Asthma
The two classifications of asthma medications frequently prescribed.
Give examples
What are Rescue (Albuterol) and Controller (Flovent)
The head of the bed is elevated ____ degrees for
patients with a trach or ETT?
What is 30?
A long expiratory phase and a whistling type sound on exhalation
Wheezing
Flow rates for nasal cannula and maximum amount of FIO2 delivered
0.1-4L
50%
Who do you call if you are concerned about
your patient or they have a PEWS of 5 or more?
RRT or resident
Escalate to attending if needed and document all escalation
The description of the x-ray of a patient with acute asthma exacerbation
What is hyperinflated?
A patient with a tracheostomy should always have these at bedside and for travel (6)
Oxygen and bag valve mask
Suction source and catheter
Trach tube same size
Trach tube one size smaller
Obturator
Extra trach ties
High pitched sound on inhalation
What is stridor?
Maximum amount of oxygen delivered using simple face mask
How face mask is weaned
50%
Do not decrease to less than 6L flow rate. Change to NC or just d/c
What do chest tubes remove (5)
Air
Blood
Pus
Chyle
Other fluid (pleural effusion)
Green, yellow or red.
What is the asthma action plan?
Ways to prevent ventilator associated pneumonia (nursing 3)
HOB elevated
Mouth care/teeth brushing
Suction mouth prior to repositioning
RT to change circuit and inline
A sound made when the glottis closes partially during exhalation to maintain PEEP
What is grunting?
Not used for oxygen delivery alone
Used to administer inhaled medications
What is the flow rate?
Nebulizer
10 L
What is assessed for a child with a chest tube? (3 main categories)
•Standard respiratory assessment (rate, WOB, BS)
•Site and dressing
•Assessment of collection device:
•Drainage amount and appearance
•Tidaling
•Air leak
Virus, mold, cats and dogs
What are triggers?
Things to review and assess in bedside report for a patient with a tracheostomy (5)
Airway type
Airway size
Cuff or cuffless
Date trach is due to be changed
Skin assessment
Seen in respiratory distress when the patient is using all of their muscles to breathe (4)
Nasal flaring
Head bobbing
Retractions
Seesaw or abdominal breathing
Used to provide maximum oxygen but no support
What is flow rate?
Non-rebreather
Reservoir must be full, 10-15 L
Name reasons why a child with a respiratory virus gets sicker than an adult (6)
•Less developed immune system
•Smaller airways
•Obligate nose breathers (4m)
•Higher baseline RR
•Cannot self clear secretions from nares/cough less effective
•Muscles weaker
Asthma education (list 5)
Disease process/patho
Medications
MDI with spacer technique
Trigger avoidance
Asthma action plan
If a tracheostomy tube becomes dislodged and
cannot be easily replaced, what should you do (2)?
What is cover the stoma and bag-valve-mask
Call for help/RRT
Term used when no breath sounds can be heard
Silent chest
Next step in respiratory support after nasal cannula or simple face mask
What is the max flow rate?
High Flow
2L/kg
Name ways to prevent respiratory distress from becoming respiratory failure (5)
Reposition
Suction
CPT
Increase oxygen amount (per order)
Increase oxygen flow (per order)
Change delivery device (per order)/Increase respiratory support
(high flow, NIMV, CPAP/BiPAP, intubation/vent)