Peds Exam 2

CH. 41, 45, 42, 48, 40, 43, 44, 49

what are innate nonspecific immune responses?

first line of defense

• skin and mucous membranes

• smooth muscle contraction and ciliary actions (bladder and bowel emptying; sneezing and coughing)

• physical and chemical membrane

what are adaptive specific immune responses?

recognizes and imprints on the pathogens (specific)

• cell mediated and hormonal

• phagocytosis: the process by which phagocytes digest and thereby destroys foreign mechanisms

what is the first stage of infection?

incubation: exposure

what is the second stage of infection?

prodrome: feeling a little sick, but not having all the symptoms

what is the third stage of infection?

illness: full blown illness (all symptoms)

what is the fourth stage of infection?

convalescent: severe illness or further complications

• this can also be where you evaluate if the infection is healing or not

why should you document lesions?

to see if it’s gotten worse or better

• use a marker on the lesion

what is the first vital sign change we notice first with infections?

change in temperature

what is rubeola (measles)?

infectious period: 4 days before the rash appears and 4 days after

• source: respiratory tract, urine, or blood of infected person

what are the s/s of rubeola?

fever, malaise, rash, koplik’s spots, photophobia

• 3 C’s: coryza, cough, conjunctivitis

• the spots can be on the buccal mucosa

what is the treatment for rubeola?

• dim the lights for photophobia

• antipyretics

• vitamin A supplements

• vaporizer

what is roseola (exanthem subitum)?

• agent: human herpesvirus type 6

• infectious period: may be from time febrile symptoms occur to when the rash appears

what are the s/s of roseola?

• sudden high fever 3-5 days; febrile seizures can occur

• rash; rose-pink macules that blanch with pressure

  • rash appears 1-2 days after the fever subsides

what is the treatment of roseola?

symptomatic

• fever control

what is varicella (chicken pox)?

infectious period: 1-2 days before the onset of rash to 6 days after the first crop vesicles (when the lesions are crusted over)

• precautions: contact and airborne

  • can be spread through lesions

what are the s/s of varicella?

• slight fever, malaise, anorexia

• rash appears on the trunk and scalp then moves to face and extremities

  • lesions becomes pustules and then crusts over; becomes very itchy

what are children more susceptible to with varicella?

infections

• scratching their lesions; open wounds

what is the treatment of varicella?

• acyclovir for children who are immunocompromised

• VCZ immune globulin or IVIG is recommended for immunocompromised children

what is scarlet fever?

infectious period: until 24 hr antimicrobial therapy has begun

• source: nasopharyngeal secretions of infected persons or ingestion of contaminated milk (breast feeding)

what are the s/s of scarlet fever?

• abrupt high fever, flushes cheeks, vomiting, headache, enlarged lymph nodes

• red fine sandpaper-like rash develops in the armpits, groin, and neck

  • skin can start sloughing off like a sheet

• strawberry tongue

  • white to red

what is the treatment for scarlet fever?

antibiotics such as penicillin for 10 days

• supportive care

what is rocky mountain spotted fever?

• agent: gram negative bacteria (Rickettsia rickettsia)

• source: wild rodents, dogs

• vector: ticks (wood, dog, lone star)

what are the s/s of rocky mountain spotted fever?

nonspecific

• headache, fever, anorexia, restlessness

third day

• maculopapular or petechial rash appears

  • on wrists, palms, ankles, and soles

• hemorrhagic and necrotic lesions can appear as the rash progresses

what is the treatment for rocky mountain spotted fever?

early detection and treatment within 5 days of the beginning of illness

• doxycycline (5-7 days) until the child is afebrile for 3 days

• avoiding ticks is the most effective way to prevent

what two STDs go hand in hand?

chlamydia and gonorrhea- treat both!

what vaccine prevents whooping coughing?

pertussis vaccine given with DTaP

• at the age of 11-12 years Tdap is recommended for children who have complete DTaP

how long is a period of apnea?

cessation of breathing for 20 secs or longer

how should a nurse plan their care throughout the day for a infant with whooping cough?

clustered care if possible to allow the child and parents’ to rest

can a child with whooping cough receive a bottle?

no, small, frequent feedings may benefit the baby more such as gavage or parenteral

what is whooping cough?

occurs in children who are not immunized

• agent: Bordetella pertussis

• highly contagious; airborne precautions

• incubation period: usually 10 days

what is a common complication seen with pertussis?

pneumonia

what are the stages of pertussis?

• incubation

• catarrhal

• paroxysmal

• convalescent

what is the catarrhal phase of pertussis?

last 1-2 weeks

• low grade fever

• cough

• nasal congestion

VERY contagious in this phase!

also best time to diagnose and kill bacteria

what is the paroxysmal stage of pertussis?

lasts 1-6 weeks

• uninterrupted series of coughing(increased severity)

  • whooping noise- older children may not manifest this

  • cough may induce vomiting

• cyanosis

• protrusion of tongue

• salivation

• distention of neck veins

• anorexia

how might infants be affected by whooping cough during the paroxysmal phase?

apnea, a.l.t.e (apparent life-threatening event), decreased O2 levels, cyanosis, or death

what is the convalescent phase of pertussis?

lasts greater than 2 weeks

• cough slowly improves

• airway heals

what are the respiratory differences in children?

• they code more from respiratory than cardiac

• smaller airways and undeveloped cartilage

  • increase work of breathing

• infants have smaller nares and narrow nasal passages

• brief apneic periods are common in newborns

what may be some clinical manifestations of respiratory infections in children?

• fever

  • under age of 3, at risk for febrile seizures

• decreased appetite, N/V/D, and abdominal pain

  • at risk for dehydration

• breathing impairment

  • increased respirations

  • respiratory sounds

  • increased work of breathing

  • retractions

  • oxygen desaturation

• cough. sore throat, nasal blockage, or discharge

ABCs!

what diagnostic tests are used for respiratory infections?

ABGs

• vomiting-metabolic alkalosis

• diarrhea- metabolic acidosis

test for RVP (respiratory viral panel) to know what precautions to be on

• always use droplet precautions before testing

how can you decrease a child’s work of breathing?

oxygen administration

how can you promote hydration?

IV fluids; Pedialyte; monitor I&O

what do you do when an infant is tachypneic >60 BPM?

NPO order; prevent aspiration

what can hyperextending a child’s neck do?

can occlude a child’s airway

what is sinusitis?

often follows other infections such as allergic rhinitis or otitis media

• s/s of cold, but no improvement after 10 days

• TX: surgery

what is nasopharyngitis?

common cold

• TX: supportive care- decrease respiratory effort

• very contagious- prevent the spread!

what are croup syndromes?

refers to a group of conditions characterized by inspiratory stridor, a harsh (brassy or croupy) cough, hoarseness, and varying degrees of respiratory distress

• “barking” or seal-like” cough

• affects the larynx, trachea, and bronchi

  • acute laryngotracheobronchitis (LTB) and acute epiglottis

what does stridor indicate?

emergency

• wheezing heard without a stethoscope

• INDICATES upper airway occlusion

what is acute epiglottitis?

medical emergency- life threatening

• intubate immediately before trach

• do NOT irritate the airway- will cause more inflammation

what are the common s/s of acute epiglottitis?

• drooling indicates airway is closed and they can’t swallow

• tripod position helps the pt. breathe better

why should the parents stay calm for the child during respiratory distress?

to reduce distress and relax the airway

• crying can aggravate laryngospasms and increases hypoxia

how can you treat a “barking” cough at home?

keep the child in a bathroom with a steaming shower or use a cool-mist vaporizer

what is acute laryngotracheobronchitis (LTB)?

most common croup syndrome

• can progress to respiratory acidosis and respiratory failure

• usually affects infants and toddlers; age 6 months to 6 years

what is the TX of acute laryngotracheobronchitis?

keep calm and relax airway- steam

• maintain hydration

• may give nebulizer of epinephrine or steroids, but may not always work

  • possibility of further closing of airway

what is bacterial tracheitis?

bacteria causative

• thick purulent secretions that result in respiratory distress

  • similar s/s of of LTB

  • can be a complication of LTB

what is the treatment of bacterial tracheitis?

humidified oxygen. antipyretics, antibiotics, possible need for intubation

what is strep throat?

• cause: group A B- hemolytic streptococcal infection

  • risk for rheumatic fever and acute glomerulonephritis

• contagious- not contagious after 24 hours of antibiotic therapy

what are the s/s of strep throat?

• pharyngitis

• headache

• fever

• abdominal pain

• tonsils and pharynx may be inflamed and covered in exudate

what is the treatment for strep throat?

oral penicillin such as amoxicillin for at least 10 days to control symptoms

• cephalosporins may be used in case of allergy to penicillins

what is tonsillitis?

• usually occurs with pharyngitis

• can be bacterial or viral

• inflammation causing kissing tonsils- closes up airway and causes difficulty breathing

what are the s/s of tonsillitis?

sore throat, ear pain, cough ,fever, odynophagia (pain in swallowing), headache, swollen or tender lymph nodes, and bad breath

what is the TX for tonsillitis?

• locate the origin and treat the causative agent

• tonsillectomy and adenoidectomy (for more severe/recurrent cases)

what is the most obvious sign of bleeding in tonsillectomy?

continuous excessive swallowing

what education should be provided to parents after a tonsillectomy?

• avoid red liquids, which can be confused with blood

• add full liquids (cream soups, gelatin, puddings, and other soups) on the 2nd day and soft foods as they tolerate it

• encourage your child to chew and swallow

• encourage abundant fluid intake (no citrus juices)

• discourage child to cough ,clear throat, or gargle

when can children receive the flu vaccine?

at 6 months of age

what is otitis media?

inflammation of the middle ear

• assessment: check tympanic membrane motility

what are the s/s of otitis media?

irritability, rub or pull at ears, ear pain, and fever

• child may also have a ear infection with pulling of ears and fever

what is the TX of otitis media?

relieve pain, antibiotics, clear the way for drainage, myringotomy or tympanostomy tube placement

what are some preventative measures you can take for otitis media?

• immunization- pneumococcal vaccine

• reduce the risks of ear infection

  • avoid bottle propping

  • decrease or discontinue pacifier use at 6 months

  • prevent exposure to tobacco smoke

what is bronchitis?

aka tracheobronchitis

• frequently associated with URI

• inflammation of large airways (trachea and bronchi)

what are the s/s of bronchitis?

dry, hacking non-productive cough(worsens at night)

• cough becomes productive within 2-3 days

what is the TX for bronchitis?

humidity, analgesics, antipyretics

what is RSV and bronchiolitis?

commonly seen with each other

• respiratory syncytial virus- common cause of bronchiolitis

• bronchiolitis: inflammation of the bronchioles that causes production of thick mucus

what is the most frequent cause of hospitalization in children?

RSV and bronchiolitis

what are the s/s of RSV and bronchiolitis?

rhinorrhea, pharyngitis, coughing, wheezing, fever, increased WOB

what is the TX for RSV and bronchiolitis?

supportive care

• suctioning, humidified oxygen, order for IV with fluids

what is the prevention of RSV and bronchiolitis?

monoclonal antibody IM infection

what is pneumonia?

can be primary disease or a complication from another infection

• causative agents: inhaled organisms or bloodstream infection

what are the s/s of pneumonia?

cough, tachypnea, breath sound (rhonchi or fine crackles), chest pain, retractions, nasal flaring

• breath sounds sound normal after breaking up mucus

what is foreign body aspiration?

swallowing and aspiration of foreign body into air passages

• most common offenders are round in shape

  • hot dogs, candy, popcorn, peanuts, or grapes

what are the signs of foreign body aspiration?

initial choking, gagging, coughing and retractions

• cyanosis may occur if condition worsens

what is aspiration pneumonia?

aspiration of fluid or food substance in a child who has difficulty swallowing

• fluid enters lung and bacteria grows

how can you prevent aspiration pneumonia?

do NOT feed child while crying or breathing rapidly (>60 BPM)

what is the TX of acute respiratory distress syndrome?

maintain adequate oxygen, treat the cause, and maintenance of adequate cardiac output

is apnea during pooping a concern?

no, this is normal

what should be noted during an episode of apnea?

• time and duration of the episode

• color changes

• bradycardia

• O2 saturation

• action that stimulated breathing

what is asthma?

chronic inflammatory disorder that causes episodic airway obstruction

• can be worse at night for children

what are the s/s of an asthma exacerbation?

nonproductive cough, chest tightness, SOB, wheezing, reduced expiratory flow, increased sputum (which causes more respiratory distress)

• if wheezing becomes audible by ear, administer albuterol

what are some indicators of respiratory distress in asthma attacks?

tachypnea, tachycardia, retractions, inspiratory and expiratory wheeze

what is silent chest?

no wheezing because of decreased air movement; decreased wheezing in a child who is not improving clinically can signal an inability to move air

what medication should be administered immediately for asthma exacerbation?

bronchodilator such as albuterol

• tachycardia can be a normal response after an atatck

anticholinergics and corticosteroids may also be used

how can you determine if a bronchodilator has been effective?

• wheezing may actually signal that the child’s condition is improving

• using a spirometry

  • tell patient to blow bubbles to help use

what education can be given for asthma?

• how to avoid triggers

• daily use of peak flowmeter to monitor pulmonary status and response to treatment

• how to recognize early warning signs of an attack

• measures that can be taken to prevent severe attacks

• medication administration

what is cystic fibrosis?

chronic, autosomal-recessive, inherited disorder of the exocrine glands

• affects multiple organ systems

• abnormal thick secretions usually by those of the bronchioles, small intestine, and pancreatic and bile ducts

  • at risk for pneumonia

should a child with CF be given a cough suppressant?

no!

• the child should be encouraged to cough up mucus to clear airways

  • usually do this with ACTs (airway clearance techniques)

what nursing interventions may be done for CF?

individualized for each child and is aimed at preventing and treating pulmonary infections, maintaining optimal nutritional status, facilitating airway clearance and gas exchange, and promoting psychological adjustment

what indicates improvement in a hospitalized CF patient?

improved breath sounds, oxygen saturation greater than 95%, and stable respiratory status, normal WBC and body temperature

how does CF affect the respiratory system?

chronic respiratory tract infection and impaired oxygen and carbon dioxide exchange cause varying degrees of hypoxia, hypercapnia, and acidosis

• may result in cor pulmonale, HF, and other complications

• death in individuals with CF is almost always from respiratory failure

how does CF affect the digestive system?

blocked by thick mucus, the pancreatic ducts are unable to secrete trypsin, amylase, and lipase into the small intestine.

• without these digestive enzymes, proteins, carbohydrates, and fats are poorly absorbed

• malnutrition and growth failure may be evident

need a high protein, high calorie diet!

why are patients with CF at increased risk of respiratory infections?

stasis of secretions from bronchial obstruction provides a medium for bacterial growth

• chronic infection causes the release of toxic chemicals that damage lung tissues and alter host defenses within the airways, thus exacerbating the infection and inflammation

what is one of the first signs of cystic fibrosis in neonates?

abnormal stool