N203 (Peds) - Exam 1Questions And
Correct Answers
,Respiratory differences in a child - CORRECT ANS- Nares are smaller, easily occluded, nose breathers
- Epiglottis: longer and more flaccid, more prone to aspiration
- Thyroid, cricoids, and tracheal cartilages are immature and more easily collapsible, more susceptible to
infection and edema
- Trachea: shorter and more narrow, about 4 mm, bifurcates at 3rd thoracic vertebra, angle much
sharper (more prone for aspiration)
- Lung tissue: immature at birth and continues to grow and develop until about age 12, less gas
exchange
- Ventilation: children under 6 are abdominal breathers, intercostals are weak
Respiratory distress in children s/sx - CORRECT ANSSternal retractions, use of intercostals muscles,
flaring of nares, grunting, restlessness, increased heart rate, increased respiratory rate
Neonates are nose breathers - CORRECT ANS- Thus obstruction in nasal passages interferes with
breathing and eating, narrower airways increase airway resistance and increase risk for obstruction by
edema, mucus, or foreign objects
- Infant's airway walls have less cartilage, are more flexible and more prone to collapse
- Intercostal muscles are immature, chest wall is less stable and retractions are more common
Respiratory assessment - CORRECT ANSposition of comfort, vital signs, lung auscultation, respiratory
effort, color, cough, behavior change, family hx
Dx procedures (respiratory concerns) - CORRECT ANSCxR, CT, bronchoscope, PFTs, sputum/throat
culture (nasopharyngeal cultures), ABGs, pulse ox, nasopharyngeal washings
Respiratory tx - CORRECT ANS- Aerosol therapy (nebs, MDIs)
- Postural drainage/chest PT
- Suctioning
- Tracheotomy
,- CPR
- O2 therapy
O2 therapy (respiratory concerns) - CORRECT ANS- Delivered for hypoxemia, oxygen consumption is
higher in children related to greater metabolic rate, oxygen consumption increases when child is in
respiratory distress
- Delivered via: mask, nasal cannula, plastic hood (well tolerated by infants), oxygen tent (older infants)
Caring for a child in an oxygen tent - CORRECT ANS- **Plan care so tent is opened as little as possible**
- If tent is opened for an extended period of time, it is 'flushed' with oxygen
- Be certain tent is 'tucked in' all along edges
- Monitor temp in tent
- Keep child warm, dry and calm
Croup syndromes (upper airway) - CORRECT ANS- Acute epiglottis, acute laryngitis, acute
laryngotracheobronchitis, bacterial tracheitis
- **Croup is a generic term applied to a broad classification of upper airway illnesses that result from
swelling of the epiglottis and larynx**
- Swelling usually extends into trachea and bronchi
- Described is described according to the main anatomical area affected
- Initial manifestations of all 3 of these include inspiratory stridor, a 'seal-like' barking cough and
hoarseness
Epiglotitis (type of croup syndrome) - CORRECT ANS- **MEDICAL EMERGENCY!**
- Inflammation of epiglottis, site of obstruction is supraglottic and life threatening because edema in this
area can obstruct airway and occlude the trachea in minutes
- Most often in children ages 2-5 years
, - Patho: bacteria causes epiglottis to become cherry, red, swollen, and edematous, obstructs airway,
secretions pool in pharynx and larynx, child has a sore throat and is unable to swallow, strep, staph, Hib
Epiglotitis s/sx and dx - CORRECT ANS- Healthy child suddenly becomes very ill, high fever, URI, severe
throat, **dysphagia, drooling, dysphonia, decreased respiratory effort*, tripod position, increased
HR/RR
- Dx: physical assessment, visual inspection of mouth/throat is CONTRAINDICATED due to complete
obstruction, lateral neck XR, CBC, blood cultures
- **Keep this child calm! Prevent laryngospasms!!**
Epiglotitis tx - CORRECT ANS- Never leave child unattended, support child in position of comfort, calm,
quiet environment, O2, IV abx, corticosteroids, antipyretics, hydration
- Nursing management: **all invasive procedures are performed in ER/OR with emergency equipment
and ventilation available**, airway management, cardiac/apnea monitor, med therapy, hydration,
emotional support of child/parents, child is closely monitored in PICU, D/C home on abx
Acute Laryngotracheobronchitis (type of croup syndrome) - CORRECT ANS- Most common of croup
syndromes, viral infection that causes inflammation, edema, and narrowing of larynx, trachea, bronchi
- Generally preceded by a recent URI, most often occurs in children younger than 5 years
- Patho: caused by parainfluenzae virus, influenza A and B, respiratory syncytial virus (RSV), or
mycoplasma plneumoniae
- Airway tissues respond to invading virus with inflammation and edema
- Copious, tenacious secretions
Acute Laryngotracheobronchitis s/sx - CORRECT ANS- Gradual onset, begins with URI, low grade fever,
sore throat/hoarseness, child goes to bed, wakes with barking cough, inspiratory stridor, uses accessory
muscles to breath, larynx, trachea, and major bronchi are inflamed, restless, frightened
- By morning, s/sx subside except for barking cough
- Dx: hx, physical assessment, pulse ox, anteroposterior and lateral x-ray
Correct Answers
,Respiratory differences in a child - CORRECT ANS- Nares are smaller, easily occluded, nose breathers
- Epiglottis: longer and more flaccid, more prone to aspiration
- Thyroid, cricoids, and tracheal cartilages are immature and more easily collapsible, more susceptible to
infection and edema
- Trachea: shorter and more narrow, about 4 mm, bifurcates at 3rd thoracic vertebra, angle much
sharper (more prone for aspiration)
- Lung tissue: immature at birth and continues to grow and develop until about age 12, less gas
exchange
- Ventilation: children under 6 are abdominal breathers, intercostals are weak
Respiratory distress in children s/sx - CORRECT ANSSternal retractions, use of intercostals muscles,
flaring of nares, grunting, restlessness, increased heart rate, increased respiratory rate
Neonates are nose breathers - CORRECT ANS- Thus obstruction in nasal passages interferes with
breathing and eating, narrower airways increase airway resistance and increase risk for obstruction by
edema, mucus, or foreign objects
- Infant's airway walls have less cartilage, are more flexible and more prone to collapse
- Intercostal muscles are immature, chest wall is less stable and retractions are more common
Respiratory assessment - CORRECT ANSposition of comfort, vital signs, lung auscultation, respiratory
effort, color, cough, behavior change, family hx
Dx procedures (respiratory concerns) - CORRECT ANSCxR, CT, bronchoscope, PFTs, sputum/throat
culture (nasopharyngeal cultures), ABGs, pulse ox, nasopharyngeal washings
Respiratory tx - CORRECT ANS- Aerosol therapy (nebs, MDIs)
- Postural drainage/chest PT
- Suctioning
- Tracheotomy
,- CPR
- O2 therapy
O2 therapy (respiratory concerns) - CORRECT ANS- Delivered for hypoxemia, oxygen consumption is
higher in children related to greater metabolic rate, oxygen consumption increases when child is in
respiratory distress
- Delivered via: mask, nasal cannula, plastic hood (well tolerated by infants), oxygen tent (older infants)
Caring for a child in an oxygen tent - CORRECT ANS- **Plan care so tent is opened as little as possible**
- If tent is opened for an extended period of time, it is 'flushed' with oxygen
- Be certain tent is 'tucked in' all along edges
- Monitor temp in tent
- Keep child warm, dry and calm
Croup syndromes (upper airway) - CORRECT ANS- Acute epiglottis, acute laryngitis, acute
laryngotracheobronchitis, bacterial tracheitis
- **Croup is a generic term applied to a broad classification of upper airway illnesses that result from
swelling of the epiglottis and larynx**
- Swelling usually extends into trachea and bronchi
- Described is described according to the main anatomical area affected
- Initial manifestations of all 3 of these include inspiratory stridor, a 'seal-like' barking cough and
hoarseness
Epiglotitis (type of croup syndrome) - CORRECT ANS- **MEDICAL EMERGENCY!**
- Inflammation of epiglottis, site of obstruction is supraglottic and life threatening because edema in this
area can obstruct airway and occlude the trachea in minutes
- Most often in children ages 2-5 years
, - Patho: bacteria causes epiglottis to become cherry, red, swollen, and edematous, obstructs airway,
secretions pool in pharynx and larynx, child has a sore throat and is unable to swallow, strep, staph, Hib
Epiglotitis s/sx and dx - CORRECT ANS- Healthy child suddenly becomes very ill, high fever, URI, severe
throat, **dysphagia, drooling, dysphonia, decreased respiratory effort*, tripod position, increased
HR/RR
- Dx: physical assessment, visual inspection of mouth/throat is CONTRAINDICATED due to complete
obstruction, lateral neck XR, CBC, blood cultures
- **Keep this child calm! Prevent laryngospasms!!**
Epiglotitis tx - CORRECT ANS- Never leave child unattended, support child in position of comfort, calm,
quiet environment, O2, IV abx, corticosteroids, antipyretics, hydration
- Nursing management: **all invasive procedures are performed in ER/OR with emergency equipment
and ventilation available**, airway management, cardiac/apnea monitor, med therapy, hydration,
emotional support of child/parents, child is closely monitored in PICU, D/C home on abx
Acute Laryngotracheobronchitis (type of croup syndrome) - CORRECT ANS- Most common of croup
syndromes, viral infection that causes inflammation, edema, and narrowing of larynx, trachea, bronchi
- Generally preceded by a recent URI, most often occurs in children younger than 5 years
- Patho: caused by parainfluenzae virus, influenza A and B, respiratory syncytial virus (RSV), or
mycoplasma plneumoniae
- Airway tissues respond to invading virus with inflammation and edema
- Copious, tenacious secretions
Acute Laryngotracheobronchitis s/sx - CORRECT ANS- Gradual onset, begins with URI, low grade fever,
sore throat/hoarseness, child goes to bed, wakes with barking cough, inspiratory stridor, uses accessory
muscles to breath, larynx, trachea, and major bronchi are inflamed, restless, frightened
- By morning, s/sx subside except for barking cough
- Dx: hx, physical assessment, pulse ox, anteroposterior and lateral x-ray
