Pediatric Respiratory System Alterations and Nursing Care

Vocabulary practice flashcards covering pediatric respiratory anatomy, acute infections, upper and lower airway disorders, diagnostic procedures, pharmacology, and emergency nursing considerations.

Obligate Nose Breathing (Pediatric)

The standard respiratory pattern in infants from $2$ to $6\text{ months}$ of age, caused by developmental anatomy where the tongue is larger and connects directly to the epiglottis.

Pediatric Chest Wall

A chest wall that is circular in shape with weak intercostal muscles, which predisposes pediatric clients to rapid respiratory muscle fatigue.

Pediatric Alveoli Count

The total number of alveoli present at birth, numbering only approximately $17\text{ million}$, compared to up to $600\text{ million}$ in adults.

Acute Viral Nasopharyngitis

A self-limiting viral infection of the nasal mucosa and throat lining (common cold) transmitted via droplets that typically runs a clinical course of $10$ to $14\text{ days}$.

Intranasal Decongestants (Pediatric Precaution)

Topical nasal vasoconstrictor sprays (such as Afrin, Sinex, and Dristan) indicated strictly for severe, acute symptoms and recommended for use for less than $3\text{ days}$ to avoid rebound congestion.

Intranasal Corticosteroids

Maintenance anti-inflammatory nasal sprays (such as Flonase, Rhinocort, Nasacort, and Nasonex) that must be taken consistently and can take up to $2\text{ weeks}$ to demonstrate therapeutic effect.

Waldeyer's Ring

The circumferential anatomical arrangement of four lymphoid tissue structures in the pharynx: the pharyngeal tonsil (adenoid), tubal tonsils, palatine tonsils, and lingual tonsil.

Peritonsillar Abscess

A serious complication of tonsillitis occurring when infection spreads beyond the tonsillar tissue and becomes trapped between the pharyngeal muscle and tonsillar capsule.

Post-Tonsillectomy Hemorrhage

A major postoperative complication heralded by frequent swallowing, throat clearing, vomiting bright red emesis, tachycardia, and pallor.

Codeine Black Box Warning (Pediatric Post-Tonsillectomy)

An FDA black box warning contraindicating codeine for pain management in children following tonsillectomy or adenoidectomy due to documented occurrences of respiratory depression, overdose, and death.

Group A Beta-Hemolytic Streptococci (GABHS) Pharyngitis

A bacterial throat infection with sudden onset, marked by high fever, severe throat redness with exudate, petechiae, headache, abdominal pain, tender cervical lymphadenopathy, and the absence of a cough.

Croup (Laryngotracheobronchitis)

A viral syndrome occurring in children aged $6\text{ months}$ to $3\text{ years}$ causing swelling of the larynx and trachea, characterized by inspiratory stridor, hoarseness, and a classic barking seal-like cough.

Steeple Sign

Subglottic tracheal narrowing caused by inflammatory mucosal edema, identifiable on an anteroposterior airway radiograph in children with croup.

Spasmodic Croup (Acute Spasmodic Laryngitis)

A recurring, transient, and non-febrile form of croup linked to allergic exposure that manifests predominantly at night with sudden barky coughing and dyspnea.

Stridor

A high-pitched, harsh, noisy sound produced during breathing (predominantly on inspiration) that indicates turbulent airflow passing through a narrowed or obstructed upper airway.

Epiglottitis (Acute Supraglottitis)

A life-threatening medical emergency involving severe inflammatory swelling of the epiglottis—often caused by Haemophilus influenzae type b (Hib)—presenting with rapid high fever, tripod positioning, severe drooling, dysphagia, and absence of cough.

Tongue Blade Examination Contraindication

The strict avoidance of throat cultures, tongue depressors, or oral invasive exams in a client with suspected epiglottitis to prevent precipitating complete airway occlusion via laryngospasm.

Prednisolone

A corticosteroid medication acting as synthetic cortisol that suppresses the immune system and decreases inflammation; client teaching instructs taking it in the morning with food to reduce insomnia and gastric irritation.

Dexamethasone

A glucocorticoid agent that suppresses neutrophil migration and decreases airway inflammation, utilized in the management of inflammatory respiratory conditions such as croup.

Bronchitis

A self-limiting viral inflammation of the bronchi typically lasting $5$ to $7\text{ days}$, characterized by mucosal edema, mucus production, fever, and a coughing response.

Bronchiolitis

Viral-induced swelling and mucus buildup in the smallest pulmonary airways (bronchioles) that damages epithelial cells, leading to airway obstruction and alveolar collapse, most frequently caused by RSV in children under $2\text{ years}$ old.

Pneumothorax

A pulmonary complication defined by the presence of free air in the pleural space, characterized clinically by dyspnea, chest pain, labored respirations, tachycardia, and reduced oxygen saturation.

Pleural Effusion

An abnormal accumulation of fluid within the pleural space complicating pneumonia, manifesting with decreased breath sounds, tachypnea, vomiting, fatigue, irritability, and hypoxia.

Pertussis (Whooping Cough)

A mandatory reportable communicable disease caused by Bordetella pertussis, which releases toxins that paralyze respiratory cilia, resulting in severe mucus accumulation and intense coughing episodes.

Paroxysmal Cough

A sudden, violent, and uncontrollable spasm of coughing that lasts continuously for several minutes at a time.

Posterior Nasopharyngeal Culture

The diagnostic test of choice for pertussis, which must be collected within the first $2\text{ weeks}$ of symptom onset and yields definitive results in approximately $7\text{ days}$.

Respiratory Syncytial Virus (RSV)

A seasonal droplet and contact virus that replicates in the nasopharynx, spreads to bronchioles, and sheds for $11\text{ days}$, posing elevated risk to infants under $6\text{ months}$ of age.

Cystic Fibrosis (CF)

An autosomal recessive genetic disorder caused by a mutated CFTR protein that impairs sodium and water transport across epithelial tissues, resulting in abnormally thick, syrupy exocrine mucus.

Meconium Ileus

Failure of a newborn to pass meconium stool due to thick, inspissated intestinal contents, serving as a primary early clinical manifestation of cystic fibrosis.

Sweat Chloride Test

The definitive diagnostic test for cystic fibrosis that evaluates the elevated concentration of salt in a client's sweat secretions.

Short-Acting Beta₂ Agonist (SABA)

A fast-acting rescue bronchodilator (such as inhaled albuterol) administered to rapidly relax airway smooth muscle and terminate acute asthma manifestations.

Long-Acting Beta₂ Agonist (LABA)

A controller bronchodilator taken daily on a scheduled basis in pediatric asthma management to maintain airway patency and minimize the need for rescue SABA use.

Asthma Action Plan: Green Zone

The zone indicating well-controlled asthma, characterized by good breathing, no cough or wheeze, uninterrupted night sleep, normal activity levels, and peak flow measurements in the optimal target range.

Asthma Action Plan: Yellow Zone

The caution zone indicating an asthma exacerbation onset triggered by cold symptoms or allergens, presenting with cough, mild wheezing, or chest tightness, requiring addition of quick-relief medications.

Asthma Action Plan: Red Zone

The medical emergency danger zone indicating severe, rapidly worsening asthma with hard and fast breathing, visible rib retractions, nasal flaring, and difficulty speaking, mandating immediate medical intervention.

Pediatric Obligate Nose Breathing Window

The developmental timeframe spanning from $2$ to $6\text{ months}$ of age during which infants breathe almost exclusively through their nasal passages due to the tongue's close proximity to the epiglottis.

Pediatric Chest Wall Mechanics

A circular thoracic structure with cartilaginous, pliable ribs and underdeveloped intercostal musculature, predisposing young children to rapid muscle fatigue and diaphragmatic dependency.

Alveolar Development at Birth vs. Adulthood

An anatomical disparity where neonates possess approximately $17\text{ million}$ terminal gas-exchange units, multiplying during childhood to reach adult levels of up to $600\text{ million}$.

Pediatric Upper Airway Anatomical Differences

Developmental characteristics including a shorter pharynx, relatively larger tongue, horizontally aligned epiglottis located higher in the neck, and narrower cricoid ring at the level of the $4\text{th}$ cervical vertebra.

Acute Viral Nasopharyngitis

A self-limiting droplet-transmitted infection of the upper respiratory mucosa lasting $10\text{ to }14\text{ days}$, characterized by rhinorrhea, low-grade fever, restlessness, coughing, and sneezing.

Acute Nasopharyngitis Supportive Management

A non-pharmacological care plan emphasizing humidified cool mist, adequate hydration, antipyretics for comfort, and suctioning, while avoiding antihistamines and prophylactic antibiotics.

Topical Nasal Vasoconstrictors (Decongestant Sprays)

Alpha-adrenergic agents such as oxymetazoline that provide rapid acute relief but must be discontinued after less than $3\text{ days}$ to avoid rebound mucosal congestion.

Intranasal Corticosteroid Therapy

Daily maintenance sprays (such as fluticasone or mometasone) used for allergic inflammation that require scheduled, consistent dosing and take up to $2\text{ weeks}$ to achieve optimal therapeutic efficacy.

Allergic Rhinitis Clinical Hallmarks

Seasonal or perennial hypersensitivity manifestations consisting of clear rhinorrhea, allergic shiners, sneezing, itching of the nose and pharynx, snoring, fatigue, and impaired classroom performance.

Red-Flag Symptoms in Pediatric Upper Respiratory Infections

Clinical warning signs warranting immediate medical evaluation, including audible stridor, inability to swallow, persistent drooling, retractions, tachypnea, and listlessness.

Waldeyer's Ring Components

An anatomical lymphoid protective circle in the pharynx consisting of the pharyngeal tonsils (adenoids), bilateral tubal tonsils, bilateral palatine tonsils, and the lingual tonsil.

Peritonsillar Abscess (Quinsy)

A severe tonsillar infection complication where purulent material collects between the pharyngeal constrictor muscle and the tonsillar capsule, causing severe dysphagia, trismus, and uvular deviation.

Group A Beta-Hemolytic Streptococcal (GABHS) Pharyngitis

A bacterial throat infection presenting suddenly with high fever, marked pharyngeal erythema, tonsillar exudate, abdominal pain, petechiae on the palate, and an absence of cough.

Differentiating Strep Pharyngitis from Viral Pharyngitis

Diagnostic assessment where bacterial etiology is identified by sudden onset, high fever, tender anterior cervical lymphadenopathy, and exudates without viral signs like cough, coryza, or conjunctivitis.

Post-Streptococcal Sequelae Prevention

The therapeutic rationale for completing a full $10\text{ day}$ course of prescribed antibiotics (such as penicillin or amoxicillin) to prevent acute rheumatic fever and glomerulonephritis.

Toothbrush Replacement in Streptococcal Pharyngitis

A vital infection control teaching measure instructing parents to discard and replace the child's toothbrush after completing $24\text{ hours}$ of antibiotic therapy to prevent reinfection.

Post-Tonsillectomy Hemorrhage Indications

Postoperative bleeding cues signaled by frequent or continuous swallowing, clearing the throat, tachycardia, pallor, restlessness, and vomiting bright red blood.

Post-Tonsillectomy Pediatric Positioning

Placing the child in a prone or side-lying position until fully awake to facilitate drainage of oral secretions, followed by elevating the head of the bed.

Post-Tonsillectomy Dietary Precautions

Offering cool clear liquids while avoiding red- or brown-colored liquids (which disguise bleeding), citrus juices, rough foods, milk products initially, and the use of drinking straws.

Pediatric Codeine Contraindication (Black Box Warning)

An official FDA safety mandate prohibiting codeine use after tonsillectomy or adenoidectomy due to unpredictable ultra-rapid hepatic metabolism leading to lethal respiratory depression.

Acute Laryngotracheobronchitis (Viral Croup)

A viral inflammatory condition primarily affecting children aged $6\text{ months to }3\text{ years}$, featuring subglottic edema, hoarseness, inspiratory stridor, and a characteristic seal-bark cough.

Steeple Sign (Airway Radiograph)

A tapered subglottic tracheal narrowing observed on an anteroposterior neck radiograph that confirms upper airway edema in croup.

Spasmodic Croup (Acute Spasmodic Laryngitis)

An afebrile, recurrent form of upper airway obstruction linked to allergic hyperreactivity that occurs suddenly at night and rapidly subsides with exposure to cool moist night air or warm bathroom steam.

Inspiratory Stridor Mechanics

A harsh, high-pitched vibrating breath sound created by turbulent airflow accelerating through narrowed extrathoracic subglottic structures.

Oral Dexamethasone in Croup Management

A long-acting systemic glucocorticoid administered as a single dose to reduce mucosal edema, relieve stridor, and decrease hospital admission rates.

Nebulized Racemic Epinephrine

An inhaled alpha- and beta-adrenergic agonist that rapidly induces mucosal vasoconstriction to decrease subglottic edema, requiring monitoring for potential rebound bronchospasm.

Acute Epiglottitis (Acute Supraglottitis)

A rapid, life-threatening supraglottic emergency historically caused by Haemophilus influenzae type b, presenting with high fever, toxic appearance, sitting in a tripod position, drooling, and dysphagia.

Oral Examination Absolute Contraindication in Suspected Epiglottitis

The complete avoidance of tongue depressors, throat swabs, or invasive oral visualization in an un-intubated child, which can precipitate immediate fatal laryngospasm and total airway obstruction.

Epiglottitis Airway Emergency Preparedness

Maintaining emergency endotracheal intubation and tracheostomy equipment readily at the bedside, accompanied by an airway specialist, while keeping the child calm and unagitated.

Epiglottitis Pharmacological Regimen

Immediate administration of intravenous broad-spectrum third-generation cephalosporins and corticosteroids once the airway is secured, maintaining droplet isolation for the first $24\text{ hours}$.

Bronchiolitis Pathophysiology

Viral infection and sloughing of epithelial cells in the smallest conducting airways, producing luminal mucus plugging, air trapping, hyperinflation, and patchy atelectasis in infants younger than $2\text{ years}$.

Respiratory Syncytial Virus (RSV) Transmission and Shedding

A contact- and droplet-spread respiratory pathogen that survives on environmental surfaces for several hours, possessing an incubation period of $4\text{ to }6\text{ days}$ and shedding viral particles for approximately $11\text{ days}$.

Severe RSV Clinical Indicators

Manifestations of critical respiratory decompensation defined by a respiratory rate exceeding $70/\text{min}$, apneic episodes, listlessness, intercostal and substernal retractions, cyanosis, and poor air exchange.

Bronchiolitis Evidence-Based Inpatient Care

Supportive measures prioritizing humidified oxygen to maintain saturations at or above $90\%$, nasal suctioning, gentle hydration, and avoidance of routine bronchodilators, systemic steroids, or chest physiotherapy.

Pertussis (Bordetella pertussis) Pathogenesis

A reportable respiratory infection where bacterial toxins selectively paralyze respiratory cilia, disabling mucus clearance and generating severe inflammatory accumulation.

Paroxysmal Stage of Pertussis

The second clinical phase of whooping cough characterized by violent, repetitive coughing bursts during single exhalations, culminating in an inspiratory crowing gasp, post-tussive emesis, and facial cyanosis.

Pertussis Diagnostic Gold Standard

A posterior nasopharyngeal swab culture obtained within the first $2\text{ weeks}$ of symptom onset, complemented by rapid polymerase chain reaction (PCR) testing.

Bacterial vs. Viral Pneumonia Clinical Presentation

A diagnostic comparison where bacterial illness features abrupt high fever, toxic appearance, productive cough, and focal consolidations, whereas viral etiology exhibits gradual onset, low fever, wheezing, and diffuse infiltrates.

Neonatal Pneumonia Systemic Indicators

Atypical clinical signs in newborns including hypothermia or temperature instability, apnea, poor peripheral perfusion, lethargy, emesis, jaundice, and metabolic acidosis.

Pneumonia-Associated Tension Pneumothorax

A dangerous pleural complication marked by sudden respiratory distress, acute unilateral pleuritic chest pain, absent breath sounds, tracheal deviation, and rapid oxygen desaturation requiring urgent needle thoracostomy.

Cystic Fibrosis Genetic Inheritance

An autosomal recessive condition involving CFTR mutations where two carrier parents face a $25\%$ risk of having an affected child, a $50\%$ carrier risk, and a $25\%$ chance of an unaffected non-carrier child.

Meconium Ileus in Cystic Fibrosis

The earliest clinical sign of cystic fibrosis seen in neonates, marked by thick, tenacious meconium obstructing the distal ileum and preventing stool passage within the first $24\text{ to }48\text{ hours}$ of life.

Quantitative Sweat Chloride Test

The gold-standard diagnostic tool for cystic fibrosis utilizing pilocarpine iontophoresis, where elevated chloride concentrations equal to or exceeding $60\text{ mEq/L}$ confirm diagnosis.

Cystic Fibrosis Gastrointestinal Enzyme Therapy

Administering pancrelipase capsules with all meals and snacks to enable digestion and absorption of fats, proteins, and fat-soluble vitamins (A, D, E, K).

Cystic Fibrosis Pulmonary Clearance Modalities

A daily respiratory regimen combining inhaled dornase alfa (mucolytic), bronchodilators, high-frequency chest wall oscillation vests, and postural drainage to clear thickened secretions.

Pediatric Asthma Pathophysiological Triad

A chronic inflammatory disorder of the lower airways characterized by reversible bronchospasm, mucosal edema, and tenacious mucous hypersecretion triggered by environmental or physical stimuli.

Short-Acting Beta₂ Agonists (SABA)

Inhaled rescue bronchodilators (such as albuterol) that stimulate beta₂-adrenergic receptors to rapidly relax bronchial smooth muscle during acute bronchospastic exacerbations.

Asthma Inhaled Corticosteroid (ICS) Therapy

Daily maintenance controller medications (such as fluticasone or budesonide) that suppress eosinophilic airway inflammation and hyperresponsiveness, requiring mouth rinsing after use to prevent candidiasis.

Pediatric Metered-Dose Inhaler Delivery Aids

The mandatory clinical practice of attaching a valved holding chamber (spacer) with a sealed face mask or mouthpiece to optimize aerosol deposition in pediatric airways and avoid oral impaction.

Asthma Action Plan: Red Zone Protocol

A medical danger zone (peak flow below $50\%$ of personal best) indicated by severe retractions, shortness of breath, nasal flaring, and inability to speak, requiring immediate rescue inhalers and emergency department evaluation.

Pediatric Nursing Diagnosis: Ineffective Airway Clearance

The inability to clear secretions or obstructions from the respiratory tract to maintain airway patency, commonly observed in cystic fibrosis, bronchiolitis, and pertussis due to thick mucus and mucosal edema.

Pediatric Nursing Diagnosis: Impaired Gas Exchange

An excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane, manifested by hypoxemia with an oxygen saturation below $90\%$, cyanosis, tachypnea, and restlessness or lethargy.

Pediatric Nursing Diagnosis: Ineffective Breathing Pattern

Inspiratory or expiratory ventilation that does not provide adequate pulmonary inflation, evidenced by tachypnea exceeding $70/\text{min}$ in infants, intercostal and substernal retractions, and nasal flaring.

Post-Tonsillectomy Nursing Diagnosis: Risk for Aspiration

Increased vulnerability to inhalation of pooled blood or oral pharyngeal secretions into the trachea and lower airways following surgical excision of the tonsils.

Severe Pediatric Respiratory Distress Clinical Symptoms

Marked intercostal, subcostal, and suprasternal retractions accompanied by nasal flaring, grunting, tachypnea, pallor or peripheral cyanosis, and deterioration in level of consciousness.

Acute Epiglottitis Clinical Symptoms

Sudden onset of high fever, toxic appearance, tripod positioning with neck extended, excessive drooling, severe dysphagia, dyspnea, muffled voice, and the absence of a spontaneous cough.

Acute Laryngotracheobronchitis (Viral Croup) Symptoms

A gradual onset following upper respiratory symptoms presenting with low-grade fever, hoarseness, inspiratory stridor, and a characteristic brassy, barking seal-like cough.

Post-Tonsillectomy Hemorrhage Clinical Symptoms

Early indicators of surgical site bleeding signaled by frequent or continuous swallowing, clearing of the throat, restlessness, tachycardia, pallor, and vomiting bright red blood.

Paroxysmal Pertussis Stage Symptoms

Severe, uncontrollable coughing fits occurring during single expirations that terminate with a high-pitched inspiratory crowing gasp (whoop), facial flushing or cyanosis, and post-tussive emesis.

Asthma Action Plan: Red Zone Danger Symptoms

Severe respiratory compromise marked by rapid, labored breathing, deep chest retractions, inability to speak full sentences, and peak expiratory flow readings falling below $50\%$ of personal best.

Pediatric Anatomical Respiratory Risk Factors

Inherent developmental traits predisposing young infants to respiratory failure, including obligate nasal breathing ($2\text{ to }6\text{ months}$), pliable thoracic walls with weak intercostal muscles, narrower airway diameters, and having only $17\text{ million}$ alveoli at birth.

Severe RSV Bronchiolitis Risk Factors

Infants aged younger than $6\text{ months}$, history of premature birth, low birth weight, underlying congenital heart anomalies, chronic lung disorders, immunocompromise, and secondhand tobacco smoke exposure.

Pediatric Asthma Exacerbation Triggers and Risk Factors

Precipitating agents including viral respiratory tract infections, indoor allergens (dust mites, pet dander), tobacco and vape smoke, cold dry air, vigorous physical exercise, and medications such as NSAIDs and beta-blockers.

Pertussis Infection Risk Factors

Incomplete or absent DTaP/Tdap immunization series, waning vaccine immunity in older children and adults, and living in crowded, unsanitary household conditions.

Post-Tonsillectomy Caregiver Discharge Education

Provide cool, non-citrus clear liquids while strictly avoiding red- or brown-colored drinks, avoid rough foods and straws, discourage coughing or clearing the throat, and seek urgent care for frequent swallowing.