Nursing 235 Exam 4 || errorless answers 100%.
Structural difference in respiratory system between children and adults correct answers
Small/narrow airways: swelling/secretions make it much more difficult to breathe
Less surface area: periods of apnea can last up to 15 seconds
Lack of collateral pathways: fewer bronchioles, easily clogged, keep nares open, suction with
bulb syringe
Nose breathers: up until 4 weeks, predominately up until 2 years; keep nose suctioned well
Diaphragmatic breathing: not as strong, can't lift ribcage like an adult
What factors can decrease respiratory resistance in children? correct answers -compromised
immune system (breastfeeding and immunizations will help)
-anemia (iron supplements help)
-nutritional deficiencies
-allergies
-exposure to 2nd hand smoke
Normal respirations in age ranges correct answers 0-6 months: 30-60
6-12 months: 24-30
1-5 years: 20-30
6-11 years: 12-20
12 and up: 12-18
Breath sounds correct answers Stridor: harsh, high pitched crowing; caused by upper airway
obstruction (croup)
Grunting: deep guttural sound; premature closing of glottis; signs of respiratory distress
Pleural rub: loud, low pitched, grating sound; inflamed surfaces rubbing together
Crackles/rales: inspiratory=pleurisy or pneumonia; expiratory=inflammation of bronchi
Rhonchi: low pitched snoring sound, may clear after cough
Wheezing: high pitched musical sounds; inspiratory=upper airway obstruction; expiratory=
lower airway obstruction
Cardinal s/s of respiratory failure and hypoxia correct answers -restlessness
,-tachypnea
-tachycardia
-diaphoresis (except in neonates)
Early hypoxia: (depends on age of child)
-mood changes
-HA
-exertional dyspnea
-anxiety
-confusion (older child)
-altered depth/pattern of respirations
-decreased LOC
-HTN
-anorexia
-nasal flaring
-chest wall retractions
-expiratory grunt
-wheezing or prolonged expiration
Late/severe hypoxia:
-HTN to hypotension
-vision decreases
-lethargic/somnolence
-stupor
-dyspnea
-depressed respirations
-bradycardia
-cyanosis (peripheral or central)
-coma
Oxygen and inhalation therapy correct answers 1. Pulse oximetry
2. Nebulizer aerosol therapy
3. Metered dose inhaler or dry powder inhaler
4. Chest physiotherapy
5. Oxygen therapy
6. Suctioning
7. Artificial airways
Pulse oximetry correct answers -make sure the pulse reading is comparable to the radial
pulse/apical pulse
-infants apply the pulse oximetry on their big toe and hold for accuracy
-move the probe every 4-8 hours if on continuous monitoring to prevent pressure necrosis in
infants who have disrupted skin integrity or poor perfusion
-if below expected ranges then confirm if correct, Oxygen is on & correct, sit the child up to
semi or high fowler's position, deep breathe, emotional support and report if no change
,Nebulizer aerosol therapy correct answers -respiratory administers these treatments that are
various meds that are minute particles to disperse throughout the respiratory tract
-treatment lasts 10-15 mins
-determine which device to use depends on age (mouthpiece vs. mask)
-may need vitals prior
-child should take slow deep breaths
-monitor child during tx
-may be ordered home nebs: may need to teach how to operate the home nebulizer
Metered dose inhaler or dry powder inhaler correct answers -open mouth vs. closed mouth
method
-deep breath 3-5 seconds and hold breath 5-10 seconds if applicable
-wait 1 minute between puffs
Education:
-clean the MDI and spacer after each use
-have the child rinse their mouth and expectorate to prevent fungal infections if using a
corticosteroid inhaler
Chest physiotherapy correct answers Includes manual or mechanical percussion (cupping of
hands), vibration (vest), cough, forceful expiration, and breathing exercises
-postural positioning for drainage also involved
-usually respiratory therapist is consulted for this treatment
-need treatments 1 hour before meals or 2 hours afterwards to prevent vomiting and aspiration
-may need bronchodilator or neb treatment prior to facilitate the expiration of the secretions
Oxygen therapy correct answers All the different types (oxygen hood that fits over the infant's
head; nasal cannula; and pediatric face mask)
-humidified to decrease dryness
Suctioning correct answers Infants may require saline squirted in nasal cavity and then suctioned
with small tube
-essential to maintain airway patency of infants and children
-temporarily takes their breath away, startles and causes tears
-educate both child and parents to establish good rapport
-5-10 seconds of suctioning as the catheter is withdrawn
Artificial airways correct answers Endotracheal, tracheostomy may required hyperoxygenation
prior to suctioning
-need to maintain patent airway and prevent mucus plug
Seasonal allergies (hay fever) correct answers Reaction to microscopic particles called allergic
rhinitis; most often in spring and autumn
S/S:
-sneeze
, -watery eyes/rhinorrhea
-nasal congestion/obstruction
-itchiness of nose, eyes, pharynx, and conjunctiva
Prevention:
-avoid irritants
-may need prophylaxis meds and preventative treatment
Treatment:
-Nasal corticosteroids: fluticasone
-Antihistamines
-Beta adrenergic decongestants: pseudoephedrine, for 4 yo and up
-Mast cell stabilizers: cromolyn, for 2 yo and up
-Leukotriene modifiers: montelukast, for 6 mo and up
-Anticholinergic: ipratropium
-Immunotherapy
Medications for allergies correct answers Nasal corticosteroids: fluticasone; 1st line treatment
(local acting anti-inflammatory and immune modifier)
-intranasal: > 4yrs.
Antihistamines (antagonizes the effects of histamine at H1 receptor sites)
-greatest side effects are anticholinergic and sedation but 1st generation has much stronger
effects than 2nd generation
(1st generation: AVOID due to sedation effects, especially under 4 years old: brompheniramine,
chlortrimeton, dimenhydrinate and diphenhydramine)
(2nd generation- cetirizine= 6 months and greater, lortadine= 2 yrs and greater, fexofenadine= 6
months and greater;
Beta Adrenergic Decongestants: pseudoephedrine
> 4 yrs
-produces vasoconstriction in the respiratory tract mucosa (alpha adrenergic stimulation) and
possibly bronchodilation (beta 2 adrenergic stimulation)
Mast cell stabilizers- cromolyn > 2 yrs
-prevents the release of histamine
Leukotriene modifiers - montelukast > 6 months: antagonizes the effects of Leukotrienes
( airway edema, smooth muscle constriction resulting in decreased inflammatory process)
Anticholinergic-ipratropium for neonates and up
-bronchodilation without the systemic anticholinergic effects with inhalant
Immunotherapy - 12 months but depends on the severity of the allergies/asthma S/S if severe
may warrant earlier treatment
Structural difference in respiratory system between children and adults correct answers
Small/narrow airways: swelling/secretions make it much more difficult to breathe
Less surface area: periods of apnea can last up to 15 seconds
Lack of collateral pathways: fewer bronchioles, easily clogged, keep nares open, suction with
bulb syringe
Nose breathers: up until 4 weeks, predominately up until 2 years; keep nose suctioned well
Diaphragmatic breathing: not as strong, can't lift ribcage like an adult
What factors can decrease respiratory resistance in children? correct answers -compromised
immune system (breastfeeding and immunizations will help)
-anemia (iron supplements help)
-nutritional deficiencies
-allergies
-exposure to 2nd hand smoke
Normal respirations in age ranges correct answers 0-6 months: 30-60
6-12 months: 24-30
1-5 years: 20-30
6-11 years: 12-20
12 and up: 12-18
Breath sounds correct answers Stridor: harsh, high pitched crowing; caused by upper airway
obstruction (croup)
Grunting: deep guttural sound; premature closing of glottis; signs of respiratory distress
Pleural rub: loud, low pitched, grating sound; inflamed surfaces rubbing together
Crackles/rales: inspiratory=pleurisy or pneumonia; expiratory=inflammation of bronchi
Rhonchi: low pitched snoring sound, may clear after cough
Wheezing: high pitched musical sounds; inspiratory=upper airway obstruction; expiratory=
lower airway obstruction
Cardinal s/s of respiratory failure and hypoxia correct answers -restlessness
,-tachypnea
-tachycardia
-diaphoresis (except in neonates)
Early hypoxia: (depends on age of child)
-mood changes
-HA
-exertional dyspnea
-anxiety
-confusion (older child)
-altered depth/pattern of respirations
-decreased LOC
-HTN
-anorexia
-nasal flaring
-chest wall retractions
-expiratory grunt
-wheezing or prolonged expiration
Late/severe hypoxia:
-HTN to hypotension
-vision decreases
-lethargic/somnolence
-stupor
-dyspnea
-depressed respirations
-bradycardia
-cyanosis (peripheral or central)
-coma
Oxygen and inhalation therapy correct answers 1. Pulse oximetry
2. Nebulizer aerosol therapy
3. Metered dose inhaler or dry powder inhaler
4. Chest physiotherapy
5. Oxygen therapy
6. Suctioning
7. Artificial airways
Pulse oximetry correct answers -make sure the pulse reading is comparable to the radial
pulse/apical pulse
-infants apply the pulse oximetry on their big toe and hold for accuracy
-move the probe every 4-8 hours if on continuous monitoring to prevent pressure necrosis in
infants who have disrupted skin integrity or poor perfusion
-if below expected ranges then confirm if correct, Oxygen is on & correct, sit the child up to
semi or high fowler's position, deep breathe, emotional support and report if no change
,Nebulizer aerosol therapy correct answers -respiratory administers these treatments that are
various meds that are minute particles to disperse throughout the respiratory tract
-treatment lasts 10-15 mins
-determine which device to use depends on age (mouthpiece vs. mask)
-may need vitals prior
-child should take slow deep breaths
-monitor child during tx
-may be ordered home nebs: may need to teach how to operate the home nebulizer
Metered dose inhaler or dry powder inhaler correct answers -open mouth vs. closed mouth
method
-deep breath 3-5 seconds and hold breath 5-10 seconds if applicable
-wait 1 minute between puffs
Education:
-clean the MDI and spacer after each use
-have the child rinse their mouth and expectorate to prevent fungal infections if using a
corticosteroid inhaler
Chest physiotherapy correct answers Includes manual or mechanical percussion (cupping of
hands), vibration (vest), cough, forceful expiration, and breathing exercises
-postural positioning for drainage also involved
-usually respiratory therapist is consulted for this treatment
-need treatments 1 hour before meals or 2 hours afterwards to prevent vomiting and aspiration
-may need bronchodilator or neb treatment prior to facilitate the expiration of the secretions
Oxygen therapy correct answers All the different types (oxygen hood that fits over the infant's
head; nasal cannula; and pediatric face mask)
-humidified to decrease dryness
Suctioning correct answers Infants may require saline squirted in nasal cavity and then suctioned
with small tube
-essential to maintain airway patency of infants and children
-temporarily takes their breath away, startles and causes tears
-educate both child and parents to establish good rapport
-5-10 seconds of suctioning as the catheter is withdrawn
Artificial airways correct answers Endotracheal, tracheostomy may required hyperoxygenation
prior to suctioning
-need to maintain patent airway and prevent mucus plug
Seasonal allergies (hay fever) correct answers Reaction to microscopic particles called allergic
rhinitis; most often in spring and autumn
S/S:
-sneeze
, -watery eyes/rhinorrhea
-nasal congestion/obstruction
-itchiness of nose, eyes, pharynx, and conjunctiva
Prevention:
-avoid irritants
-may need prophylaxis meds and preventative treatment
Treatment:
-Nasal corticosteroids: fluticasone
-Antihistamines
-Beta adrenergic decongestants: pseudoephedrine, for 4 yo and up
-Mast cell stabilizers: cromolyn, for 2 yo and up
-Leukotriene modifiers: montelukast, for 6 mo and up
-Anticholinergic: ipratropium
-Immunotherapy
Medications for allergies correct answers Nasal corticosteroids: fluticasone; 1st line treatment
(local acting anti-inflammatory and immune modifier)
-intranasal: > 4yrs.
Antihistamines (antagonizes the effects of histamine at H1 receptor sites)
-greatest side effects are anticholinergic and sedation but 1st generation has much stronger
effects than 2nd generation
(1st generation: AVOID due to sedation effects, especially under 4 years old: brompheniramine,
chlortrimeton, dimenhydrinate and diphenhydramine)
(2nd generation- cetirizine= 6 months and greater, lortadine= 2 yrs and greater, fexofenadine= 6
months and greater;
Beta Adrenergic Decongestants: pseudoephedrine
> 4 yrs
-produces vasoconstriction in the respiratory tract mucosa (alpha adrenergic stimulation) and
possibly bronchodilation (beta 2 adrenergic stimulation)
Mast cell stabilizers- cromolyn > 2 yrs
-prevents the release of histamine
Leukotriene modifiers - montelukast > 6 months: antagonizes the effects of Leukotrienes
( airway edema, smooth muscle constriction resulting in decreased inflammatory process)
Anticholinergic-ipratropium for neonates and up
-bronchodilation without the systemic anticholinergic effects with inhalant
Immunotherapy - 12 months but depends on the severity of the allergies/asthma S/S if severe
may warrant earlier treatment
