Comprehensive Study Guide on Respiratory Disorders: Key Terms and Nursing Care Techniques

Describe the airway of infants

It is highly compliant meaning it doesn't keep its shape and can pinch off

What type of breathers are infants?

Obligate nose breathers

Describe the anatomy and physiology of infants noses

•Obligate nose breathers

•Produce less mucus

•More susceptible to infections

•Sinuses are not developed

•Small nasal passages prone to obstruction

Infants throat

What will increase the risk for airway obstruction?

Enlarged tongue

When is it best to perform an assessment/inspection on an infant?

When they are asleep

What is the first sign of a serious illness in infants?

Changes in breathing including depth and rate

What are the signs of respiratory distress in infants?

•Anxiety

•Restlessness

•Nasal Flaring

•Tracheal tugging

Signs of respiratory distress in infants

How will their appearance change?

They can become pale or cyanotic

What is the intervention for an infant that is having contractions?

Oxygen therapy

Describe rhonchi

•Low pitched snoring

•Common in secretions

•Continuous sounds heard on inspiration and expiration

Describe wheezing breath sounds

•Whistling sounds

•Common in asthma and inflammation

•Heard on expiratory

•Can be heard on inspiratory as well but having both is worse

Describe fine crackles breath sounds

•Crackle sounds

•Common in pneumonia

•NOT continuous

Infants/children with respiratory distress

What will a chest radiograph (x-ray) show?

•Hyperinflation

•Atelectasis

•Infiltration (pneumonia)

Infants/children with respiratory distress

What will a blood gas test show?

•Carbon dioxide retention

•Hypoxemia

Oxygen saturation

What should it be kept at?

Above 92% when awake

Above 88% when asleep

Instant test for presence of streptococcus A antibody in pharyngeal secretions

Throat swab for rapid strep testing

Why is humidity used for respiratory distress?

It will help liquefy secretions for ease in clearance.

What are the common medical treatments for respiratory distress?

•Oxygen

•High humidity

•Suctioning

•Chest physiotherapy and postural drainage

•Saline gargles or lavage

•Chest tube

•Bronchoscopy

What is suctioning used for and when will you use it?

Used for babies with RSV. This treatment will be used before bottle feedings

Promotes mucus clearance by mobilizing secretions with the assistance of percussion or vibration accompanied by postural drainage

Chest physiotherapy

Relieves throat pain via salt water gargle

Saline gargles

Normal saline introduced into the airway, followed by suctioning

Saline lavage

Benefits of a nasal cannula

Child can eat and talk without interrupting oxygen delivery

Negatives of a nasal cannula

•FI02 inconsistent

•Drying of nasal mucosa

Nasal cannula maximum rate

4-6L/min

Negatives of a Simple Mask

Must be removed for eating

FI02 inconsistent

Simple mask flow rate

6-10L/min (mask must fit snugly)

Benefits of venturi mask

Delivers precise high flow rates of O2

Simple facemask with valves at the exhalation ports and an oxygen reservoir bag with a valve to prevent exhaled air from entering the reservoir

Non rebreather mask

Which type of oxygen delivery method is a short term solution?

Nonrebreather mask

Nonrebreather mask flow rate

15L/min

Which type of oxygen delivery method is used for severe respiratory distress?

High flow oxygen

High flow oxygen

What is the maximum flow rate for a child?

2L/kg/min

Describe high flow oxygen

•Used for severe respiratory distress

•NOT used as first intervention

•Heated and humidified

•Larger cannula prongs

•Flow and FI02 can be adjusted separately

Risk factors for respiratory disorders

•Prematurity

•Chronic illness

•Developmental disorders

•Passive exposure to cigarette smoke

•Immune deficiency

•Crowded living conditions or lower socioeconomic status

•Daycare attendance

What type of chronic illnesses are risk factors for respiratory distress?

•Diabetes

•Sickle cell anemia

•Cystic fibrosis

•Congenital heart disease

•Chronic lung disease

What type of developmental disorders are risk factors for respiratory distress?

Cerebral palsy (affects mobility)

Risk factors for tuberculosis

•HIV infection (immunocompromised)

•Incarceration and institutionalization

•Positive recent history of TB

•Immigration or travel to endemic countries

•Exposure at home to people with any of the above factors

Acute infectious disorders

•Common cold, sinusitis

•Pharyngitis, tonsilitis, laryngitis

•Respiratory syncytial virus

•Influenza

•Coup syndromes

•Pneumonia, bronchitis

Chronic respiratory disorders

•Allergic rhinitis

•Asthma

•Chronic lung disease (bronchopulmonary dysplasia)

•Cystic fibrosis

•Apnea

What is croup?

Viral infection and inflammation of the upper respiratory tract

Pneumothorax

What are the signs?

•Chest pain

•Tachypnea

•Retractions

•Nasal flaring

•Grunting

Risk factors for pneumothorax

•Chest trauma

•Intubation and mechanical ventilation

•History of chronic lung disease

Treatment for pneumothorax

•Chest tube

•Nonrebreather oxygen therapy (small pneumothorax only)

What is Bronchiolitis (RSV)?

Inflammation of the bronchioles

Bronchiolitis (RSV)

What is the first sign?

Clear runny nose

What symptoms will develop with Bronchiolitis?

•Pharyngitis

•Low grade fever

•Poor feeding

•Coughing

•Wheezing

Bronchiolitis

When does a cough develop?

1-3 days into illness

Bronchiolitis

When do the symptoms become worse?

Day 4-5 of illness

Bronchiolitis

How is it treated?

•Fluids

•Oxygen

•Suctioning (do it before feeding)

Children under 5 years old are diagnosed with what type of asthma?

Reactive airway disease

Why are children under 5 diagnosed with reactive airway disease instead of just asthma?

It's possible they will grow out of it

Chronic inflammatory airway disorder

Asthma

Exaggerated bronchoconstrictive response to stimuli seen in asthma

Airway hyperresponsiveness

Signs of asthma

•Airway hyperresponsiveness

•Airway edema

•Mucus production

•Tachypnea

•Cough

•Increased work of breathing

•Wheezing

Asthma

What is it triggered by?

•Allergens

•Illness

•Exercise/activity

What is an asthma score based off?

Work of breathing, O2 sat on room air, breath sounds, lung sounds

How is asthma treated?

•Short acting bronchodilators (rescue medications)

•Maintenance medications (everyday use)

What are the type of maintenance medications used for asthma?

•Long acting bronchodilators

•Inhaled corticosteroids

Cystic fibrosis

What type of disorder is this?

Autosomal recessive

What is cystic fibrosis?

Autosomal recessive disorder that produces excess mucous and decreases pancreatic enzymes

What will cause cystic fibrosis?

•Problems in exocrine glands

•Decreased pancreatic enzymes

•Hypersecretion of glands

Cystic fibrosis

What are the treatments through PO?

•Pancreatic enzyme supplementation

•ADEK vitamin supplementation

•Well balanced, high calorie, high protein diet

Cystic fibrosis

What are the treatments through inhalation?

•Inhaled bronchodilators

•Inhaled dornase alfa (pulmonary enzyme)

•Inhaled antibiotics

Cystic fibrosis

What treatment will help break up the mucus?

Chest physiotherapy

Tonsillectomy Nursing Care

How do you promote airway clearance?

Placing the patients on side lying or prone position

Tonsillectomy treatment involves coughing T/F

False. You want to maintain fluid volume and coughing cam cause damage

Tonsillectomy Nursing Care

How will you maintain fluid volume?

•Discourage coughing

•Encourage fluids

Tonsillectomy Nursing Care

What type of fluids do you want to avoid?

Citrus, brown or red fluids

Tonsillectomy Nursing Care

How can you relieve pain?

Ice collar and analgesics

Tonsillectomy Nursing Care

What does frequent swallowing indicate?

Bleeding!

Tonsillectomy Nursing Care

Why do you want to frequently inspect the throat?

To check for bleeding