NUR 425 Peds Exam 2 Study Questions
and Complete Solutions
Developmental differences between adult vs child respiratory system: ✅1. the
nasopharynx is smaller (problem because it's easily occluded during infection)
2. the tonsils and adenoids (lymph tissue) grow rapidly and become swollen which can
result in an airway obstruction; atrophy with age
3. nose is smaller (again a problem because it's easily occluded)
4. the mouth is smaller and tongue is larger (could fall back and occlude the airway)
5. epiglottis is long and floppy (it can become swollen with infection and occlude the
airway)
6. larynx and glottis are higher in the neck (increased risk of infection)
7. thyroid, cricoid, and tracheal cartilage are all immature (can easily collapse when
neck is flexed)
8. fewer functional muscles in the airway (harder to compensate for edema, spasm, and
trauma)
9. large amounts of soft tissue and loosely anchored mucous membranes line the
airway (increased risk of edema and obstruction)
10. eustachian tubes are short, open and horizontal (increased potential for ear
infections - otis media)
Other differences between peds patient and adult patient ✅-short neck, which means
short trachea (ETT can become easily dislodged)
-long floppy epiglottis
-infants are nose breathers
-ribs are horizontal
-diaphragmatic breathers
-poorly developed muscles
-lots of soft tissue in airway
-premature cilia in airway (waste products cannot be moved as easily)
-fewer, smaller alveoli (less gas exchange)
-walls of the alveoli are thicker
-increased compliance in chest wall
-higher RR
-increased potential for atelectasis
-blunted ventilatory response in newborns
-sleep a lot (reduces functional reserve capacity; leads to loss of PEEP, which
increases potential for apnea)
Why are children diaphramatic breathers ✅rib cage can't expand because they are
horizontal and so the intercostal muscles can't lift the ribs
How can you help infant breathing (due to prominent occiput problem) ✅put
blanket/towel under shoulders or upper chest to prevent their neck from facing down
,How big is a newborn airway ✅4 mm in diameter (can be compared to a little finger)
eustachian tube ✅-extends from middle ear to pharynx
-a child's is shorter, wider, and straighter than an adults
What happens when respiratory muscle fatigue develops ✅respiratory failure can
occur
Cardinal signs of respiratory failure ✅-restlessness
-tachypnea, tachycardia
-diaphoresis
Early and less obvious signs of respiratory failure ✅-mood changes/anxiety/irritability
-decreased LOC
-headache
-change in respirations
-hypertension
-DOE
-anorexia
-nasal flaring/grunting
-retractions
-wheezing or prolonged expiration
S/s of more severe hypoxia in respiratory failure ✅-hyper or hypotension
-dimness of vision
-somnolence
-stupor: if you have to perform sternal rub on them
-coma
-dyspnea
-depressed respirations
-brady (CPR when HR <60)
-cyanosis, peripheral or central: cyanosis can also occur when cold (not emergent)
Interventions for respiratory distress ✅-depends on clinical signs
-mild: oxygen via nasal prongs
-no so mild: oxygen via non rebreather (10 L or above), open airway, reposition (raise
HOB), stimulation, suctioning NP or mushroom tip catheter
-bad: start CPR and call for help
-consider hx
Asthma characteristics ✅-recurring/chronic
-most common chronic disease in US children
-major contributor to health disparities
-atopy
, S/S of asthma ✅-especially at night
-wheezing
-breathlessness
-chest tightness
-cough
Early signs of an asthma attack ✅-prodromal itching at the front of the neck or over the
upper part of the back before an attack
Components of asthma ✅-inflammation: results in hyperresponsiveness to stimuli,
reversible spontaneously or with treatment
-bronchospasm: clamping down; smooth muscle spasms and constricts
-obstruction caused by: inflammatory response to the stimuli, airway edema, mucous
production, smooth muscle spasms causing constriction, airway remodeling (permanent
changes)
What does bronchial constriction result in ✅-air trapping, which results in:
-unable to breathe in enough air despite efforts to do so, which results in:
-fatigue
-decreased effectiveness of respirations
-increased O2 consumption
-hyperinflation of alveoli
-cough becomes less effective
-status asthmaticus (despite what we try to do, we can't remedy the situation, medical
emergency)
What does increased obstruction cause ✅-CO2 retention
-hypoxemia
-respiratory acidosis
-respiratory failure
Peak expiratory flow meter and the zones ✅-measures how fast air can be expelled
from the lungs
1. green: asthma is under control
2. yellow: asthma is not well controlled, possibly an exacerbation
3. red: severe narrowing of airway may be occurring
-children should use same peak flow meter over time because different brands can give
different values
Treatment for asthma ✅-control allergens
-drug therapy: corticosteroids, leukotriens (long term)
-quick relief medications: use if they're currently having an asthma attack; beta 2
agonists, corticosteroids, anticholinergics
-delivery methods: small volume nebulizer, metered dose inhaler with spacer
and Complete Solutions
Developmental differences between adult vs child respiratory system: ✅1. the
nasopharynx is smaller (problem because it's easily occluded during infection)
2. the tonsils and adenoids (lymph tissue) grow rapidly and become swollen which can
result in an airway obstruction; atrophy with age
3. nose is smaller (again a problem because it's easily occluded)
4. the mouth is smaller and tongue is larger (could fall back and occlude the airway)
5. epiglottis is long and floppy (it can become swollen with infection and occlude the
airway)
6. larynx and glottis are higher in the neck (increased risk of infection)
7. thyroid, cricoid, and tracheal cartilage are all immature (can easily collapse when
neck is flexed)
8. fewer functional muscles in the airway (harder to compensate for edema, spasm, and
trauma)
9. large amounts of soft tissue and loosely anchored mucous membranes line the
airway (increased risk of edema and obstruction)
10. eustachian tubes are short, open and horizontal (increased potential for ear
infections - otis media)
Other differences between peds patient and adult patient ✅-short neck, which means
short trachea (ETT can become easily dislodged)
-long floppy epiglottis
-infants are nose breathers
-ribs are horizontal
-diaphragmatic breathers
-poorly developed muscles
-lots of soft tissue in airway
-premature cilia in airway (waste products cannot be moved as easily)
-fewer, smaller alveoli (less gas exchange)
-walls of the alveoli are thicker
-increased compliance in chest wall
-higher RR
-increased potential for atelectasis
-blunted ventilatory response in newborns
-sleep a lot (reduces functional reserve capacity; leads to loss of PEEP, which
increases potential for apnea)
Why are children diaphramatic breathers ✅rib cage can't expand because they are
horizontal and so the intercostal muscles can't lift the ribs
How can you help infant breathing (due to prominent occiput problem) ✅put
blanket/towel under shoulders or upper chest to prevent their neck from facing down
,How big is a newborn airway ✅4 mm in diameter (can be compared to a little finger)
eustachian tube ✅-extends from middle ear to pharynx
-a child's is shorter, wider, and straighter than an adults
What happens when respiratory muscle fatigue develops ✅respiratory failure can
occur
Cardinal signs of respiratory failure ✅-restlessness
-tachypnea, tachycardia
-diaphoresis
Early and less obvious signs of respiratory failure ✅-mood changes/anxiety/irritability
-decreased LOC
-headache
-change in respirations
-hypertension
-DOE
-anorexia
-nasal flaring/grunting
-retractions
-wheezing or prolonged expiration
S/s of more severe hypoxia in respiratory failure ✅-hyper or hypotension
-dimness of vision
-somnolence
-stupor: if you have to perform sternal rub on them
-coma
-dyspnea
-depressed respirations
-brady (CPR when HR <60)
-cyanosis, peripheral or central: cyanosis can also occur when cold (not emergent)
Interventions for respiratory distress ✅-depends on clinical signs
-mild: oxygen via nasal prongs
-no so mild: oxygen via non rebreather (10 L or above), open airway, reposition (raise
HOB), stimulation, suctioning NP or mushroom tip catheter
-bad: start CPR and call for help
-consider hx
Asthma characteristics ✅-recurring/chronic
-most common chronic disease in US children
-major contributor to health disparities
-atopy
, S/S of asthma ✅-especially at night
-wheezing
-breathlessness
-chest tightness
-cough
Early signs of an asthma attack ✅-prodromal itching at the front of the neck or over the
upper part of the back before an attack
Components of asthma ✅-inflammation: results in hyperresponsiveness to stimuli,
reversible spontaneously or with treatment
-bronchospasm: clamping down; smooth muscle spasms and constricts
-obstruction caused by: inflammatory response to the stimuli, airway edema, mucous
production, smooth muscle spasms causing constriction, airway remodeling (permanent
changes)
What does bronchial constriction result in ✅-air trapping, which results in:
-unable to breathe in enough air despite efforts to do so, which results in:
-fatigue
-decreased effectiveness of respirations
-increased O2 consumption
-hyperinflation of alveoli
-cough becomes less effective
-status asthmaticus (despite what we try to do, we can't remedy the situation, medical
emergency)
What does increased obstruction cause ✅-CO2 retention
-hypoxemia
-respiratory acidosis
-respiratory failure
Peak expiratory flow meter and the zones ✅-measures how fast air can be expelled
from the lungs
1. green: asthma is under control
2. yellow: asthma is not well controlled, possibly an exacerbation
3. red: severe narrowing of airway may be occurring
-children should use same peak flow meter over time because different brands can give
different values
Treatment for asthma ✅-control allergens
-drug therapy: corticosteroids, leukotriens (long term)
-quick relief medications: use if they're currently having an asthma attack; beta 2
agonists, corticosteroids, anticholinergics
-delivery methods: small volume nebulizer, metered dose inhaler with spacer
