NSG 3107: Week 1 (intro to peds) & 2 (respiratory dysfunction)

Infant mortality

Number of deaths per 1,000 live births during 1st year of life

Risk factors for infant death

Low maternal education, inadequate housing, lack of access to health care, food insecurity, poverty, unemployment

Childhood morbidity

Prevalence of specific illnesses in the population at a particular time

Children with increased morbidity

Homeless and immigrant children, children living in poverty, indigenous children, children in child care services, LBW children, children with chronic illnesses

15%

Up to what percent of Canadian children have mental health issues?

Empower & enable

What are the 2 key concepts of family centered care?

Atraumatic care

Provision of therapeutic care in settings, by personnel & through the use of interventions, that eliminate/minimize psychological and physical distress

Prevent/minimize the child's separation from the family

1st P of atraumatic care

Promote a sense of control

2nd P of atraumatic care

Prevent/minimize bodily injury and pain

3rd P of atraumatic care

Culture

Shared patterns of learned behaviors & values that are transmitted over time, and that distinguish the members of one group from another

Protest phase

1st phase of separation anxiety where child cries, screams, and clings to parent

Despair phase

2nd phase of separation anxiety; crying stops, evidence of depression

Detachment phase

3rd phase of separation anxiety; denial, resignation but not contentment; may seriously affect attachment to parent after separation

True

True or false? The child's concept of illness is more important in predicting anxiety than is intellectual maturity

Oronasopharynx, pharynx, larynx, upper trachea

What structures constitute the upper respiratory tract?

Lower trachea, bronchi, bronchioles, alveoli

What structures constitute the lower respiratory tract?

False

True or false? The child's eustachian tube is at a steeper angle than the adult's

Observation

Which step of the general assessment precedes palpating the patient?

Nasopharyngitis (Common cold)

Inflammation of the nose and pharynx; caused by RSV, rhinovirus, adenovirus, influenza, and para-influenza

Acute streptococcal pharyngitis (Strep throat)

GABHS (group A β-hemolytic streptococci) infection; manifests as pharyngitis, fever, abdominal pain, inflamed tonsils/pharynx with exudate; risk of rheumatic fever and acute glomerulo-nephritis

80-90%

What percentage of acute pharyngitis cases are viral?

Tonsillitis

Inflammation of the tonsils; viral or bacterial; diagnosed with a throat culture

6 months

At what age should children start getting flu shots?

True

True or false? A person's first ever flu shot requires 2 doses

Otitis media

Inflammation of the middle ear; most common illness in young children, rare to see in children >6 years old; treated with antibiotics, myringotomy, tympanostomy

5 nursing considerations for OM

Relieve pain, facilitate drainage, prevent complications/recurrence, educate family/child, provide emotional support

Infectious mononucleosis

Acute, self-limiting infectious disease, common among adolescents; S&S: headache, fatigue, cervical adenopathy, hepatosplenomegaly

Herpes-like Epstein-Barr virus

What is the principle cause of infectious mononucleosis?

Croup

Common childhood condition involving inflammation of the larynx, trachea, bronchial passages and, sometimes, lungs; characterized by hoarseness, "barking" cough, inspiratory stridor, varying degrees of respiratory distress

Acute epiglottitis

Croup syndrome that affects epiglottis; bacterial, affects children ages 2-5, progresses rapidly

S&S: dysphagia, stridor when supine, drooling, high fever, rapid pulse/RR

Dyspnea, drooling, dysphonia, dysphagia

4 D's for acute epiglottitis diagnosis

Acute laryngotracheobronchitis

Croup syndrome that inflames larynx, trachea, bronchi; usually affects children under 5; viral; slow progression; treated with humidifier, corticosteroids; most common croup syndrome

S&S: stridor, brassy cough, hoarseness, dyspnea, restlessness, irritability, low-grade fever

Acute spasmodic laryngitis

Croup syndrome that inflames larynx and trachea; usually affects children aged 1-3; viral with allergic component; sudden progression, at night

S&S: hoarse cough, stridor, dyspnea, restlessness, symptoms awakening child but disappear during day

Acute tracheitis

Croup syndrome that inflames trachea; affects children aged 5-7; viral/bacterial with allergic component; moderately progressive

S&S: hoarse cough, purulent secretions, high fever, no response to LTB therapy

Bronchitis

Inflammation of the large airway; primarily caused by virus; persistent dry hacking cough, productive by days 2-3; mild & self-limiting, requires only symptomatic treatment

RSV/Bronchiolitis

Inflammation of bronchioles; most common infectious disease of lower airways; seen in 2-12 month infants, uncommon after 3 y/o

S&S: begins like a cold, then worsens to wheezing, resp. distress, intercostal retractions, cyanosis

Pertussis (whooping cough)

Highly contagious bacterial infection of pharynx; caused by Bordetella pertussis; occurs in children under 4 & not immunized

2 months of age

When does immunization against pertussis begin?

Aspiration pneumonia

Caused by foreign matter that is inhaled into the lungs

S&S: increased cough or fever with foul-smelling sputum, deteriorating chest radiographs, signs of lower airway involvement

Asthma

Chronic inflammatory disorder of airways; bronchial hyper-responsiveness

PRAM (pediatric respiratory assessment measure)

Respiratory assessment used in pediatrics to assess lung function

No/mild respiratory dysfunction

What does a PRAM score of 0-3 indicate?

Moderate respiratory dysfunction

What does a PRAM score of 4-7 indicate?

Severe respiratory dysfunction

What does a PRAM score of 8-12 indicate?

Suprasternal retractions, scalene muscle contraction, air entry, wheezing, O2Sat

What are the 5 parameters that the PRAM uses to score patients?

Reliever medications

Short-acting broncho-dilating medications that act quickly to relieve airflow limitation; AKA quick relief medicine or rescue puffers; usually BLUE

Controller medications

Long-term medications to manage asthma symptoms; used every day to manage swelling; takes 1-6 weeks to work at its fullest potential; usually RED

Spacer with mouthpiece

Which asthma medication administration tool is considered the gold standard?

True

True or false? Using a spacer with a mask to administer asthma medication results in a larger proportion of lost medication

Status asthmaticus

Severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure

Cystic fibrosis

Multisystem genetic disorder that affects 1 in 3,600 Canadian children; caused by a CFTR gene mutation which inhibits chloride molecules from crossing cell membranes => thick mucus development