Nursing 235 Exam 4 Study Guide with Questions and Correct Answers
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Course
NUR 235
Institution
NUR 235
Structural difference in respiratory system between children and adults Small/narrow airways: swelling/secretions make it much more difficult to breathe
Less surface area: periods of apnea can last up to 15 seconds
Lack of collateral pathways: fewer bronchioles, easily clogged, keep nares open, s...
Nursing 235 Exam 4 Study Guide with
Questions and Correct Answers
Structural difference in respiratory system between children and adults ✅Small/narrow
airways: swelling/secretions make it much more difficult to breathe
Less surface area: periods of apnea can last up to 15 seconds
Lack of collateral pathways: fewer bronchioles, easily clogged, keep nares open,
suction with bulb syringe
Nose breathers: up until 4 weeks, predominately up until 2 years; keep nose suctioned
well
Diaphragmatic breathing: not as strong, can't lift ribcage like an adult
What factors can decrease respiratory resistance in children? ✅-compromised immune
system (breastfeeding and immunizations will help)
-anemia (iron supplements help)
-nutritional deficiencies
-allergies
-exposure to 2nd hand smoke
Normal respirations in age ranges ✅0-6 months: 30-60
6-12 months: 24-30
1-5 years: 20-30
6-11 years: 12-20
12 and up: 12-18
Breath sounds ✅Stridor: harsh, high pitched crowing; caused by upper airway
obstruction (croup)
Grunting: deep guttural sound; premature closing of glottis; signs of respiratory distress
Cardinal s/s of respiratory failure and hypoxia ✅-restlessness
-tachypnea
-tachycardia
-diaphoresis (except in neonates)
Early hypoxia: (depends on age of child)
-mood changes
-HA
-exertional dyspnea
-anxiety
-confusion (older child)
-altered depth/pattern of respirations
-decreased LOC
-HTN
-anorexia
-nasal flaring
-chest wall retractions
-expiratory grunt
-wheezing or prolonged expiration
Late/severe hypoxia:
-HTN to hypotension
-vision decreases
-lethargic/somnolence
-stupor
-dyspnea
-depressed respirations
-bradycardia
-cyanosis (peripheral or central)
-coma
Pulse oximetry ✅-make sure the pulse reading is comparable to the radial pulse/apical
pulse
-infants apply the pulse oximetry on their big toe and hold for accuracy
,-move the probe every 4-8 hours if on continuous monitoring to prevent pressure
necrosis in infants who have disrupted skin integrity or poor perfusion
-if below expected ranges then confirm if correct, Oxygen is on & correct, sit the child up
to semi or high fowler's position, deep breathe, emotional support and report if no
change
Nebulizer aerosol therapy ✅-respiratory administers these treatments that are various
meds that are minute particles to disperse throughout the respiratory tract
-treatment lasts 10-15 mins
-determine which device to use depends on age (mouthpiece vs. mask)
-may need vitals prior
-child should take slow deep breaths
-monitor child during tx
-may be ordered home nebs: may need to teach how to operate the home nebulizer
Metered dose inhaler or dry powder inhaler ✅-open mouth vs. closed mouth method
-deep breath 3-5 seconds and hold breath 5-10 seconds if applicable
-wait 1 minute between puffs
Education:
-clean the MDI and spacer after each use
-have the child rinse their mouth and expectorate to prevent fungal infections if using a
corticosteroid inhaler
Chest physiotherapy ✅Includes manual or mechanical percussion (cupping of hands),
vibration (vest), cough, forceful expiration, and breathing exercises
-postural positioning for drainage also involved
-usually respiratory therapist is consulted for this treatment
-need treatments 1 hour before meals or 2 hours afterwards to prevent vomiting and
aspiration
-may need bronchodilator or neb treatment prior to facilitate the expiration of the
secretions
Oxygen therapy ✅All the different types (oxygen hood that fits over the infant's head;
nasal cannula; and pediatric face mask)
-humidified to decrease dryness
Suctioning ✅Infants may require saline squirted in nasal cavity and then suctioned with
small tube
-essential to maintain airway patency of infants and children
-temporarily takes their breath away, startles and causes tears
-educate both child and parents to establish good rapport
-5-10 seconds of suctioning as the catheter is withdrawn
Artificial airways ✅Endotracheal, tracheostomy may required hyperoxygenation prior to
suctioning
, -need to maintain patent airway and prevent mucus plug
Seasonal allergies (hay fever) ✅Reaction to microscopic particles called allergic
rhinitis; most often in spring and autumn
S/S:
-sneeze
-watery eyes/rhinorrhea
-nasal congestion/obstruction
-itchiness of nose, eyes, pharynx, and conjunctiva
Prevention:
-avoid irritants
-may need prophylaxis meds and preventative treatment
Treatment:
-Nasal corticosteroids: fluticasone
-Antihistamines
-Beta adrenergic decongestants: pseudoephedrine, for 4 yo and up
-Mast cell stabilizers: cromolyn, for 2 yo and up
-Leukotriene modifiers: montelukast, for 6 mo and up
-Anticholinergic: ipratropium
-Immunotherapy
Medications for allergies ✅Nasal corticosteroids: fluticasone; 1st line treatment (local
acting anti-inflammatory and immune modifier)
-intranasal: > 4yrs.
Antihistamines (antagonizes the effects of histamine at H1 receptor sites)
-greatest side effects are anticholinergic and sedation but 1st generation has much
stronger effects than 2nd generation
(1st generation: AVOID due to sedation effects, especially under 4 years old:
brompheniramine, chlortrimeton, dimenhydrinate and diphenhydramine)
(2nd generation- cetirizine= 6 months and greater, lortadine= 2 yrs and greater,
fexofenadine= 6 months and greater;
Beta Adrenergic Decongestants: pseudoephedrine
> 4 yrs
-produces vasoconstriction in the respiratory tract mucosa (alpha adrenergic
stimulation) and possibly bronchodilation (beta 2 adrenergic stimulation)
Mast cell stabilizers- cromolyn > 2 yrs
-prevents the release of histamine
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