lOMoAR cPSD| 45431851
1
RN330 Pediatric Nursing Study Guide Exam 2
(Cardiovascular, Respiratory, GI, GU) ATI Book: CH
16-26 Respiratory:
Upper Respiratory Infection
• Include Oronasopharynx, pharynx, larynx, and trachea
• Commonly caused by viruses like coronavirus, rhinovirus, adenovirus
• Symptoms include runny nose, sore throat, fever, congestion, and
malaise
• Management - hydration is important o Avoid antibiotics since URI
are usually viral
o Symptomatic treatment like acetaminophen for fever and
pain, rest.
Acute Pharyngitis
• Seen in 4–12-year-old children • Patho: inflammation of the pharynx
• Clinical Manifestations:
o Low-grade fever, sore throat, rhinitis, conjunctivitis, cough, hoarseness, erythema of pharynx,
headache, anorexia (d/t sore throat), malaise (not feeling well like fatigue)
o Streptococcal pharyngitis: white exudate in pharynx and fever • Throat culture performed to
reveal pathogenic agent • Medical management:
o Viral - treated symptomatically with lozenges (choking hazard for under 5), gargles for
soothing throat, and acetaminophen for fever
o Streptococcal pharyngitis - 10-day antibiotics penicillin
• Nursing interventions and teaching o If streptococcal left untreated it can travel to Heart
and kidneys causing acute glomerulonephritis and rhematic fever
o Cool fluids to soothe throat, soft and bland diet - hard and spices can irritate throat o Scarlet
fever may be caused by group A streptococcus, but not commonly seen in US
Tonsillitis/Tonsillectomy
• Inflammation of tonsils, could be viral or bacterial and usually occurs with pharyngitis
• Clinical Manifestations:
o Sore throat, edema of tonsils, white exudate with bacterial, nasal and muXled voice d/t tonsils
covering airway, tender cervical lymph node since
it is closer, fever, persistent cough
o Possible OM and diXiculty hearing since tonsils
and ears really close in kids
o May have “kissing tonsils” since their tonsils are
already close swelling can cause them bigger
• Medical Management:
o Bacterial treated with antibiotics
, lOMoAR cPSD| 45431851
2
o If recurrent and interfere with eating or breathing or frequent streptococcal → tonsillectomy
recommended
o Surgery is also to decrease deafness and OM
• Nursing intervention:
o Keep them in semi-prone position postoperatively o Monitor for frequent swallowing → may
indicate bleeding and turn them to the side
o No red or acidic food or drinks and no chocolate drinks to distinguish bleeding fresh or old
from food color
o Give analgesics as ordered
o Signs of hemorrhage: tachycardia, pallor, low bp (late sign), frequent clearing of throat,
hypovolemic shock
Otitis media
• Most acute otitis media episodes are seen in first 24 months of life
• Many cases occur after viral respiratory infection
• Caused by streptococcus pneumoniae, H. influenzae, and Moraxella catarrhalis
• Eustachian tube is small, short, and wide in children, → allows passage of nasopharyngeal into the
middle ear
• Clinical manifestation: o Fever as high as above 104 F, rhinitis, irritability, pulling onto ear (infants
turning head around)
• Upright feeding position (especially in bottle-fed), Do not “PROP”
• Evaluate foreign bodies in ear • Medical management:
o High dose of amoxicillin 80mg/kg/day - 90mg/kg/day for 10 days o
Acetaminophen for fever and discomfort o Ibuprofen should be given to older
Myringotomy - tube placed in ear by surgery to allow drainage of fluid, for recurrent
infection, if falls oX placed back by surgery
than 6 months o
• Nursing care:
o Pain relief, prevent complication, education and support
Airway obstruction
• Objects placed in mouth, nose, or ear
• May lodge in mainstem or lobar bronchus, or more distal lung field, or trachea
• Could move from smaller to larger airways with cough or may re-aspirated into diXerent passageway
or be ejected into the mouth and swollen
• First degree obstruction: wheezing heard, air passes around object during inspiration and expiration
• Second degree: bronchioles enlarge and allow air to pass from distal portion but on expiration airway
diminishes
• Third degree: air unable to move either way, obstruction occurs with atelectasis
• Symptoms may include stridor, wheezing, choking, cyanosis
• An emergency and may require intubation or tracheostomy • Page 285 on ATI book
, lOMoAR cPSD| 45431851
3
•
Croup/Laryngotracheobronchitis
• Hoarseness, “barking” “seal-like” or “brassy” (croupy) cough, inspiratory stridor (high pitch, upper
airway), and respiratory distress from larynx or obstruction in the larynx and subglottic airway
• Usually viral and starts in late fall and early winter
• Caused by hib
• Can impact larynx, trachea, and bronchi
• Described according to primary area aXected such as epiglottitis (deadly), laryngitis • Common in 6
months to 3-year-old
•
• Medical management: o Secure the child’s airway, artificial airway as needed! o Most benign
condition causing upper airway obstruction o Most of the times they don’t require oxygen
o Must be correctly identified early to rule out more serious conditions like epiglottitis o Sound
worse than they look
1
RN330 Pediatric Nursing Study Guide Exam 2
(Cardiovascular, Respiratory, GI, GU) ATI Book: CH
16-26 Respiratory:
Upper Respiratory Infection
• Include Oronasopharynx, pharynx, larynx, and trachea
• Commonly caused by viruses like coronavirus, rhinovirus, adenovirus
• Symptoms include runny nose, sore throat, fever, congestion, and
malaise
• Management - hydration is important o Avoid antibiotics since URI
are usually viral
o Symptomatic treatment like acetaminophen for fever and
pain, rest.
Acute Pharyngitis
• Seen in 4–12-year-old children • Patho: inflammation of the pharynx
• Clinical Manifestations:
o Low-grade fever, sore throat, rhinitis, conjunctivitis, cough, hoarseness, erythema of pharynx,
headache, anorexia (d/t sore throat), malaise (not feeling well like fatigue)
o Streptococcal pharyngitis: white exudate in pharynx and fever • Throat culture performed to
reveal pathogenic agent • Medical management:
o Viral - treated symptomatically with lozenges (choking hazard for under 5), gargles for
soothing throat, and acetaminophen for fever
o Streptococcal pharyngitis - 10-day antibiotics penicillin
• Nursing interventions and teaching o If streptococcal left untreated it can travel to Heart
and kidneys causing acute glomerulonephritis and rhematic fever
o Cool fluids to soothe throat, soft and bland diet - hard and spices can irritate throat o Scarlet
fever may be caused by group A streptococcus, but not commonly seen in US
Tonsillitis/Tonsillectomy
• Inflammation of tonsils, could be viral or bacterial and usually occurs with pharyngitis
• Clinical Manifestations:
o Sore throat, edema of tonsils, white exudate with bacterial, nasal and muXled voice d/t tonsils
covering airway, tender cervical lymph node since
it is closer, fever, persistent cough
o Possible OM and diXiculty hearing since tonsils
and ears really close in kids
o May have “kissing tonsils” since their tonsils are
already close swelling can cause them bigger
• Medical Management:
o Bacterial treated with antibiotics
, lOMoAR cPSD| 45431851
2
o If recurrent and interfere with eating or breathing or frequent streptococcal → tonsillectomy
recommended
o Surgery is also to decrease deafness and OM
• Nursing intervention:
o Keep them in semi-prone position postoperatively o Monitor for frequent swallowing → may
indicate bleeding and turn them to the side
o No red or acidic food or drinks and no chocolate drinks to distinguish bleeding fresh or old
from food color
o Give analgesics as ordered
o Signs of hemorrhage: tachycardia, pallor, low bp (late sign), frequent clearing of throat,
hypovolemic shock
Otitis media
• Most acute otitis media episodes are seen in first 24 months of life
• Many cases occur after viral respiratory infection
• Caused by streptococcus pneumoniae, H. influenzae, and Moraxella catarrhalis
• Eustachian tube is small, short, and wide in children, → allows passage of nasopharyngeal into the
middle ear
• Clinical manifestation: o Fever as high as above 104 F, rhinitis, irritability, pulling onto ear (infants
turning head around)
• Upright feeding position (especially in bottle-fed), Do not “PROP”
• Evaluate foreign bodies in ear • Medical management:
o High dose of amoxicillin 80mg/kg/day - 90mg/kg/day for 10 days o
Acetaminophen for fever and discomfort o Ibuprofen should be given to older
Myringotomy - tube placed in ear by surgery to allow drainage of fluid, for recurrent
infection, if falls oX placed back by surgery
than 6 months o
• Nursing care:
o Pain relief, prevent complication, education and support
Airway obstruction
• Objects placed in mouth, nose, or ear
• May lodge in mainstem or lobar bronchus, or more distal lung field, or trachea
• Could move from smaller to larger airways with cough or may re-aspirated into diXerent passageway
or be ejected into the mouth and swollen
• First degree obstruction: wheezing heard, air passes around object during inspiration and expiration
• Second degree: bronchioles enlarge and allow air to pass from distal portion but on expiration airway
diminishes
• Third degree: air unable to move either way, obstruction occurs with atelectasis
• Symptoms may include stridor, wheezing, choking, cyanosis
• An emergency and may require intubation or tracheostomy • Page 285 on ATI book
, lOMoAR cPSD| 45431851
3
•
Croup/Laryngotracheobronchitis
• Hoarseness, “barking” “seal-like” or “brassy” (croupy) cough, inspiratory stridor (high pitch, upper
airway), and respiratory distress from larynx or obstruction in the larynx and subglottic airway
• Usually viral and starts in late fall and early winter
• Caused by hib
• Can impact larynx, trachea, and bronchi
• Described according to primary area aXected such as epiglottitis (deadly), laryngitis • Common in 6
months to 3-year-old
•
• Medical management: o Secure the child’s airway, artificial airway as needed! o Most benign
condition causing upper airway obstruction o Most of the times they don’t require oxygen
o Must be correctly identified early to rule out more serious conditions like epiglottitis o Sound
worse than they look
