Lecture 2 - Respiratory

The thoracic cavity has 3 major sections:

1. The lung lobes which consist on ___ lobes on the right and ___ lobes on the left.

2. The bronchi, bronchioles, and ____

3. The _____ which is the space between the lungs. This is where the ____, trachea, large blood vessels, and the ____ is.

The mechanics of breathing consist of ____ which is the ability to expand and _____ which is the difficulty of getting air in. Ventilation is also affected by ____ which coats the alveoli and prevents it from collapsing by reducing surface tension.

The primary function of the lungs is gas ____. This tales place at the _____.

The exhange of gases in the lung is called ____. This occurs due to changes in ____ gradients created by changes in the ___ of thoracic cavity. The major forces are compliance and resistance.

In children, it can be difficult to listen to heart/lung sounds, so listen ____.

The upper respiratory tract consists of the ____, larynx, and upper trachea. The lower respiratory tract consists of the lower trachea, ___, bronchioles, and alveoli.

Diseases easily spread to the _____ nature of the mucous membrane.

3; 2; alveoli; mediastinum; esophagus; heart; compliance; resistance; surfactant; exchange; alveoli; ventilation; pressure; size; laterally; pharynx; bronchi; continuous

The measure of chest wall and lung distensibility is called ____. It is affected alveolar surface ____and elastic _____.

Increased work of breathing can be caused by ___ reisistance or inc/dec ______.

compliance; tension; recoil; increased; compliance

In children, the airway is ____ in diameter and ____ in length with a dec distance between structures. This inc the risk for ____ as there is less distance to the resp tract.

The eustacian stubes are short, wide, and ____. To visualize the tympanic membrane, you want to pull ____ and then ____.

The epiglottis is long and ____ as it is not sophisticated.

Compliance is _____ in infancy. As the child grows, the compliance will ____ and the resistance will ____ to improve ventilation. The alveoli will multiple until ____. They will lengthen and enlarge with age allowing for more _____ area for gas exchange.

Theare are inc soft ___ that surrounds the trachea. As the trachea grows, the resistance will ____.

smaller; shorter; aspiration; straight; down; back; floppy; high; decrease; increase; puberty; surface; tissue; decrease

The intrinsic defense mechanisms consist of:

1. The ___ tyissue which is found in the tonsils,.

2. The ____ blanket which is secreted by the respiratory tract.

3. The ____ action which carries microorganisms away from the lungs.

4. The ___ which protects the larynx from invading materian.

5. A ____ which is the expulsive force that protects the lower airway. A _____ one is one in which they have a sound before the cough and then cough and then after you dont hear the mucus.

6. Position changes encourage ____ of airway passages.

7. Humoral defectes including ____, enzymes, and immunoglobulins,

8. Lymphatics in which the lymph nodes ___ and destroy.

lymphoid; mucus; ciliary; epiglottis; cough; productive; drainage; phagocytes; filter

IgG production begins after ___ and inc throughout the 1st year of life. If the child is < 3 months, the ___ antibodies protect the infant.

From 3-6 months, the infection rates ____. In the toddler and preschool years, ther is a high rate of ____ infections.

When they are > 5 years, there is an inc in Mycoplasma pneumoniae and Group A beta-hemolytic ____ infections.

The assessment triangle includes circulation, ____, and work of ____.

birth; maternal; increase; viral; streptococcal; appearance; breathing

Visual findings of respiratory issues include:

1. Nasal ____ which is meant to reduce nasal resistance. Observe if it is ____ or intermittent.

2. Head ____ which is forward movement with each inspiration.

3. The sinking of soft tissues called ____ which are defined by anatomicla area of occurrence.

4. The proliferation of tissue at the ends of the fingers called ____. This is associated w chronic _____.

Abnormal lung sounds include:

1. _____ which are high-piitched on inspiration or expiration. These can be heard ____ a stethoscope.

2. A continuous musical sound is called ____. This stems from ____ airways

3. Rails or crackles signal issues in the ____

4. Rhonchi

When assessing the lung tihe sounds take note of the ____ (inspiration/expiration), the pitch of it, if it is ____or not, and the _____ of where it is heard.

Early signs of tissue hypoxia include a ____ RR, inc resp effort like nasal flaring and _____, ____(HR), pallor, mottling, _____, agitation, ____, and irritability.

Late signs of tissue hypoxia include a ____ RR, apnea, inc resp effort (head bobbing, ___ resp, grunting), ____(HR), pallor, cyanosis, mottling, and a decreased _____.

flaring; continuous; bobbing; retractions; clubbing; hypoxia; stridor; without; wheezing; narrowed; alveoli; timing; continuous; location; fast; retractions; tachycardia; cyanosis; anxiety; slow; seesaw; bradycardia; LOC

Diagnostic tooks for respiratory issues include:

1. Noninvasive measures like:

   1. Pulse ___

   2. End ____ CO2 monitoring

   3. Transcutaenous monitoring which only works on ____.

2. Blood gas determination. A normal pH ranges from ___ to 7.45.

3. Radiology

4. Pulmonary ____ tests.

ox; tidal; infants; 7.35; function

Respiratory emergencies include:

1. Respiratory ____ is when there is inc work of breathing but near normal gas exchange.

2. Respiratory _____ is inability to maintain adequate gas exchange. This results in hypoxemia or ____.

3. Respiratory ____ is cessation of respiration < 20 sec. This is the most common cause of ____ arreast in children.

4. ____ is cessation of breathing > 20 sec or shorter if accompanied by hypoxemia or ____.

insufficiency; failure; hypercapnia; arrest; cardiopulmonary; apnea; bradycardia

To improve oxygenation, you can use mechanical clearance techniques which can include:

1. ____ the nares, nasopharynx, oropharynx, and deeper in the larger lower airways

2. CPT involves ____ over the thoracic cavity or using a high frequency ____ vest. Be careful to not cause injury to the ____ or sternum.

3. Postural drainge in which you move to allow ___ to help mobilize secretions

4. Using an incentive spiromter which allows for lung ___ and alveoli patency

5. Using ___ and deep breaths to move the mucous.

Pharmalogical airway TXT to help w oxygenation includes”

1. The use of inhalers and _____ aerosols to allow the medication to get right to the lungs and for a ___ response. These often use:

   1. _____ like albuterol

   2. _____ like budesonide. These help to reduce ____.

   3. Racemic ____ which is used for the upper airways.

   4. ____ like Pulmozyme

2. PO/IV steroids

3. ____ for bacterial infections

4. Antivirals

5. Symptom relief meds like ____, antihistamines, cough suppressants, etc. Nasal deconggestants may be used but generally not used before ___ years of age.

suctioning; tapping; oscillating; kidneys; gravity; expansion; coughing; nebulizer; quick; bronchodilators; corticosteroids; swelling; epinephrine; mucolytics; antibiotics; antipyretics; 2

A permanent or temporary opening into the trachea is called a _____. This is for ___ term support. This is needed for children who have:

1. Congential/acquired ___ defects like vocal cord paralysis, subglottic stenosis, etc.

2. Emergencys like foreign body ___, epiglottitis, and croup

3. Are on long -term ____ use.

Post-op care includes transfer to the ___ from surgery. ___ sutures are used and are life saving in case of decannulation. It takes ___ days for the tract to develop. The ____ will perform the first trach change.

Daily care includes:

1. Using ___ technique when suctioning nasal or oral areas.

2. Use _____ technique when suctioning tracheal area. Obtain baseline ____ and O2 sats. ____ or hyperoxygenate the patient. For infants, limit suctioning to ____ sec and for a child limit suctioning to ___ sec. Do not apply suction during ____ of catheter. Rest for ____ to 60 sec in between. Afterwards, you can ___ to see if you cleared anything and have someone hold the trach

3. Changing the ties which requires ___ people

4. Clean around _____ site and neck.

Also have an emergency go bag that should be ___ the chiild at all times include:

1. 2 spare trach tubes: one of the same size and one that is _____.

2. Oxygen, suction, and ___

3. Spare trach ___

4. Gauze, lubricating ____, and an ___ bag w a mask.

tracheostomy; long; structural; aspiration; ventilator; PICU; stay; 5; surgeon; clean; sterile; VS; hyperventiate; 5; 10; insertion; 30; auscultate; 2; stoma; with; smaller; catheter; ties; jelly; ambu

Nursing care for a child with a resp tract infection:

1. Assess ____, resp effort, ____ status, oxygenation, body ___, and activity level

2. Ease resp effort

3. Promote ____ and comfort

4. Prevent ____ of infection

5. Provide ____and promote hydration.

There is inc immunity with ____.

For URI, ___ pediatric cold remedies are not recommended for treating common cold. Antihistamines are ___ in most cases and antipyretics can be used for comfort from fever. Cough suppressants can be used for ____ coughs but should be cautioned due to ___ content. Decongestants can be used to ____ swollen nasal passages. Nose ____ are more effective than oral administration.

HR; hydration; temp; rest; spread; nutrition; age; OTC: ineffective; dry; alcohol; shrink; drops

Acute laryngotracheobronchitis is also known as ___ syndrome. This is an ____ respiratory tract infection. This is usually a _____ induced inflammation. IT is often preceded by an _____. It primarily occurs in children 6 to ____ months of age and most occur in the fall or ____.

This is mostly caused from the ____ virus (type 1 and 2) but also other viruses as well.

Upon assessment you may see the following

1. ______

2. A ___ or brassy cough

3. Inspiratory ____ and resp distress

4. Symptoms that worsen at ___

5. Upon x-ray you will see the ___ sign

Interventions include:

1. Use a cool ___ to provide relief

2. Encourage ___ intake

Meds include:

1. 1st choice of oral ____

2. Necbulized or racemic ____

3. IV fluids

4. ____ which is threaded into oxygen and reduces airway resistance if needed.

croup; upper; virus; URI; 36; winter; parainfluenza; hoarseness; barking; stridor; night; steeple; mist; fluid; corticosteroids; epinephrine; heliox

Epiglottitis is also a ___ syndrome. This is a life ____ emergency. This is common in 2 to ___ years of age and leads to a supraglottitic ____.

It is mostly caused by _____ or noninfectious reasons.

Assessment findings can include:

1. A ____ position which helps keep the epiglottis open

2. An ____ onset

3. A ___ appearance and resp distress

4. A high fever and agitation

5. A sore throat and ____ upon swallowing. The patient may also exhibit a lot of ____ due to the inability to swallow saliva

6. Absence of spontaneous __

7. A ____ voice due to effects on the larynx.

Interventions include:

1. No tongue ___

2. Put patient on ___ isolation fro first 24 hrs after antibiotics start

3. Give prophylactic TXT for ___

4. The airway should NOT be assessed without emergency ____. There will be no culture or exam until a permanent ___ is established.

Diagnostics include a ___ neck film which will show the ____ sign.

Meds include IV antibiotics like _____ and vancomycin. IV corticosteroids, and prevention includes the Hib _____.

croup; threatening; 5; obstruction; hib; tripod; abrupt; toxic; pain; drooling; cough; muffled; blades; droplet; family; equipment; airway; lateral; thumb; ceftraxone; vaccine

Inflammation of the tonsillar tissue is called ____. This often occurs in combination with ____ and is self-limiting.

It can be caused by viral pathogens but also by Group ____ streptococi in children 5-15 years old.

Assessment findings include:

1. Difficulty ____ and breathing

2. The use of mouth breathing which cause mucous membranes to be ____ and have an offensive ____.

3. Taste and ___ senses are imparied

4. Muffled speech sounds

5. A persistent ____

6. Bacterial causes will lead to fever and tonsillar ____.

Interventions include comfort, a soft/____ diet, and cool mist.

Meds include lozenges, ____ gargles, tylenol, IV ____ if bacterial, and analgesics.

Surgical TXT is called a ____ and it is usually done ___. This can be done if infection is recurrent or if there is extreme ____. The older the child is, the higher the risk for ____ bc the more vascular it is. This is also why you want to try not to dislodge a ____.

Post-op interventions includes:

1. Position the patient to promote ____

2. Put them on a clear, cool liquids, and then ___ food

3. Discourage ___ or blowing nose as this can dislodge any closts

4. The patient should be on ____ for the day

5. Minimize agitation and ____

6. Use a ____ collar if needed

7. Analgesiscs for 24-48hrs

Discharge teaching includes

1. A ___ color membrane on tonsillar membrane is normal

2. Avoid irritating or highly ___ foods

3. No gargles or vigorous ___ of teeth.

4. Limit ___ to dec bleeding risk

Bleeding can occur up to ___ days after surgery. Signs to observe for include frequent ___, inc HR, pallor, frequent ___ clearing, vomiting blood, and dec ___ is a late sign.

tonsillitis; pharyngitis; A; swallowing; dry; odor; smell; cough; exudate; liquid; saltwater; antibiotics; tonsillectomy; outpatient; hypertrophy; bleeding; clot; drainage; soft; coughing; bedrest; crying; ice; cream; seasoned; brushing; activity; 10; swallowing; throat; BP

Bronchiolitis is an acute viral infection of the ____. This is a virus of the ____ respiratory tract. It is most common in kids less than ___ years of age. It is mostly common in the fall and ____. It is caused mostly by ____, COVID, adenoviruses, parainfluenza, and human metapneumovirus.

There is a lower occurrence of RSV in ____ infants. It is more common in ____ living conditions. Subsequent ____ are common. This is the most frequent cause of ______ in those less than 2. RSV occurs in the fall, ____in the winter and dec in the spring. Transmission is most commonly via ____ but also droplet via mucus.

Initial manifestations of RSV include _____, low-grade fever, ear/____ infection, sneezing, wheezing, cough.

It will progress to inc coughing/wheezing, _____, crackles, tachynpea, and poor _____.

Severe and life threatening manifestations include > ____breaths/min, listless, ____ hunger, poor air exchange, ____ breath sounds, cyanosis, and ____ spells.

Interventions for bronchiolitis and RSV include supportive TXT, maintain SpO2 > ____%, giving ____ via IV or oral, maintain airway, suction, and humidified ____ flow oxygen.

Management includes putting them on _____ precaution, hand washing, monitor SpO2, ____ teaching, and encourage breastfeeding.

TXT for RSV include _____ which is still controversial and is an anti-viral. Synagis/Palivizumab are ___ meds which are given IM every ____ days during RSV season betwen Nov-March.

High-risk patients include ____ born < 29 weeks, <32 weeks w chronic ____ disease, and infants less than 12 months with a ___ disease.

bronchi; lower; 2; winter; RSV; breastfed; crowded; reinfections; hospitalization; peaks; contact; rhinorrhea; eye; retractions; feeding; 70; air; diminished; apneic; 90; hydratioin; high; contact; suction; ribavirin; preventative; 30; premies; lung; heart

Foreign body aspirations are most common to 1 to ___ year olds. Severity depends on the object, location, and extent of _____. It can be potentially life ____ especially for infants. This is an infection of the ____ airway.

Commonly aspirated foods include nuts, hot dogs, hard candy, and ____.

It starts off in the ____ or lobar bronchus. Then it goes into the ____ and then into the lungs. Small objects partially obstruct and can cause _____. Large obstruction allows air in but gets ____. A complete obstruction usually occurs in the ____ bronchus.

Be aware that half of ingestions are _____. Upon assessment, they may be initially ____, gagging, and coughing. Symptoms are dependent on ____ of obstructuction. They may also experience respiratory ___, stridor, and ___ breath sounds.

DIagnostics include AP and lateral _____.

Management includes anticipating a ____ which is the gold standard for FB removal.

3; obstruction; threatening; lower; grapes; mainstem; trachea; wheezing; trapped; right; asymptomatic; choking; site; distress; asymmetric; xray; bronchoscopy

Asthma is a chronic ____ disorder of the airway. It includes bronchial ____, episodic acute ______. and reversible airflow obstruction. It is the ____ cause of chronic illness in children. It is the ____ leading cause of hospitalization. It can be triggered by various ____. The first attack occurs around ___ to 8 years old.

Classic symptoms include ___, wheezing, and coughing. Other symptoms include chest ____ and pain. It is worse at night or during ____. It starts off as a dry cough with inc ____ to follow.

For younger children, they mostly are in a ____ position to help them breathe. Older children tend to sit ____ with hunched shoulders w arms brached to use ____ muscles.

Diagnostics include

1. ____ which are performed by pulmonary service. It determines the ____ of lung disease.

2. The ____ expiratory flow rate. This shows the max flor of air _____ in 1 sec. The baseline should be done when _____. It measured using a PEFM. For the green (80-100%), have them on ____ meds. For the yellow (50-79%), it may be not well ____ and may need additional meds. In the red is below 50% and is a medical ____ and need attention.

Interventions include an asthma ____ plan. This includes avoiding exposure to ____. Educate ____ of bronchospasm. Assist w MDI teaching.

ASthma meds include:

1. Formoterol and salmeterol which are ______. This are used in combination with _____ therapy and can be preventative.

2. _____, levabuterol, and terbutaline are called SABas and are rescue meds.

3. Anti-inflammatory meds include inhaled _____ like fluticasone and _____ modifers like montelukast.

4. Cholintergic ____ like ipratropium bromide to dry everything up. This also includes a bronchodilator for an acute _____.

5. Mag sulfate given via ____ in the ED/ICU. This is a potent ____ relaxer.s

inflammatory; hyperresponsiveness; exacerbations; leading; 3rd; allergens; 3; dyspnea; tightness; exercise; secretions; tripod; upright; accessory; PFT; extent; peak; expired; stable; maintenance; controlled; alert; action; allergens; symptoms; LABA; antiinflammatory; albuterol; corticosteroids; leukotriene; antagonists; bronchospasm; IV; muscle

In terms of asthma, ____ can induce bronchospasm. It stops 20 to ____ min after exercise. It can be difficult to ___ or play soccer/basketball. Acceptable sports include ____, baseball, and gymnastics.

Encourage exercise for ____ interaction and physical health. Prophylactic TXT includes the use of ____.

Respiratory distress that continues despite vigorous therapeutic measures is called ____ asthmaticus. It can be a ____ infection in some cases. Emergency TXT includes the use of ____ 0.01mL/kg SQ. Other TXT includes:

1. IV ____ sulfate and ketamine

2. IV corticosteroids and heliox

exercise; 30 ; run; swimming; peer; SABA; status; concurrent; epinephrine; magnesium

Cystic fibrosis is an autosomal ____ genetic disorder. It is a dysfunction of the _____ or mucus producing gland. 95% known cases occur in _____.

The patho consists of the epithelial cells which are unable to transport ____. There is inc ____ of mucous gland secretions. This clots the ___, lungs, liver, small intestine, and reproductive system. It most prominently affects the ___ system by producing too much salt.

The abnormal gene is located on the long arm of chromosome ____.
Clinical manifestations includes:

1. A progressive chronic ____ lung disease associated w infection.

2. ____ from exocrine pancreatic insufficiency

3. ____ failure from malabsorption and anorexia.

4. _____ (sugar), polyuria, and weight loss due to pancreatic insufficiency.

Respiratory manifestations include:

1. Initial include wheezing and a ____, nonproductive cough.

2. It progresses to dyspnea and obstructive emphysema with patchy ______.

3. Advanced symptoms include cyanosis, ___ shaped chest, ____ of fingers/toes, and repeated ____ and pneumonia.

GI manifestations include:

1. A ___ ileus which is the earliest sign in newborn.

2. Bulky , ____ smelling stools. Steatorrhea from undigested ___ and azotorrhea which is undigested _____. They may be on stool ____.

3. Failure to ____

4. Reflux

5. Prolapsed _____

6. Decrease in pancreatic ____.

recessive; exocrine; caucasians; chloride; viscosity; pancreas; respiratory; 7; obstructive; maldigestion; growth; hyperglycemia; dry; atelectasis; barrel; clubbing; bronchtis; meconium; foil; fats; protein; softeners; thrive; rectum; enzymes

Reproductive manfestations of cystic fibrosis include:

1. In female, there is ___ puberty and vicious ___ mucus.

2. In males, they are typically ____.

Integumentary manifestations include:

1. Patient reports that their child tastes _____

2. _____ which you will see by tenting of the skin

3. A state of _____ or hyponatremic alkalosis.

Diagnostic procedures include:

1. Early Infancy screening and DNA testing

2. A ___ chloride test which is used for confirmation. Its for infants less than or equal to ___ months.

3. A chest ___ may show atelectasis and emphysema.

The goal of respiratory management includes _____ of pulmonary mucus. Management includes:

1. Mechanical methods of expectoration include ____ and forced expiration called ____ coughing.

2. Medical management includes ____ medicines, aerosilized Pulmozyme which dec ___ of mucus.

3. You may also treat infection, do home IV ____, ___ antibiotics like tobramycin, antiinflammatory, a lung ____, and encourage exercise.

GI and nutrition management:

1. Replace pancreatic _____ via Pancrease/Creon meds. The amount depends on teh pancrreatic insufficiency. Do not put enzymes on ____ foods like icecream or yogurt.

2. Encourage a high ___ and calorie diet as much as ____% RDA.

3. Manage intestinal obstruction by giving ____

4. Provide ___ supplementation w exercise

5. Use oral glucose lowering agents or ____ as needed

6. Adminster ____ soluble vitamins like multivitamins and vitamins.

delayed; cervical; sterile; salty; dehydration; hypochloremia; sweat; 3; xray; expectoration; CPT; huff; bronchodilator; viscosity; antibiotics; aerosolized; transplant; enzymes; alkaline; protein; 150; miralax; salt; insulin; fat

Chronic lung disease is also called _____ _____(BPD). It occurs when an ____ lung becomes injured. This leads to a chronic inflammatory process that leads to injury and abnormal ___. Specifically it becomes fibrous and develops ____ tissue. The highest incidence occurs in those 22 to ___ weeks GA.

Patho includes interstitial ____ and epithelial swelling. Then there is thickening/fibrosis of ____ walls. Then there is _____ of bronchiolar epithelium.

They can ____ this condition bc alveoli with grow and mature.

Risk factors include premature infants, neonatal ____ ventilation, high ____ of O2, and full-term infants with ____ aspiration.

Assessment findings include tachypnea, ____ flaring, mild to sever ____, wheezing, and supplemental O2 w inability to ____.

The progonosis is generally good, but there are some ____ delays bc they were intubated and sedated. There is growth failure and risk for respiratory ____ due to the weak lungs. There may be consults with PT and ___ therapy.

If a child has a trach, the parents will have to be ____ trained and trach trrained.

Nursing management includes:

1. Adequate rest and ___ but frequent feedings with high calories

2. Possible ___ restriction

3. Strict I&Os to monitro over/under ____. Also do daily ___

4. Strict feeding ____

5. Home oxygen therapy, _____, vent training, and CPR teaching

6. Involve the parents

bronchopulmonary dysplasia; immature; healing; scar; 28; edema; alveolar; metaplasia; outgrow; mechanical; concentration; meconium; nasal; retractions; wean; developmental; infection; speech; CPR; small; fluid; hydration; weights; schedule; tracheostomy

For COVID, the pharm TXT approved for peds is IV ______.

remedesivir