BROWARD COLLEGE NUR 1310 EXAM 2 OUTLINE 2 PEDS
QUESTIONS AND ANSWERS |
COMPLETE PEDIATRIC NURSING STUDY GUIDE 2026/2027
UNIT 8: RESPIRATORY DISORDERS
STRUCTURES OF UPPER/LOWER RESPIRATORY TRACT
• UPPER RESPIRATORY TRACT
o Mouth and nose
o Pharynx
o Larynx (voicebox)
▪ Infections of the epiglottis and larynx are categorized as croup syndromes
(respiratory INFECTION/SWELLING OF TRACHEA SYMPTOMS ARE
BARKING COUGH, HOARSE VOICE)
o Upper trachea
• LOWER RESPIRATORY TRACT
o Lower trachea
o Bronchi
o Bronchioles
o Alveoli
• Respiratory infections seldom fall into discrete anatomic areas
o Infections often spread from one structure to another because of the
contiguous nature of the mucous membrane lining the entire tract
o The effect on one area may predominate in any given illness
• Most respiratory infections are caused by viruses (e.g. RSV-RESPIRATORY
SYNTICAL VIRUS)
• RIGHT LUNG HAS THREE LOBES AND LEFT LUNG HAS TWO (the heart shares same space
as left lung).
RESPIRATORY RATES AT REST
• < 1 year = 30-40 breathes/min
• 1-2 = 25-35
• 2-5 = 25-30
• 5-12 = 20-25
• > 12 = 15-20
ASSESSING BREATH SOUNDS
• http://www.youtube.com/watch?v=5JA6D1Mguh0
• http://www.youtube.com/watch?v=t2QE0O_exAQ
• http://www.youtube.com/watch?v=Z1_uKqmPyLA
• HYPOPNEA: breathing that is too shallow
• HYPERPENEA: breathing that is too deep
• ORTHOPNEA: difficulty breathing except in upright position
o Associated with intercostal or substernal retractions
▪ Inspiratory “sinking in” of soft tissues in relation to the cartilaginous
, and bony thorax
• PULSUS PARADOXUS: blood pressure falling with inspiration and rising with expiration
, • HEAD BOBBING: head of sleeping child with sub-occipital area supported on caregiver’s
forearm bobbing forward in synchrony with each inspiration
•
• COUGH (observe characteristics)
o Under what circumstances (night only, on arising)
o Nature of the cough (paroxysmal (sudden and violent), with or
without wheezing, “croupy” or “brassy”
o Frequency of cough
o Association with swallowing or other activity
o Character of cough (moist and dry)
o Productivity
• HALITOSIS: (Term for BAD BREATHE)
o May be associated with some upper airway infections
o More common in mouth breathers
PEDIATRIC DIFFERENCES
• Diameter of airway smaller in young children
o Subject to considerable narrowing from edematous mucous membranes
and increased production of secretions
o Organisms may move rapidly down the shorter respiratory tract of
younger children, causing more extensive involvement
• Eustachian tube shorter
o Allows pathogens easy access to the middle ear
• Daycare attendance and exposure to secondhand smoke increase the likelihood of
infection
• INFANTS especially are prone to fluid and electrolytic deficits during respiratory illness
because a rapid respiratory rate that accompanies such illnesses precludes adequate
oral fluid intake
• Also, the presence of fever increases the total body fluid turnover in infants
• A/P: lateral diameter
o They are equal before age 2
o Ratio is 2:1 starting at age 2
LESS RESISTANCE TO RESPIRATORY INFECTIONS:
• Deficit in immune system (children in general)
o Children between 6 months and 3 years of age react more severely to acute
respiratory tract infections than older children
• Allergies
• Cardiac anomalies
• Cystic fibrosis
• Daycare attendance
• Second-hand smoke
o Smoke outside, not in the house
, SEASONAL VARIATIONS IN RESPIRATORY INFECTION
• Respiratory conditions more common during winter and spring
• Mycoplasma infections aka (PNEUMONIA) OTITIS MEDIA WHICH IS EAR INFECTION
ALSO OCCUR: fall and early winter
• Asthma: more frequent in cold weather, winter and early spring
• RSV (respiratory synctical virus) season: winter and early spring
BRONCHIOLOTIS
• Inflammation of bronchioles
• Viral infection
• Maximum effect at the bronchiolar level
• INCIDENCE
o Common cause for hospitalization < age 1
o More common in children < 2 years
o Peak age: 2-6 months
o Tends to occur in winter and spring
• ETIOLOGY-CAUSE
o Viral: adenovirus, parainfluenza
o Bacteria
o Microplasma AKA PNEUMONIA
o Most common cause: RSV (respiratory synctical virus)
TRANSMISSION/PATHOPHYSIOLOGY OF BRONCHIOLOTIS
• TRANSMISSION
o Person to person from contaminated hands
▪ Virus can live several hours on fomites(door,table,desk etc) and on
hands for 30 minutes
o Nosocomial outbreaks common
• PATHOPHYSIOLOGY
o Viruses invade epithelial cell walls of respiratory tract (RSV produces a fusion of
cell membranes, forming a giant cell) edema, mucus, cellular debris clogging of
bronchioles obstruction & irritation, edema & inflammation increased mucus
and decreased air transport hyperinflation impaired gas exchange (patient
can’t exhale well, trapping air in alveoli) increased PaCO2, acidosis
o ALTERNATIVE PATHOPHYSIOLOGY FROM CHART ON NEXT SLIDE:
▪ Upper respiratory infection usually by respiratory syncytial virus (RSV)
edema, mucus, and cellular debris obstruct bronchioles bronchioles
constrict during expiration, causing hyperinflation of lungs atelectasis
(which is complete or partial collapse of lung/lobe) occurs when
obstruction is complete and trapped air is absorbed normal exchange of
gases impaired hypoxemia metabolic acidosis, mild respiratory alkalosis
QUESTIONS AND ANSWERS |
COMPLETE PEDIATRIC NURSING STUDY GUIDE 2026/2027
UNIT 8: RESPIRATORY DISORDERS
STRUCTURES OF UPPER/LOWER RESPIRATORY TRACT
• UPPER RESPIRATORY TRACT
o Mouth and nose
o Pharynx
o Larynx (voicebox)
▪ Infections of the epiglottis and larynx are categorized as croup syndromes
(respiratory INFECTION/SWELLING OF TRACHEA SYMPTOMS ARE
BARKING COUGH, HOARSE VOICE)
o Upper trachea
• LOWER RESPIRATORY TRACT
o Lower trachea
o Bronchi
o Bronchioles
o Alveoli
• Respiratory infections seldom fall into discrete anatomic areas
o Infections often spread from one structure to another because of the
contiguous nature of the mucous membrane lining the entire tract
o The effect on one area may predominate in any given illness
• Most respiratory infections are caused by viruses (e.g. RSV-RESPIRATORY
SYNTICAL VIRUS)
• RIGHT LUNG HAS THREE LOBES AND LEFT LUNG HAS TWO (the heart shares same space
as left lung).
RESPIRATORY RATES AT REST
• < 1 year = 30-40 breathes/min
• 1-2 = 25-35
• 2-5 = 25-30
• 5-12 = 20-25
• > 12 = 15-20
ASSESSING BREATH SOUNDS
• http://www.youtube.com/watch?v=5JA6D1Mguh0
• http://www.youtube.com/watch?v=t2QE0O_exAQ
• http://www.youtube.com/watch?v=Z1_uKqmPyLA
• HYPOPNEA: breathing that is too shallow
• HYPERPENEA: breathing that is too deep
• ORTHOPNEA: difficulty breathing except in upright position
o Associated with intercostal or substernal retractions
▪ Inspiratory “sinking in” of soft tissues in relation to the cartilaginous
, and bony thorax
• PULSUS PARADOXUS: blood pressure falling with inspiration and rising with expiration
, • HEAD BOBBING: head of sleeping child with sub-occipital area supported on caregiver’s
forearm bobbing forward in synchrony with each inspiration
•
• COUGH (observe characteristics)
o Under what circumstances (night only, on arising)
o Nature of the cough (paroxysmal (sudden and violent), with or
without wheezing, “croupy” or “brassy”
o Frequency of cough
o Association with swallowing or other activity
o Character of cough (moist and dry)
o Productivity
• HALITOSIS: (Term for BAD BREATHE)
o May be associated with some upper airway infections
o More common in mouth breathers
PEDIATRIC DIFFERENCES
• Diameter of airway smaller in young children
o Subject to considerable narrowing from edematous mucous membranes
and increased production of secretions
o Organisms may move rapidly down the shorter respiratory tract of
younger children, causing more extensive involvement
• Eustachian tube shorter
o Allows pathogens easy access to the middle ear
• Daycare attendance and exposure to secondhand smoke increase the likelihood of
infection
• INFANTS especially are prone to fluid and electrolytic deficits during respiratory illness
because a rapid respiratory rate that accompanies such illnesses precludes adequate
oral fluid intake
• Also, the presence of fever increases the total body fluid turnover in infants
• A/P: lateral diameter
o They are equal before age 2
o Ratio is 2:1 starting at age 2
LESS RESISTANCE TO RESPIRATORY INFECTIONS:
• Deficit in immune system (children in general)
o Children between 6 months and 3 years of age react more severely to acute
respiratory tract infections than older children
• Allergies
• Cardiac anomalies
• Cystic fibrosis
• Daycare attendance
• Second-hand smoke
o Smoke outside, not in the house
, SEASONAL VARIATIONS IN RESPIRATORY INFECTION
• Respiratory conditions more common during winter and spring
• Mycoplasma infections aka (PNEUMONIA) OTITIS MEDIA WHICH IS EAR INFECTION
ALSO OCCUR: fall and early winter
• Asthma: more frequent in cold weather, winter and early spring
• RSV (respiratory synctical virus) season: winter and early spring
BRONCHIOLOTIS
• Inflammation of bronchioles
• Viral infection
• Maximum effect at the bronchiolar level
• INCIDENCE
o Common cause for hospitalization < age 1
o More common in children < 2 years
o Peak age: 2-6 months
o Tends to occur in winter and spring
• ETIOLOGY-CAUSE
o Viral: adenovirus, parainfluenza
o Bacteria
o Microplasma AKA PNEUMONIA
o Most common cause: RSV (respiratory synctical virus)
TRANSMISSION/PATHOPHYSIOLOGY OF BRONCHIOLOTIS
• TRANSMISSION
o Person to person from contaminated hands
▪ Virus can live several hours on fomites(door,table,desk etc) and on
hands for 30 minutes
o Nosocomial outbreaks common
• PATHOPHYSIOLOGY
o Viruses invade epithelial cell walls of respiratory tract (RSV produces a fusion of
cell membranes, forming a giant cell) edema, mucus, cellular debris clogging of
bronchioles obstruction & irritation, edema & inflammation increased mucus
and decreased air transport hyperinflation impaired gas exchange (patient
can’t exhale well, trapping air in alveoli) increased PaCO2, acidosis
o ALTERNATIVE PATHOPHYSIOLOGY FROM CHART ON NEXT SLIDE:
▪ Upper respiratory infection usually by respiratory syncytial virus (RSV)
edema, mucus, and cellular debris obstruct bronchioles bronchioles
constrict during expiration, causing hyperinflation of lungs atelectasis
(which is complete or partial collapse of lung/lobe) occurs when
obstruction is complete and trapped air is absorbed normal exchange of
gases impaired hypoxemia metabolic acidosis, mild respiratory alkalosis
