Pediatric Nursing – Respiratory Topic Final Exam
Questions and Answers
What is acute epiglottitis?
A serious obstructive inflammatory process requiring IMMEDIATE MEDICAL
ATTENTION!
What usually causes acute epiglottitis?
Haemophilus influenzae type B (Hib), Strep and Staph
What are the clinical manifestations of acute epiglottitis?
Fever, sore throat, pain
Dysphagia - drooling
Tripod positioning (leaning forward, chin out, mouth open), retractions
Inspiratory stridor (frog like croaking sound on inspiration, mild hypoxia
Irritable, restless, anxious, frightened
Describe the therapeutic measures taken to manage acute epiglottitis.
Assess for potential respiratory obstruction
Nasotracheal intubation or tracheostomy
,Medications like:
Heliox
Rifampin
Antipyretics for fever and pain
Rifampin
Antimicrobial: inhibitor of DNA-dependent RNA polymerase used in drug
regimens for tuberculosis and the meningococcal carrier state. Tox: hepatic
dysfunction, induction of liver drug- metabolizing enzymes (drug interactions),
flulike syndrome with intermittent dosing. Rifabutin similar but associated with
fewer drug interactions.
Heliox
breathing gas that consists of helium and oxygen that redistributes other gases
and opens up airways
Describe the nursing interventions employed to manage acute epiglottitis
Avoid throat exam unless emergency airway equipment is available
Delay start of IV or any procedure that may cause anxiety
Administer Oxygen
Prepare for intubation
Reduce anxiety
Implement comfort measures
,Minimize crying
How effective is the Hib vaccine?
99% reduction of epiglottitis
What is bronchiolitis?
An acute viral infection that effects the bronchioles. 70% of cases are caused by
RSV (Respiratory Syncytial Virus) but may also be caused by adenovirus,
parainfluenza and metapneumovirus
When does RSV normally occur and in which patient population?
winter and spring
children under 3
What is the most frequent cause of hospitalization in children under 1 year?
RSV Bronchiolitis
A severe RSV infection in the first year of life can be a significant factor in
developing what in later years?
Asthma
, How many cases of RSV are recorded in Arizona each year
2000 - 3000 cases
Describe the Patho of RSV
Affects the epithelial cells of the respiratory tract
Invaded cells die when the virus bursts from inside the cell to invade adjacent
cells
Creates large masses of cells that clog and irritate the airway
Lumina swells and fills with mucus and exudate
Symptoms peak at 5-7 days.
What are the clinical manifestations of RSV?
-Usually happens after an URI or may have no symptoms except slight lethargy,
poor feeding or irritability
-Mx progress to severe runny/stuffy nose, wheezing, retractions, crackles,
dyspnea, tachypnea, diminished breath sounds
Retractions - start low on chest - substernal or subcostal
- move upward as severity increases - intercostal, then supraclavicular and
suprasternal
- Apnea may be first symptom in very young infants
Questions and Answers
What is acute epiglottitis?
A serious obstructive inflammatory process requiring IMMEDIATE MEDICAL
ATTENTION!
What usually causes acute epiglottitis?
Haemophilus influenzae type B (Hib), Strep and Staph
What are the clinical manifestations of acute epiglottitis?
Fever, sore throat, pain
Dysphagia - drooling
Tripod positioning (leaning forward, chin out, mouth open), retractions
Inspiratory stridor (frog like croaking sound on inspiration, mild hypoxia
Irritable, restless, anxious, frightened
Describe the therapeutic measures taken to manage acute epiglottitis.
Assess for potential respiratory obstruction
Nasotracheal intubation or tracheostomy
,Medications like:
Heliox
Rifampin
Antipyretics for fever and pain
Rifampin
Antimicrobial: inhibitor of DNA-dependent RNA polymerase used in drug
regimens for tuberculosis and the meningococcal carrier state. Tox: hepatic
dysfunction, induction of liver drug- metabolizing enzymes (drug interactions),
flulike syndrome with intermittent dosing. Rifabutin similar but associated with
fewer drug interactions.
Heliox
breathing gas that consists of helium and oxygen that redistributes other gases
and opens up airways
Describe the nursing interventions employed to manage acute epiglottitis
Avoid throat exam unless emergency airway equipment is available
Delay start of IV or any procedure that may cause anxiety
Administer Oxygen
Prepare for intubation
Reduce anxiety
Implement comfort measures
,Minimize crying
How effective is the Hib vaccine?
99% reduction of epiglottitis
What is bronchiolitis?
An acute viral infection that effects the bronchioles. 70% of cases are caused by
RSV (Respiratory Syncytial Virus) but may also be caused by adenovirus,
parainfluenza and metapneumovirus
When does RSV normally occur and in which patient population?
winter and spring
children under 3
What is the most frequent cause of hospitalization in children under 1 year?
RSV Bronchiolitis
A severe RSV infection in the first year of life can be a significant factor in
developing what in later years?
Asthma
, How many cases of RSV are recorded in Arizona each year
2000 - 3000 cases
Describe the Patho of RSV
Affects the epithelial cells of the respiratory tract
Invaded cells die when the virus bursts from inside the cell to invade adjacent
cells
Creates large masses of cells that clog and irritate the airway
Lumina swells and fills with mucus and exudate
Symptoms peak at 5-7 days.
What are the clinical manifestations of RSV?
-Usually happens after an URI or may have no symptoms except slight lethargy,
poor feeding or irritability
-Mx progress to severe runny/stuffy nose, wheezing, retractions, crackles,
dyspnea, tachypnea, diminished breath sounds
Retractions - start low on chest - substernal or subcostal
- move upward as severity increases - intercostal, then supraclavicular and
suprasternal
- Apnea may be first symptom in very young infants
