Respiratory for Pediatrics

What are newborns until 4 weeks old?

Preferential nose breathers, cannot open mouth unless crying.

Why are newborns more prone to infection?

They produce little mucus and have small nasal passages.

Why are newborns less likely to have sinus infections?

They are born without frontal and sphenoid sinuses which develop later in childhood.

Why is a large tongue in infants significant?

It increases the risk of airway obstruction if displaced posteriorly.

What is the difference in trachea size between infants and adults?

Infant trachea ~4mm vs adult ~20mm; small decrease causes large increase in resistance.

Why are infants at higher risk for foreign body aspiration?

Trachea bifurcation occurs higher, and their larynx/glottis are positioned higher.

What is the main muscle responsible for tidal volume in infants?

The diaphragm.

Why does hypoxemia occur more quickly in children?

They have a higher metabolic rate and oxygen demand (6-8 L/min vs adults 3-4 L/min).

What should be included in the respiratory health history?

Present illness, immunizations, recurrent colds/sore throats, birth history, chronic lung disease, smoke exposure.

What physical exam findings suggest respiratory distress?

Retractions, accessory muscle use, grunting, nasal flaring, stridor.

What is the maximum O2 flow rate for nasal cannula in children?

4 L/min (can go as low as 25 mL/min).

Why must oxygen be humidified for children?

To prevent drying and damage to mucous membranes.

What is tonsillitis?

Inflammation of the tonsils, can be viral or bacterial.

What are assessment findings for tonsillitis?

Fever, hoarseness, pain, difficulty swallowing/breathing, snoring, enlarged tonsils (kissing tonsils = 4+).

What is a major complication of tonsillitis?

Airway obstruction.

What are key discharge instructions after tonsillectomy?

Watch for hemorrhage (frequent swallowing, throat clearing, vomiting blood). Avoid coughing, nose blowing, straws. Avoid citrus/red/brown fluids. Ensure hydration and pain management.

What causes croup?

Most commonly parainfluenza virus.

What are symptoms of croup?

Barking cough, inspiratory stridor, hoarseness, symptoms worse at night, fever possible.

What are treatments for croup?

Corticosteroids and racemic epinephrine.

What should caregivers do at home for croup?

Use humidified air, monitor for respiratory distress, give meds as prescribed.

What is epiglottitis most often caused by?

Haemophilus influenzae type B.

What are hallmark symptoms of epiglottitis?

Sudden high fever, drooling, refusal to speak, tripod position, anxious/frightened, absence of cough.

What should nurses never do in suspected epiglottitis?

Do not visualize throat, do not lay supine, do not leave unattended.

What are appropriate nursing actions for epiglottitis?

Keep child calm, allow position of comfort, provide 100% O2 in least invasive manner, have emergency equipment available.

What is bronchiolitis usually caused by?

Respiratory Syncytial Virus (RSV), also adenovirus, parainfluenza, metapneumovirus.

What is the pathophysiology of RSV bronchiolitis?

Virus invades epithelium → necrosis, mucus plugging → obstruction, hyperinflation, atelectasis, hypoxemia, CO2 retention.

What are early symptoms of RSV bronchiolitis?

Clear runny nose, pharyngitis, low-grade fever.

What are later symptoms of RSV bronchiolitis?

Cough, wheeze, tachypnea, retractions, poor feeding, apnea, cyanosis, listlessness.

What diagnostics are used for bronchiolitis?

Pulse ox, CXR, blood gases, nasal washing.

What is the main treatment for RSV bronchiolitis?

Supportive care: O2, suction, hydration, antipyretics, bronchodilators (sometimes).

When should infants with bronchiolitis be hospitalized?

If they have tachypnea, significant retractions, poor oral intake, or lethargy.

What nursing care is important in RSV bronchiolitis?

Elevate HOB, suction PRN with 60-100 mmHg, frequent respiratory assessments.

What infection control precautions are needed for RSV?

Contact and droplet precautions, cohort patients, handwashing, monoclonal antibody for high-risk infants.

What family education should be provided for RSV?

Recognize worsening distress (rapid/difficult breathing, poor eating). Cough may persist weeks. Prevent spread with good hand hygiene.

What age group is most at risk for foreign body aspiration?

6 months - 3 years.

What are symptoms of foreign body aspiration?

Sudden onset of cough, wheeze, stridor.

What foods are high-risk for aspiration?

Raw carrots, grapes, hotdogs, peanuts, popcorn.

What is the main nursing intervention for foreign body aspiration?

Prevention and anticipatory guidance at well visits.

What is pneumothorax?

Air collection in pleural space.

What causes pneumothorax?

Spontaneous or from CLD, CPR, surgery, trauma.

What are symptoms of pneumothorax?

Chest pain, tachypnea, retractions, nasal flaring, grunting, pallor/cyanosis, tachycardia, decreased breath sounds.

What is the treatment for pneumothorax?

Needle aspiration and/or chest tube placement.

What emergency supplies should be at bedside for pneumothorax?

Hemostat and Vaseline gauze with occlusive dressing.

What is asthma?

Chronic inflammatory airway disorder with hyperresponsiveness, edema, and mucus production.

What is the hallmark sign of asthma?

Wheezing.

What does a 'quiet chest' in asthma indicate?

An ominous sign of severe airway obstruction.

What complications can occur in asthma?

Status asthmaticus, respiratory failure, irreversible airway changes with repeated exacerbations.

What diagnostic tests are used in asthma?

Pulmonary Function Tests (PFTs), Peak Expiratory Flow Rate (PEFR).

What are goals of asthma management?

Avoid triggers, reduce/control inflammation, prevent infections.

What teaching is important for asthma patients/families?

Identify triggers, prevention strategies, keep rescue meds available, correct inhaler/nebulizer use.

What is apnea?

Absence of breathing >20 seconds, may be with bradycardia, color change, gagging (BRUE).

What causes apnea in infants?

May be central (idiopathic) or secondary to illness such as sepsis or infection.

How should apnea be managed?

Gently stimulate; if no response start rescue breathing/BVM. Maintain neutral thermal environment. Medications: caffeine or theophylline if prescribed.

What education is important for parents of infants with apnea?

Medication use, apnea monitor at home, when to notify HCP, CPR training.

What genetic mutation causes CF?

CFTR mutation on chromosome 7 (autosomal recessive).

What is the pathophysiology of CF?

Defective chloride transport prevents water from thinning secretions → thick mucus in lungs, pancreas, GI tract.

What are respiratory symptoms of CF?

Thick sputum, chronic cough, airway obstruction, decreased pulmonary function, clubbing, recurrent pneumonia, hemoptysis, pneumothorax, sinusitis, nasal polyps, cor pulmonale.

What are gastrointestinal symptoms of CF?

Meconium ileus, fecal impaction, bowel obstruction, rectal prolapse, cirrhosis, varices, gallstones, GERD, malabsorption of protein and ADEK vitamins, FTT, diabetes.

What diagnostic test confirms CF?

Sweat chloride test (high sodium and chloride levels in sweat).

What newborn screening is required for CF?

Blood spot testing (mandatory in NJ and many states).

What therapeutic management is used for CF?

Airway clearance (CPT, postural drainage), Dornase alfa, bronchodilators, anti-inflammatories, inhaled antibiotics, pancreatic enzymes, ADEK vitamins, high-calorie/high-protein diet, feeding tubes, lung transplantation.

What nursing care is important in CF?

Maintain airway, prevent infection, promote nutrition/growth, support family coping.

What vitamins are malabsorbed in children with Cystic Fibrosis?

Fat-soluble vitamins A, D, E and K