Peds Exam 2 (interventions and respiratory)

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33 Terms

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consent

-laws vary by state

-parents give consent

-child over age 7 should assent (not legally binding)

-emergency treatment does not require parental consent

-adolescents (in certain states) do not need parental consent for:

—STI treatment

—mental health care

—substance abuse treatment 

—pregnancy care

—contraception 

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tips for procedures

-do not trick kids

-traumatic care: use a separate room (so their normal room is not associated with scary procedures)

-infants cannot be NPO for a long time

-CHG used >2 mo

-1 g = 1 mL of fluid

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kids’ temperatures

-fever = increase in set point

—d/t infection

—Rx: Tylenol, light climates, cool compress

—seizure risk

-hyperthermia = temp > set point

—d/t heat stroke, hyperthyroidism, seizures

—meds will not work

—Rx: cooling blankets, tepid bath

—do not over-treat; prevent shivering

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pediatric meds considerations

-weight- or BSA- based dosing

-increased metabolism

-use syringe for oral meds

-give slowly

-IM: max dose = 0.5 mL (small infants) or 1 mL (older infants/kids)

-may mix meds in one bite but not in a bottle

-IV

—smallest/shortest needle & cath

—do not encircle limb w/ bandage

—allow kids to help w/ removal

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O2 therapy

-hood: >7 L/min

-watch for CO2 retention

-regularly measure ETCO2 for pt with ventilator, sedation, or asthma

-intubation: 100% O2 beforehand

—may be nasotracheal, orotracheal, or tracheostomy

-ventilator

—assess Displacement, Obstruction, Pneumothorax, Equipment failure

—assess QD whether pt can extubate

-tracheostomy

—care requires 2 people

—keep spare 1 size down at bedside

—clean BID, change weekly

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chest tube

-maintain gentle bubbling in suction

-drainage flat and below insertion site

-need order to milk or clamp

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specimen collection

-U bag for urinalysis

—works best for male and incontinent pt

-urine culture

—clean catch for older kids (must clean area first and catch midstream)

—straight cath for younger/incontinent pt

-24 hr collection for kidney issues

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respiratory assessment

-respirations (rate, rhythm, depth)

-respiratory efforts (grunting, nasal flaring, retractions)

-cough (characteristics, frequency, sputum)

-HR

-O2 sat

-skin color

-hydration (mucus membranes, I&O)

-temp

-LOC

-activity level

-comfort/pain

*treat respiratory problems to prevent respiratory failure d/t fatigue

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pharyngitis 

-viral or strep

-may become rheumatic fever and damage heart valves, or glomerulonephritis

-viral

—common cold

—treat S/S: rest, fluids, antipyretics, elevate HOB, suction, saline

—limit cough suppressants

-strep (GABHS)

—S/S: HA, fever, ab pain, tonsillitis, tender lymph nodes, sore throat

—dx w/ rapid test; confirm negative result w/ culture

—Rx: PCNs, compress, salin gargle, Tylenol. fluid (maybe antibiotics)

—improves w/in 24-48 hr; contagious for 24 hr after Rx

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tonsillitis

-bacterial or viral

-adenoid swelling obstructs nasal airway

-S/S: sore throat, difficulty swallowing, fever, snoring

-dangerous if tonsils touch

-Rx: analgesics, antipyretics, antibiotics, T&A

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T&A post op

-small amounts of old blood are ok; bleeding 5-10 days after = dangerous

—S/S: frequent swallowing, vomiting, tachycardia, pallor

-elevate head

-hydrate, soft or liquid diet (avoid red/brown colors, citrus)

-analgesics

-ice pack on neck

-no straws

-do not cough, blow nose, or clear throat

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flu

-S/S: cough, fever, myalgia, sore throat, fatigue, vomiting, diarrhea, croup

-lasts 4-5 days

-Rx the S/S

-Rx w/ oseltamivir QDx5 if started w/in 48 hr of S/S onset

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causes of coughs 

-barky = croup

-wet = common cod (see Dr after 2 weeks)

-dry/nighttime = asthma

-whooping/gasping = pertussis

-raspy = flu, pneumonia

-rattling = bronchitis

-phlegmy/post meal = reflux

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otitis media

-common under age 2

-d/t blocked tubes → negative pressure → fluid

-acute = w/ infection S/S; w/ effusion = no S/S

-d/t flu or RSV

-risk fx: URI, rhinitis, Down syndrome, cleft palate, bottle propping, daycare, no vax, winter time, secondhand smoke

-recurrent may lead to hearing loss

-prevent: vaccine, antibiotics, breastfeed for 6 mo

-Rx: antibiotics, myringotomy, tympanostomy tubes

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mononucleosis

-Epstein Barr virus

-S/S: fever, sore throat, fatigue, lymphadenopathy, hepatosplenomegaly

-Rx: analgesics, gargles, steroids, rest

-avoid contact sports (risk of spleen rupture)

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croup

-viral

-excessive crying worsens

-laryngeal swelling

-droplet precautions

-types

—epiglottitis: emergency!

  • S/S: drooling, tripod

  • Rx: calm child, O2, steroids

  • must be dx w/ x-ray

—laryngotracheobronchitis: Barry cough, Rx w/ racemic EPI and steroids

—spasmodic: at night, self-limiting, Rx w/ mist

—bacterial tracheitis: thick secretions that obstruct airway

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tuberculosis 

-airborne precautions

-risk fx: HIV

-dx: physical exam, hx, skin test, cultures, x-ray

-Rx: meds, nutrition

-under age 2 = serious

-vaccine available

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asthma

-chronic airway inflammation → bronchospasm

-may grow out of it

-onset by age 5

atopy = genetic predisposition for IgE response to allergens

-bronchospasm, irritants, inflammation, mucus→decreased lumen size/airway remodeling→obstruction→air trapping→hyperinflation, increased effort, decreased cough effectiveness

-silent breath sounds are BAD (airway constriction)

-may lead to status asthmaticus: severe emergency requiring SABA, IV steroids/fluids, magnesium sulfate, possibly intubation

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asthma S/S

-cough

-SOB

-prolonged expiration

-wheezing

-crackles

-coarse breath sounds

-restlessness

--apprehension

-tripod

-sweating

-hyperresonance

-retractions

-hypoxia

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asthma Rx

-dx: S/S, hx, physical exam, CXR, PFTs, PEFR (amount of air forcefully expelled in 1 min: >80% is good, <50% is emergency)

-Rx:

—rescue meds: albuterol, steroids

—long term meds: inhaled steroids, LABAs, montelukast

—decrease exposure to allergens

—exercise

—breathing exercises

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asthma meds

-short acting / rescue

—beta agonists (e.g. albuterol) to treat spasm

—steroids to decreased inflammation

—magnesium sulfate to relax smooth muscle

-long acting / prevention

—inhaled steroids to decrease inflammation

—beta agonists

—theophylline (later resort)

—leukotriene modifiers (e.g. montelukast) to decrease spasm & inflammation

—cromolyn sodium to decrease inflammation

—omalizumab to manage atopy

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cystic fibrosis

-viscous mucus secretions systematically

-CFTR protein → abnormal movement of chloride ions → mucus is more viscous

-genetic (autosomal recessive)

-may lead to DM

-life expectancy = 37 years

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CF S/S

-respiratory: emphysema, pneumonia, infections, pulmonary HTN, respiratory failure

-GI: meconium ileus, bowel obstruction, rectal prolapse

-liver: acidic bile, portal HTN, gallstones

-pancreas: malabsorption, DM

-reproductive: cervical plug, preterm labor, SGA, male sterility

-development: FTT, delayed bone growth

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CF dx

-newborn screening

-sweat chloride test

-DNA test

-CXR, PFTs

-stool analysis

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Rx for cystic fibrosis

-pulmonary: CPT, nebulizers, antibiotics, airway clearance therapy, O2, NSAIDs, lung transplant

-GI: pancreatic enzymes, high kcal/protein diet, supplements, maybe TPN

—risk of obstruction, GERD

—Rx decreased motility with laxatives

—limit to 1-2 stools per day

-endocrine: GH injections

-CFTRE modulators, dry powder mannitol

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sleep apnea

-airway obstruction during sleep

-S/S: snoring, pause in breathing, daytime sleepiness, choking, neuro/behavioral problems

-may lead to death

-dx: sleep study

-Rx: T&A, CPAP or BiPAP, weight loss

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trach care

-humidified

-suction PRN

-clean BID, change weekly

-may have speaking valves

-keep extra trach at bedside (1 size down)

-TWO people needed for care!

-if it dislodges, cover with gauze and bag pt

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RSV/bronchiolitis

-risk fx: young baby, chronic lung disease, daycare, no breastfeeding

-airway swelling, mucus

-dx: CXR, panel

-S/S: rhinorrhea, choky cough, fever, adventitious breath sounds, dyspnea, retractions, apnea

-Rx: fluids, suction, O2, Palivizumab

-contact and/or droplet precautions

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pneumonia

-viral, bacterial, mycoplasma, or aspiration

-S/S: never, cough, chest/ab pain, distress, crackles

-Rx: O2, percussion, fluids, Tylenol, antibiotics, suction, bronchodilator, lie on side w/ bad lung

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pulmonary edema

-fluid in alveoli

-increased pulmonary pressure or permeability

-Rx: high pressure O2, ventilator, elevate HOB, monitor F&E

-S/S: respiratory distress, orthopnea, heart murmur, JVD, pink sputum, BP change

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ARDS

-life-threatening

-d/t injury (sepsis, drug OD, submersion)

-inflammation → pulmonary edema, pulmonary HTN, low lung FC

-leads to hyperventilation, cyanosis, tachypnea

-Rx: ECMO, diuretics, vasodilators, arterial lines, supplemental nutrition

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smoke inhalation injury

-heat injury in upper airways

-chemical injury deep in lungs

-systemic injury from CO (low O2 though pulse ox reads normal sats)

-assess w/ scope

-Rx: O2, bronchodilators, steroids, fluids, chest percussion

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respiratory emergencies

-insufficiency = increased work to breathe, normal gas exchange, abnormal ABG

-failure = inability to exchange gases

-arrest = respirations cease (may lead to cardiac arrest)

-apnea = respirations cease for >20 sec or <20 sec + hypoxemia + bradycardia