NURS 211 Quiz 2-Exam 2 Study Guide

Iron deficiency anemia anemia caused by inadequate iron intake Iron deficiency anemia predictable At developmental periods: -premature infants due to low fetal supply -at 12-36 mo due to infection of large amounts of cows milk and diet - in adolescents due to rapid growth and poor diet Therapeutic management of iron deficiency anemia infants - iron fortified formula, iron supplements, limit cows milk intake to 23oz/day, iron fortified cereal Therapeutic management of iron deficiency anemia in children -encourage iron rich foods and vitamin c Dietary vs ferrous iron supplements Prognosis of untreated iron deficiency anemia Developmental delay Family support and education for iron deficiency anemia -Give iron before or after milk, tea, antacids to prevent decreased absorption -GI upset is coming and will decrease over time -Give on an empty stomach -Use straw or dropper to administer to prevent teeth staining -Use z-track method for injections How to give iron through injections Z-track method Why give oral iron through straw To prevent teeth staining Iron stools what to expect Green/black and tarry These are normal with iron supplementation Brush teeth when taking oral iron To help prevent staining along Use of straw or dropper upper respiratory tract nose, pharynx, larynx, upper trachea lower respiratory tract lower trachea, bronchi, bronchioles, alveoli Pediatric respiratory tract Similar to adult but much smaller Pediatric respiratory rate Higher than adult RR Kids primary breathing pattern Belly breather Check abdomens for breathes Obligate nose breather Infants until 4 mo only breath through their nose Infectious agents (pathogens) respiratory Viruses: RSV Others:GABHS, staphylococci, chlamydia trachomatis, mycoplasma organisms, pneumococci, haemophilus influenzae RSV respiratory syncytial virus GABHS Group A beta-hemolytic streptococci Infants younger than 3 mo Maternal antibodies offer protection from respiratory diseases Infants 3-6 mo Respiratory infection rates increase Toddlers and preschoolers High rates of viral respiratory infection Kids older than 5 Increase in GABHS and mycoplasma pneumoniae infections Increased immunity Develops with age Babies Use their mouths for learning creating increased risk of infection Size of airways in peds Smaller diameter Shorter structures Short and open Eustachian tubes Decreased resistance Immune system deficiency Allergies/asthma Cardiac anomalies Cystic fibrosis Exposure to infections from day care Expose to second hand smoke Seasonal variations Most common during winter and spring Mycoplasmal infections more common in fall and winter Asthmatic bronchitis more frequent in cold weather RSV season considered winter and spring Clinical manifestations of resp infection Vary with age Generalized signs and symptoms Generalized signs and symptoms of respiratory infections Fever Anorexia Vomiting Diarrhea Abd pain Cough Sore throat Nasal blockage or discharge Respiratory sounds Fussy or irritable Lethargy Accessory muscles for breathing Head Bob Color changes/blue Facial congestion/crackles heard in face Low wheezes in chest/stridor high Nasal flaring Grunting Retractions Nursing intervention for respiratory infections Ease respirations effort Manage fever Promote rest and comfort Control infection Promote hydration and nutrition Provide family support and teaching BBG Big booger getter Suction tip for nasal passages in babies The more you suction The more secretions are produced Upper respiratory infections (URI) acute nasopharyngitis Caused by numerous viruses Fever and home management varies by age acute nasopharyngitis Common Cold. An upper respiratory infection can be caused by any one of 200 different viruses. pharyngitis (sore throat) Young kids: fever, restless, redness in back of throat, headache, no eating, sore throat Diagnosis of pharyngitis -Rapid throat swab -Throat culture if rapid comes back negative Treatment of pharyngitis Penicillin, erythromycin, or cephalosporins may be used to treat a bacterial infection. Saltwater gargle Antipyretic Analgesic medications Which pharyngitis kid is infectious For some time Until ATB Therapy commences for at least 24 hours ATB therapy Must take full course of meds! Recurrent pharyngitis Major problem: Could be caused by not taking all of your ATB Infection can move to other places like the heart Tonsillitis acute or chronic inflammation of the tonsils Exudate present Kissing tonsils kissing tonsils If tonsils are touching each other. Makes it hard to breathe and swallow. Having too big of tonsils or adenoids leads to Delay of growth and development so we remove them Nursing Considerations tonsillitis Improve comfort and minimize ax or interventions that precipitate bleeding Prepare for the surgery and post op care *increased swallowing is a sign of hemorrhage and needs reported to surgeon immediately! Popsicles post tonsillectomy No red or brown flavors Post surgery tonsillectomy Avoid coughing, nose blowing Don't clear throat Drink lots of fluids(nothing red) May need mild opioids for pain or acetaminophen post tonsillectomy Scabs need to stay moist so drink as much as possible Hemorrhage post tonsillectomy signs and symptoms Increased swallowing! Emergency!!! Choking on blood Coughing up fresh blood Excessive nausea All of these are emergent and child will have to go to OR for cauterization Otitis Media Ear infection Etiology of Otitis Media Streptococcus pneumoniae and Haemophilus influenzae are the most common bacterial causes of otitis media. As well as being caused by Streptococcus pneumoniae and Haemophilus influenzae it can also be caused by the common cold. Pathophysiology of otitis media Malfunctioning Eustachian tubes Fluid gets trapped and infection results in the middle ear Visual evidence of otitis media Discolored ear drum Can be red also ATB Use with otitis media kids older than 2 Generally not useful for children older than 1 Safe and appropriate to not use for at least 72 hours in non emergency cases ATB use for otitis media in infants >6 mo ATB to be used due to underdeveloped immune systems and risk of secondary bacterial infections Pain management otitis media Alternate acetaminophen and ibuprofen every three hours Recurrent otitis media Acute otitis media that occurs 3 or more times within 6 months, or 4 or more times within 12 months Might have to have tubes surgically placed for drainage Prevent recurrence of otitis media Surgically placed tubes for drainage Reduce contact with sick people Infectious mononucleosis an infection caused by the Epstein-Barr virus (EBV) that is characterized by fever, a sore throat, and enlarged lymph nodes Common among adolescents Diagnostic testing for infectious mononucleosis Heterophil antibody testing Paul-Bunnell or Monospot tests treatment of infectious mononucleosis Self limiting so no specific treatment Subtle symptoms of mononucleosis General fatigue and feeling unwell Mononucleosis clinical manifestations Along with the subtle symptoms, fever, decreased appetite, sore throat Mononucleosis prodromal stage Beginning of infection post contact with Epstein-Barr virus, General fatigue Mononucleosis illness stage 7-10 days Enlarged spleen No contact sports for months No sharing utensils or other items that come in contact with oral cavity and no kissing Mononucleosis convalescence Last stage and takes months to fully recover Croup syndromes Affect the larynx trachea and bronchi Characterized by: hoarseness Barking cough Inspiratory stridor Varying degrees of respiratory distress Most common croup syndrome Acute Laryngotracheobronchitis (LTB) Viral in nature Humidifiers used Cool mist, especially for acute spasmodic laryngitis Acute Epiglottitis Inflammation of the epiglottis; H influenzae type b is the most common cause, especially in nonimmunized children Acute Epiglottitis symptoms Sore throat Pain Tripod positioning Retractions Inspiratory stridor Mild hypoxia Distress Acute Epiglottitis therapeutic management Potential for complete respiratory obstruction Prevention of acute epiglottitis Haemophilus influenzae type b (Hib) vaccine Bacterial Croup **Emergency!!!** Very dangerous rapidly progressive Bacterial Croup s/s Dysphagia, stridor thats aggravated when supine, drooling, toxic appearance, increased fever, rapid pulse and respirations, accessory muscles used for breathing Bacterial croup treatment Airway protection Corticosteroids Fluids ATB Reassurance Bacterial Croup Nursing considerations Do not take Oral temp, do not open the mouth for assessment. This can cause the airway to close. Get an airway kit ASAP! Stay with the pt and family to keep them calm Acute Laryngotracheobronchitis (LTB) Most common croup syndrome Generally affects children <5 yo Organisms that cause LTB RSV, parainfluenza virus, mycoplasma pneumoniae, influenza a and b viruses Manifestations of LTB Inspiratory stridor Suprasternal retractions Barking or seal-like cough Increasing respiratory distress and hypoxia Can progress to respiratory acidosis, respiratory failure, and death Therapeutic management of LTB Airway management (most important) Maintain hydration (PO or IV) High humidity with cool mist Nebulizer treatments (epinephrine, steroids [dexamethasone]) --Dexamethasone is helpful in decreasing swelling and helping the child breathe Infections of the lower airways Reactive portion of the lower respiratory tract Includes bronchi and bronchioles Cartilaginous support not fully developed until adolescence Constriction of airways Bronchiolitis and RSV Lots of secretions lots of suctioning O2 Medication We need an order for it it can cause major issues Major considerations for use of O2 Can cause toxicity Premature babies can get retinopathy from having it applied. It can decrease a patient's drive to breathe. RSV kids occasionally require O2 but not always. Can receive monoclonal antibodies for RSV Monoclonal Antibodies for RSV Synagis Prophalaxis Given as an IM injection monthly with a maximum of 5 doses Children with Respiratory problems Require small frequent feeds if respirations are >60 breaths per minute hold food or they will aspirate. Make sure that they are eating though Foreign body aspiration Most common in 1-3 year olds Diagnosis is based on Hx and physical signs May result in life threatening airway obstruction Nursing assessment must recognize the signs of foreign body aspiration Prevention is key Prevention of foreign body aspiration Keep small items away and make sure that nothing in the area where the child is. NO BALOONS OR BLOWN UP GLOVES!!! Asthma Chronic inflammatory disorder of the airways Limited airflow or obstruction that reverses spontaneously or with treatment Bronchial hyperresponsiveness Recurring episodic symptoms of Asthma Wheezing Breathlessness Chest tightness Cough (especially at night) Asthma diagnostics • Pulmonary function tests-most accurate • Skin testing for allergens Reactive Airway Disease Pre-asthma a term used to describe any condition that causes hyperreactive bronchioles and bronchospasm; asthma silent chest EMERGENCY!!! This means that no air is moving in and out of lungs! Ominous sign Asthma treatment in pediatrics Long-term control medications Quick relief medications Long term control medications for asthma Prevention -steroids, chromulin, steroids salmeterol (serevent) theophylline - need to monitor serum levels for toxicity Quick relief medications for asthma Rescue Beta2-adrenergic agonists Anticholinergics Metered-Dose Inhaler MDI A miniature spray canister used to direct medications through the mouth and into the lungs. Corticosteroids for Asthma -Reduce inflammation -Used LONG TERM to prevent asthma attacks -NOT Used for immediate relief Cromolyn Sodium for asthma helps reduce inflammation. This medicine is used to treat the symptoms of asthma. It is also used to prevent bronchospasm from exercise or irritants. Never use this medicine to treat an acute asthma attack. Albuterol, metaproterenol, terbutaline beta adrenergic agents (short acting bronchodilators) used for asthma that provide quick relief of symptoms through bronchodilation Theophylline Bronchodilator monitor serum levels of drug Leukotriene modifiers Montelukast (Zafirlukast, Zileuton) Treats exercise induced asthma "Lukast will decrease the effect of Leukotrienes" Reduces airway inflammation and bronchoconstriction by decreasing leukotrienes Side effects: increased liver enzymes with Zafirlukast Take in the evening or two hours before exercise Exercise-Induced Bronchospasm typically begins at the start of exercise and peaks 5-10 minutes after exercise Use short acting B agonist (albuterol) 15 minutes before exercise Chest Physical therapy Aids in lung hygiene; may include postural drainage, percussion, breathing retraining and coughing. hyposensitization the process of rendering hyposensitive, e.g., exposing a patient to an offending substance to reduce his or her sensitivity to the substance Nursing care with Asthma Keep a calm nursing presence Monitor pt with pulse oximetry Allow older children to sit up if they are more comfortable that way Allow parents to remain with their kids Goals of Asthma management Avoid exacerbation Avoid allergens Relieve asthmatic episodes promptly Relieve bronchospasm Monitor function with peak flow meter Self-management of inhalers, devices, and activity regulation Peak Flow Meter a handheld device often used to test those with asthma to measure how quickly the patient can expel air red zone of peak flow meter <50% of personal best Seek medical help NOW! Yellow zone on peak flow meter 50-80% of personal best Symptoms aren't being managed well and will need addressed Green zone of peak flow meter 80% to 100% of personal best Symptoms are being managed well with current treatments Spacer with inhaler use Chamber device that attaches to the mouthpiece of an inhaler. It allows the medication to spread for ease of inhalation. Spacer use steps Shake inhaler test spray of inhaler place inhaler mouthpiece into spacer spray inhaler into spacer have child breath in and out 10 times spray again have child breath in and out 10 times Cystic fibrosis CF Exocrine gland dysfunction that produces multisystem involvement Most common lethal genetic illness among Caucasian children Autosomal recessive trait CF Autosomal Recessive Trait -Child inherits a defective gene from BOTH parents, with an overall incidence of 1:4 -Approximately 3% of the US Caucasian population are symptom free carriers CF Characterized by Thick Sticky mucous Elevation of sweat electrolytes Increase in several organic and enzymatic constituents of saliva Abnormalities in the autonomic nervous system Increase in Na+ and Cl- in saliva and sweat