), rales and prolonged expiratory phase, tachypnea, fever of
up to 102ºF, decreased appetite and poor feeding, dehydration, thick mucus, obstruction with gas exchange, otitis
media and conjunctivitis.
• diagnosis: nasal secretions
• prevention: handwashing, avoiding secondhand smoke, and IM injection of monoclonal antibodies palivizumab.
• medical/nursing: management of hydration, fever control, oxygenation, and keeping the mucus membranes clear
of mucus. in hospital setting, head of bed elevated to 30-40º, monitor O2 saturation, cool-mist therapy to relieve
dyspnea, education for handwashing and contact precautions (gloves, gown, and mask), and the first 24-72 hours
are a critical time for recovery.
7. Tonsilitis: • inflammation of the tonsils that are caused by viruses and group A beta-hemolytic streptococcus.
- the tonsils enlarge 2-10 years of age and reduce progressively during preadolescence, so tonsils in children are
, NSG 4800: Pediatrics
Study online at https://quizlet.com/_jnvd8x
larger than adults.
• symptoms: enlarged tonsils, dysphagia, headache, malaise, and halitosis.
• complications: peritonsillar abscess
• education/discharge: keep child away from highly seasoned and "sharp" foods for 2 weeks, have the child avoid
vigorous tooth brushing and gurgling, instruct the child to not cough or clear the throat, and limit the child's activities
that may result in bleeding.
8. Tonsilectomy: • surgical care: tonsillectomy (removal of the tonsils) is indicated for patients with e 3 infections
per year as sufficient to necessitate surgical intervention and is performed 6 weeks after infection has resolved.
- after surgery children are kept on their side to drain secretions, provide comfort and reduce activities that cause
bleeding, coughing, clearing the throat, and blowing the nose are avoided, secretions and vomit are checked for
blood, apply ice collars or ice packs, provide water, crushed ice, and popsicles (avoid brown or red-colored fluids
because the nurse has to watch for bleeding, and avoid foods such as ice cream, milk, and pudding (causes bleeding
because it coats the throat causing the child to clear the throat).
9. otitis media: • etiology: streptococcus pneumoniae, H. influenza & Moraxella catarrhalis are the most
common bacteria
- Passive smoke increase risk
- URI, allergic rhinitis or hypertrophic adenoids
- Breastfeeding babies have a lower risk
- both horizontal positioning and immature structure/function of the eustachian tubes predispose small children
• manifestations: ear pain, fever, purulent discolored effusion and a bulging, red, immobile tympanic membrane, and
irritability and ear pulling is the initial signs for infants who are non-verbal.
• pharmacologic: antibiotic x 10-14 days, acetaminophen or ibuprofen for pain management, and ear drops.
- hold child upright when feeding, do not prop bottle, no Q-tips, no second hand smoke exposure
10. Cystic Fibrosis: • an inherited autosomal-recessive disorder of the exocrine glands that causes the
production of thick mucus that affects several body systems (respiratory, GI, and reproductive system)
- most common in Caucasian population.
- increased mucus production causes airway obstruction, stasis soft fluid, providing a rich habitat for bacterial growth.
- pancreatic ducts are blocked by mucus, prohibiting the secretion of pancreatic enzymes necessary for the metabo-
lism of food nutrients.
- patients become symptomatic at birth or soon after birth.
- respiratory infections and poor weight gain are the most frequent presentations coupled with pancreatic insuffi-
ciency signify CF.
Study online at https://quizlet.com/_jnvd8x
1. Respiratory Distress: S/S: grunting, nasal flaring, retractions, cyanosis (late sign), tachypnea, fever,
anorexia, vomiting, nasal blockage, nasal discharge (thin & watery vs thick & purulent), and agitation/excessive
fussiness.
- cardinal signs: restlessness (early signs), increased pulse, respirations, and diaphoresis.
• interventions: ease respiratory efforts, promote rest, promote comfort, prevent spread of infection, reduce temper-
ature, promote hydration/nutrition, provide family support, and pharmacological therapy, if age is appropriate.
2. Croup (laryngotracheobronchitis): • a group illnesses cause by parainfluenza and RSV that affects
the larynx, trachea, and bronchi and described as epiglottis, supraglottitis laryngitis, laryngotracheobronchitis, and
bacterial tracheitis.
• risk factors: males, ages 3 months-5 years (more common in 2 year olds), and winter months.
• causes: S. pyogens, S. pneumoniae, S. aureus, haemophilus influenza, and corynebacterium diphtheriae.
- can lead to obstruction because child have a narrow airway diameter.
• symptoms: acute onset, hoarseness, barky cough, inspiratory stridor, purulent sputum, toxic appearance marked
distress, and high fever 102.2ºF.
3. croup medical: • medications: corticosteriods (mainstay treatment), dexamethasone, nebulized epineph-
rine is an accepted treatment in patients with moderate to severe croup, and adrenaline reduces respiratory distress
in less than 10 minutes.
• interventions:
1. patent airway
2. monitor for respiratory distress
3. elevated HOB and provide rest.
4. cool air humidified oxygen
5. fluids: IV if child cannot swallow
6. avoid cough syrups: thicken secretions
7. resuscitation
4. epiglotititis: • medical emergency characterized by high fever, sore throat, dyspnea, and progressing respi-
ratory obstruction that requires immediate attention,
• risk factors: ages 2-8
• symptoms: rapid onset, sore throat, dysphagia, anxiety due to inspiratory distress, drooling, muffled speech, toxic
appearance, tripod positioning (classic sign), marked distress, high fever (101.8ºF-104ºF), and inspiratory stridor
• diagnosis: "steeple sign" or subglottic narrowing, blood cultures, absence of thumb sign on radiograph, elevated
, NSG 4800: Pediatrics
Study online at https://quizlet.com/_jnvd8x
WBC's (leukocytosis with a left shift)
• prevention: Hib immunization, hand washing, covering cough, and proper tissue disposal.
5. epiglottis: • nursing care: in mild croup, a child will have a croupy cough and only need parental guidance,
reassurance, given alertness, baseline minimal respiratory distress, proper oxygenation, and stable fluid status.
maintaining airway and adequate oxygen exchange are the goals. maintain airway, provide rest and humidification,
monitoring fluid balance, administer medications, and assess LOC.
- patients who receive nebulized epinephrine, needs to be observed for 3 hours because of concerns of returning
bronchospasm, worsening respiratory distress, and persistent tachycardia.
• medical care:
1. cool mist for mild cases (O2 hoods for infants and O2 tents for toddlers),
2. nebulizer epinephrine: mucosal vasoconstriction decreases subglottic edema that's indicated for children with
moderate-severe stridor does not respond to cool mist.
3. corticosteroids: decrease edema and has anti-inflammatory effects.
4. antibiotics (ampicillin and sulbactum)
• education/discharge: instructions on cool-mist and steamy bathroom for distress, medication compliance and
administration, potential side effects and symptoms of worsening condition.
- do not place in supine and do not take oral temperature.
- provide heliox
6. Bronchiolitis (RSV) respiratory syncytial virus: • inflammation of the bronchioles and small
bronchi that is common in children ages 2 and younger that is highly contagious and spreads by direct contact.
• symptoms: URI (cough, coryza, and rhinorrhea), respiratory distress marked by noisy, raspy breathing, and cyanosis.,
audible wheezing, intercostal retractions (hallmark sign), rales and prolonged expiratory phase, tachypnea, fever of
up to 102ºF, decreased appetite and poor feeding, dehydration, thick mucus, obstruction with gas exchange, otitis
media and conjunctivitis.
• diagnosis: nasal secretions
• prevention: handwashing, avoiding secondhand smoke, and IM injection of monoclonal antibodies palivizumab.
• medical/nursing: management of hydration, fever control, oxygenation, and keeping the mucus membranes clear
of mucus. in hospital setting, head of bed elevated to 30-40º, monitor O2 saturation, cool-mist therapy to relieve
dyspnea, education for handwashing and contact precautions (gloves, gown, and mask), and the first 24-72 hours
are a critical time for recovery.
7. Tonsilitis: • inflammation of the tonsils that are caused by viruses and group A beta-hemolytic streptococcus.
- the tonsils enlarge 2-10 years of age and reduce progressively during preadolescence, so tonsils in children are
, NSG 4800: Pediatrics
Study online at https://quizlet.com/_jnvd8x
larger than adults.
• symptoms: enlarged tonsils, dysphagia, headache, malaise, and halitosis.
• complications: peritonsillar abscess
• education/discharge: keep child away from highly seasoned and "sharp" foods for 2 weeks, have the child avoid
vigorous tooth brushing and gurgling, instruct the child to not cough or clear the throat, and limit the child's activities
that may result in bleeding.
8. Tonsilectomy: • surgical care: tonsillectomy (removal of the tonsils) is indicated for patients with e 3 infections
per year as sufficient to necessitate surgical intervention and is performed 6 weeks after infection has resolved.
- after surgery children are kept on their side to drain secretions, provide comfort and reduce activities that cause
bleeding, coughing, clearing the throat, and blowing the nose are avoided, secretions and vomit are checked for
blood, apply ice collars or ice packs, provide water, crushed ice, and popsicles (avoid brown or red-colored fluids
because the nurse has to watch for bleeding, and avoid foods such as ice cream, milk, and pudding (causes bleeding
because it coats the throat causing the child to clear the throat).
9. otitis media: • etiology: streptococcus pneumoniae, H. influenza & Moraxella catarrhalis are the most
common bacteria
- Passive smoke increase risk
- URI, allergic rhinitis or hypertrophic adenoids
- Breastfeeding babies have a lower risk
- both horizontal positioning and immature structure/function of the eustachian tubes predispose small children
• manifestations: ear pain, fever, purulent discolored effusion and a bulging, red, immobile tympanic membrane, and
irritability and ear pulling is the initial signs for infants who are non-verbal.
• pharmacologic: antibiotic x 10-14 days, acetaminophen or ibuprofen for pain management, and ear drops.
- hold child upright when feeding, do not prop bottle, no Q-tips, no second hand smoke exposure
10. Cystic Fibrosis: • an inherited autosomal-recessive disorder of the exocrine glands that causes the
production of thick mucus that affects several body systems (respiratory, GI, and reproductive system)
- most common in Caucasian population.
- increased mucus production causes airway obstruction, stasis soft fluid, providing a rich habitat for bacterial growth.
- pancreatic ducts are blocked by mucus, prohibiting the secretion of pancreatic enzymes necessary for the metabo-
lism of food nutrients.
- patients become symptomatic at birth or soon after birth.
- respiratory infections and poor weight gain are the most frequent presentations coupled with pancreatic insuffi-
ciency signify CF.
