Chapter 40
Respiratory
Respiratory
What are some respiratory conditions that chest physiotherapy (CPT) and postural drainage would be helpful for?
What are bronchiolitis, pneumonia, cystic fibrosis and other conditions resulting in increased mucus production.
See nursing procedure on CPT and postural drainage on page 1337 - 1339
PAGE 1298
What are the 3 fetal heart structures?
What are the ductus venosus, ductus arteriosus, and foramen ovale
PAGE 1351
All blood cells originate from this single type of cell called what?
Multipotent stem cell
PAGE 1569
Do B cells or T cells cross the placenta?
B Cells
Comparison chart 47.1 PAGE 1630
Barotrauma
PAGE 1753 & 1769
The nurse is examining a 5-year-old child. What is a reliable FIRST indication of respiratory illness in a child of this age?
What is Tachypnea or increased respiratory rate.
Often the first sign of respiratory illness in infants and children.
PAGE 1301
What is the most common CHD that Down Syndrome children have?
Atrioventricular Septal Defect (AVSD)
PAGE 1368
What diagnostic tests is used to confirm neuroblastoma?
Urine catecholamines (VMA and HVA)
PAGE 1583
Children with a wheat allergy should also avoid what?
Cereal extract, couscous, durum, semolina, spelt
Some imitation crab meat and wheat flour shaped to look like shrimp, beef, or pork
Teaching Guideline 47.1 PAGE 1651
Rashes that do not blanch may be classified as petechiae or purpura. What serious condition could this indicate?
Meningococcemia
Clinical reasoning alert PAGE 1758
A child requires supplemental oxygen therapy at 8 L/min. Which delivery device will the nurse use?
A simple mask is used to deliver a flow rate between 6 L/min and 10 L/min. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 L/min. An oxygen hood requires a liter flow of 10 to 15 L/min.
PAGE 1308
When should digoxin be administered? (Provide intervals & with food? yes or no)
When would it be with-held? (Provide pulse rate & signs of toxicity)
Give digoxin at regular intervals, every 12 hours, such as at 8 a.m. and 8 p.m., 1 hour before or 2 hours after a feeding. If a digoxin dose is missed, give the dose as soon as it is realized the dose was missed. If it is close to the next dose’s time, hold the missed dose. Monitor potassium levels, as a decrease enhances the effects of digitalis, causing toxicity.
Prior to administering each dose, count apical pulse for one full minute, noting rate, rhythm, and quality. Withhold if apical pulse is <60 in an adolescent, <90 in an infant.
• Avoid giving oral form with meals, as altered absorption may occur.
• Monitor serum digoxin levels (therapeutic range: 0.8–2 ng/mL).
• Note signs of toxicity: nausea, vomiting, diarrhea, lethargy, and bradycardia.
TAKE NOTE PAGE 1351, DRUG GUIDE 1352
What are some health history risk factors for iron-deficiency anemia?
Maternal anemia during pregnancy, Poor controlled diabetes during pregnancy, prematurity, low birth weight, multiple birth, cows milk consumption prior to 12 months, over 24 ounce of cows milk daily, consuming low-iron formula, lack of iron supplementation after age 6 months for breastfed infants, Excessive weight gain, Chronic infection or inflammation, Chronic or acute blood loss, Restricted diets, Use of medication interfering with iron absorption, such as antacids, Low socioeconomic status, Recent immigration from a developing country
PAGE 1594
What is the most common type of JIA
Paucuarticular (Involvement of four or fewer joints; quite often, the knee is involved)
TABLE 47.2 PAGE 1645
What is included in the pediatric chain of survival?
Prevention of cardiac arrest and injuries
Early CPR
Early access to emergency response system
Early advanced care (pediatric advanced life support [PALS])
Integrated postcardiac arrest care
PAGE 1753
A diagnosis of cystic fibrosis has just been made in your client. What is the diagnostic test level of a sweat chloride test that would confirm this finding?
What is a level above 60 mEq/L
PAGE 1337
Describe what each grade heart murmur sounds like?
• Grade 1
• Grade 2
• Grade 3
• Grade 4
• Grade 5
• Grade 6
Intensity: grade I, soft and hard to hear; grade II, soft and easily heard; grade III, loud without thrill; grade IV, loud with a precordial thrill; grade V, loud with a precordial thrill, audible with a stethoscope partially off chest; grade VI, very loud, audible with a stethoscope or with the naked ear
PAGE 1356
To help prevent infection in SCD patients what medication is started by 2 months of age? and how long do we continue it for?
Oral Penicillin V potassium as prophylaxis against pneumococcal infections. Continue until at least 5 y/o
*Erythromycin may be used if allergy to PCN
PAGE 1602
What medications are often prescribed to children with mild or moderate SLE?
NSAIDS, corticosteroids and antimalarial drugs (hydroxychloroquine sulfate, helps prevent flares)
PAGE 1633 & 1644
What would be the appropriate size of ET tube for a patient 3 y/o
Formula: divide child's age by 4, add 4
3 divided by 4 = 0.75 + 4 = 4.75
Always have one size smaller and one size bigger available
PAGE 1770
Teach your patient how to use a metered dose inhaler.
Shake inhaler and take off cap, attach inhaler to the spacer or holding chamber, breathe out completely, place the spacer mouthpiece in the mouth or place the mask over the child's nose and mouth, ensuring a good seal, compress the inhaler and inhale slowly and deeply. hold breath for a count of 10, wait one full minute before second inhalation, if prescribed.
Teaching guideline: 40.5 PAGE 1331
What are the CHD that make up the condition of Tetralogy of Fallot?
How do you treat a hypercyanotic spell?
Pulmonic stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
Knee to chest position
PAGE 1364
What are the chelating agent used in the treatment of hemoasiderosis? SUBQ and ORAL
SUBQ: Deferoxamine
ORAL: Deferasirox
PAGE 1574 & 1603
Name 3 warning signs of a primary immunodeficiency
Four or more new episodes of acute otitis media in 1 year
Two or more episodes of severe sinusitis in 1 year
Treatment with antibiotics for 2 months or longer with little effect
Two or more episodes of pneumonia in 1 year
Failure to thrive in the infant
Recurrent deep skin or organ abscesses
Persistent oral thrush or skin candidiasis after 1 year of age
History of infections requiring IV antibiotics to clear
Two or more serious infections such as sepsis
Family history of primary immunodeficiency
BOX 47.1 PAGE 1637
what is the treatment for uncompensated SVT
INFANT >220
CHILD >180
TX: adenosine or synchronized cardioversion
PAGE 1778 & 1781