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Pediatric Respiratory SystemMaternity & Pediatric Nursing

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If a child has swallowed or inhaled a foreign body, what is the emergency management?
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Abdominal thrusts for children over 1 year of age, back blows and chest thrusts for children under 1 year of age. Removal as soon as possible. Monitoring irritation after removal of FB.
What are the signs and symptoms of a foreign body in the nose?
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Unilateral nasal discharge, foul smell, sneezing. Infection can follow if not removed, need to remove is as soon as possible
Items smaller than _____inches/____ cm can be aspirated easily.
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Items smaller than 1.25 inches/3.2 cm can be aspirated easily.
What respiratory problem? Occurs following a primary insult associated with: sepsis, trauma, viral pneumonia, fat emboli, drug overdose, near-drowning and smoke inhalation. Characterized by: respiratory distress, hypoxemia that occurs within 72 hours of a serious injury or surgery. A hallmark symptom is pulmonary edema.
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Acute Respiratory Distress Syndrome
What might be seen on an Xray of a child suspected of having ARDS?
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Diffuse bilateral infiltrates on X-ray
What respiratory problem? An initial injury leads to the development of pulmonary edema. A hyaline membrane forms over the alveolar surfaces along with decreased surfactant production which causes lungs to become stiff. Cellular debris and mucosal swelling fills alveolar spaces causes congestive atelectasis to occur.
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Acute Respiratory Distress Syndrome
What are the signs and symptoms of ARDS?
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Hyperventilation, tachypnea, tachycardia, increasing respiratory effort, cyanosis, decreasing oxygen saturation occur
What is the medical management of ARDS?
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Oxygen delivery, endotracheal intubation, exogenous surfactant administration, mechanical ventilation and life support, prevention of further lung damage
What are the nursing responsibilities related to treatment of a patient with ARDS?
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Monitor oxygen status, F&E, vital signs, perfusion, capillary filling, urinary output, respiratory and cardiac status. Administer diuretics like Furosemide (Lasix), vasodilators, perform blood gas analysis, monitor pulse ox, provide family support, pain management. Due to the high mortality rate of ARDS parents need to be kept informed.
In allergic rhinitis, ____ mediates the immune response to an allergen and triggers the release of histamine and leukotrienes. This results in tissue edema and mucus production.
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IgE
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What conditions are closely associated with allergic rhinitis ? (4)
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otitis media, asthma, chronic sinusitis, atopic dermatitis
What respiratory problem? Watery rhinorrhea, nasal obstruction, sneezing, nasal pruritis, conjunctivitis, snoring, fatigue, malaise, poor school performance
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Allergic rhinitis
How is allergic rhinitis diagnosed?
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A nasal smear will be positive for eosinophilia, a skin test for allergens will react positively or a positive RAST are diagnostic for allergic rhinitis.
What respiratory problem? A diffuse obstructive pulmonary disease characterized by airway inflammation and bronchial smooth muscle constriction resulting from airway hyperresponsiveness which is manifested by wheezing, dyspnea, and cough
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Asthma
If a child's asthma is classified as extrinsic, this means that the asthma is caused by...
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an immunologic, allergic response
If a child's asthma is classified as intrinsic, this means that the asthma is caused by...
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non-allergic, often triggered by infection
Asthmatic episodes of progressively worsening shortness of breath, cough, wheezing, or chest tightness. Hypoxemia can occur, increasing C02 and decreasing O2. Referred to as...
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Exacerbations
T/F If at all possible, don't intubate a patient with exacerbations of asthma because they are hard to get back off of a ventilator.
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True
What repiratory problem? Cough at night, hacking cough is initially non-productive but becomes productive with a frothy sputum, shortness of breath, chest tightness, pain, dyspnea with exercise, wheezing, anxiety, possible hyperresonance on percussion, may hear coarse breath sounds
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Asthma
How is asthma diagnosed?
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Presence of hyperinflation on chest Xray, hypoxemia/carbon dioxide retention on ABGs, decreased PEFR during an exacerbation, PFTs to determine degree of disease (not useful during an attack)
If a patient is experiencing an exacerbation of asthma, what should their Albuterol dosing regimen look like?
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1 puff of Albuterol every 5 minutes, up to 3 times. If not helping, go to ER.
  
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