NURS 330 EXAM2 STUDY GUIDE REVIEW WITH
COMPLETE SOLUTIONS
Respiratory
-respiratory anatomy and physiology: tongue, airway compliance, metabolic rates, cartilage
• Tongue:
o The tongue of the infant relative to the oropharynx is larger than in adults
o Posterior displacement of the tongue can quickly lead to severe airway obstruction
• Airway Compliance
o The infant’s trachea is approximately 4 mm wide compared with the adult width
of 20 mm
o When edema, mucus, or bronchospasm is present, the capacity for air passage is
greatly diminished
o The child’s airway is highly compliant, making it quite susceptible to
dynamic collapse in the presence of airway obstruction
• Cartilage
o In teenagers and adults the larynx is cylindrical and fairly uniform in width
o In infants and children younger than 10 years old, the cricoid cartilage is
underdeveloped, resulting in laryngeal narrowing
• Metabolic Rates
o Children have a significantly higher metabolic rate than adults
o Their resting respiratory rates are faster and their demand for oxygen is higher
- respiratory distress: signs and symptoms early VS late, S/S in various age groups
• a respiratory disorder that is specific to neonates
• It results from lung immaturity and a deficiency in surfactant, so it is seen most often in
premature infants
o Other infants who might experience RDS include infants of diabetic mothers, those
delivered via cesarean section without preceding labor, and those experiencing
perinatal asphyxia
o Newborn- exhibits signs of respiratory distress, including tachypnea, retractions,
nasal flaring, grunting, and varying degrees of cyanosis. Auscultation reveals fine
rales and diminished breath sounds. If untreated, RDS progresses to seesaw
respirations, respiratory failure, and shock
-chest physiotherapy: purpose and nursing interventions
• Chest physiotherapy is often used as an adjunct therapy in respiratory illnesses, but for
children with cystic fibrosis it is a critical intervention
• Chest physiotherapy involves percussion, vibration, and postural drainage, and either it or
another bronchial hygiene therapy must be performed several times a day to assist with
mobilization of secretions
• Purpose: Bronchiolitis, pneumonia, cystic fibrosis, or other conditions resulting in
increased mucus production. Not effective in inflammatory conditions without increased
mucus
• Nursing Implications: May be performed by respiratory therapist in some institutions, by
nurses in others. In either case, nurses must be familiar with the technique and able to
educate families on its use
,NURS 330 EXAM2 STUDY GUIDE REVIEW WITH
COMPLETE SOLUTIONS
-nasopharyngitis/URI: nursing assessment and management
• Assessment:
o child may have either a stuffy or runny nose
o Nasal discharge is usually thin and watery at first but may become thicker and
discolored. The color of nasal discharge is not an accurate indicator of viral
versus bacterial infection
o The child may be hoarse and complain of a sore throat. Cough usually
produces very little sputum
o Fever, fatigue, watery eyes, and appetite loss may also occur
o Symptoms are generally at their worst over the first few days and then decrease
over the course of the illness.
o Assess for risk factors such as day care or school attendance. Inspect for edema and
vasodilation of the mucosa. Diagnosis is based on clinical presentation rather than
laboratory or x-ray studies.
• Management
o Therapeutic management of the common cold is directed toward symptom relief
o Promotion of adequate oral fluid intake is important to liquefy secretions
o A cool mist humidifier also helps with nasal congestion
o No OTC cold meds- Several research studies have not shown the preparations to be
effective and they are known to have potentially serious side effects
o No antibiotics if viral
o Teaching about ways to prevent the common cold is a vital nursing intervention:’
▪ frequent hand washing helps to decrease the spread of viruses that cause the
common cold
▪ Teach parents and family to avoid second-hand smoke as well as crowded
places, especially during the winter
▪ Avoid close contact with individuals known to have a cold
▪ Encourage parents and families to consume a healthy diet and get enough
rest
-croup: pathophysiology
• also referred to as laryngotracheobronchitis because inflammation and edema of the
larynx, trachea, and bronchi occur as a result of viral infection
• Parainfluenza is responsible for the majority of cases of croup
• Other causes include adenovirus, influenza virus A and B, RSV, and rarely measles virus
or Mycoplasma pneumoniae
• The inflammation and edema obstruct the airway, resulting in symptoms
• Mucus production also occurs, further contributing to obstruction of the airway.
• Narrowing of the subglottic area of the trachea results in audible inspiratory stridor
• Edema of the larynx causes hoarseness
• Infammation in the larynx and trachea causes the characteristic barking cough of croup
-strep throat: treatment and management
• Inflammation of the throat mucosa (pharynx) is referred to as pharyngitis
• Assessment:
o Onset of pharyngitis is often quite abrupt
, NURS 330 EXAM2 STUDY GUIDE REVIEW WITH
COMPLETE SOLUTIONS
o History may include a fever, sore throat and difficulty swallowing, headache, and
abdominal pain. Inquire about recent incidence of viral or strep throat in the
family, day care center, or school
o Inspect the pharynx and tonsils
o The nurse may obtain a throat swab for rapid diagnostic testing and throat culture.
The rapid strep test is a sensitive and reliable measure, rarely resulting in false-
positive readings
• Management
o Saline gargles (made with 8 oz of warm water and a half-teaspoon of table salt)
are soothing for children old enough to cooperate
o Acetaminophen or ibuprofen for fever and pain
o Throat lozenges or hard candy
o Cool mist humidity
o Ingest popsicles, cool liquids, or ice chips for hydration
-epiglottitis: nursing management and assessment
• Assessment
o Carefully assess the child with suspected epiglottitis. Note sudden onset of
symptoms and high fever
o The child has an overall toxic appearance
o He or she may refuse to speak or may speak only with a very soft voice
o The child may refuse to lie down and may assume the characteristic position:
sitting forward with the neck extended. Drooling may be present
o Note anxiety or a frightened appearance
o Note the child’s color
o Cough is usually absent
o A lateral neck radiograph may be performed to determine whether epiglottitis is
present. This is done cautiously, so as not to induce airway obstruction with
changes in position of the child’s neck
• Management
o Do not leave the child unattended
o Keep the child and parents as calm as possible
o Allow the child to assume a position of comfort. Do not place the child in a supine
position, as airway occlusion may occur
o Provide 100% oxygen in the least invasive manner that is acceptable to the child. If
the child with epiglottitis experiences complete airway occlusion, an emergency
tracheostomy may be necessary
o Ensure that emergency equipment is available and that personnel trained in
intubation of the pediatric occluded airway and percutaneous tracheostomy are
notified of the child’s presence in the facility
o Epiglottitis is characterized by dysphagia, drooling, anxiety, irritability, and
significant respiratory distress. Prepare for the event of sudden airway occlusion
-tonsillectomy/adenoidectomy: post-op care and assessment
• Tonsillectomy (surgical removal of the palatine tonsils) may be indicated for the child
with recurrent streptococcal tonsillitis or massive tonsillar hypertrophy or for other
reasons
COMPLETE SOLUTIONS
Respiratory
-respiratory anatomy and physiology: tongue, airway compliance, metabolic rates, cartilage
• Tongue:
o The tongue of the infant relative to the oropharynx is larger than in adults
o Posterior displacement of the tongue can quickly lead to severe airway obstruction
• Airway Compliance
o The infant’s trachea is approximately 4 mm wide compared with the adult width
of 20 mm
o When edema, mucus, or bronchospasm is present, the capacity for air passage is
greatly diminished
o The child’s airway is highly compliant, making it quite susceptible to
dynamic collapse in the presence of airway obstruction
• Cartilage
o In teenagers and adults the larynx is cylindrical and fairly uniform in width
o In infants and children younger than 10 years old, the cricoid cartilage is
underdeveloped, resulting in laryngeal narrowing
• Metabolic Rates
o Children have a significantly higher metabolic rate than adults
o Their resting respiratory rates are faster and their demand for oxygen is higher
- respiratory distress: signs and symptoms early VS late, S/S in various age groups
• a respiratory disorder that is specific to neonates
• It results from lung immaturity and a deficiency in surfactant, so it is seen most often in
premature infants
o Other infants who might experience RDS include infants of diabetic mothers, those
delivered via cesarean section without preceding labor, and those experiencing
perinatal asphyxia
o Newborn- exhibits signs of respiratory distress, including tachypnea, retractions,
nasal flaring, grunting, and varying degrees of cyanosis. Auscultation reveals fine
rales and diminished breath sounds. If untreated, RDS progresses to seesaw
respirations, respiratory failure, and shock
-chest physiotherapy: purpose and nursing interventions
• Chest physiotherapy is often used as an adjunct therapy in respiratory illnesses, but for
children with cystic fibrosis it is a critical intervention
• Chest physiotherapy involves percussion, vibration, and postural drainage, and either it or
another bronchial hygiene therapy must be performed several times a day to assist with
mobilization of secretions
• Purpose: Bronchiolitis, pneumonia, cystic fibrosis, or other conditions resulting in
increased mucus production. Not effective in inflammatory conditions without increased
mucus
• Nursing Implications: May be performed by respiratory therapist in some institutions, by
nurses in others. In either case, nurses must be familiar with the technique and able to
educate families on its use
,NURS 330 EXAM2 STUDY GUIDE REVIEW WITH
COMPLETE SOLUTIONS
-nasopharyngitis/URI: nursing assessment and management
• Assessment:
o child may have either a stuffy or runny nose
o Nasal discharge is usually thin and watery at first but may become thicker and
discolored. The color of nasal discharge is not an accurate indicator of viral
versus bacterial infection
o The child may be hoarse and complain of a sore throat. Cough usually
produces very little sputum
o Fever, fatigue, watery eyes, and appetite loss may also occur
o Symptoms are generally at their worst over the first few days and then decrease
over the course of the illness.
o Assess for risk factors such as day care or school attendance. Inspect for edema and
vasodilation of the mucosa. Diagnosis is based on clinical presentation rather than
laboratory or x-ray studies.
• Management
o Therapeutic management of the common cold is directed toward symptom relief
o Promotion of adequate oral fluid intake is important to liquefy secretions
o A cool mist humidifier also helps with nasal congestion
o No OTC cold meds- Several research studies have not shown the preparations to be
effective and they are known to have potentially serious side effects
o No antibiotics if viral
o Teaching about ways to prevent the common cold is a vital nursing intervention:’
▪ frequent hand washing helps to decrease the spread of viruses that cause the
common cold
▪ Teach parents and family to avoid second-hand smoke as well as crowded
places, especially during the winter
▪ Avoid close contact with individuals known to have a cold
▪ Encourage parents and families to consume a healthy diet and get enough
rest
-croup: pathophysiology
• also referred to as laryngotracheobronchitis because inflammation and edema of the
larynx, trachea, and bronchi occur as a result of viral infection
• Parainfluenza is responsible for the majority of cases of croup
• Other causes include adenovirus, influenza virus A and B, RSV, and rarely measles virus
or Mycoplasma pneumoniae
• The inflammation and edema obstruct the airway, resulting in symptoms
• Mucus production also occurs, further contributing to obstruction of the airway.
• Narrowing of the subglottic area of the trachea results in audible inspiratory stridor
• Edema of the larynx causes hoarseness
• Infammation in the larynx and trachea causes the characteristic barking cough of croup
-strep throat: treatment and management
• Inflammation of the throat mucosa (pharynx) is referred to as pharyngitis
• Assessment:
o Onset of pharyngitis is often quite abrupt
, NURS 330 EXAM2 STUDY GUIDE REVIEW WITH
COMPLETE SOLUTIONS
o History may include a fever, sore throat and difficulty swallowing, headache, and
abdominal pain. Inquire about recent incidence of viral or strep throat in the
family, day care center, or school
o Inspect the pharynx and tonsils
o The nurse may obtain a throat swab for rapid diagnostic testing and throat culture.
The rapid strep test is a sensitive and reliable measure, rarely resulting in false-
positive readings
• Management
o Saline gargles (made with 8 oz of warm water and a half-teaspoon of table salt)
are soothing for children old enough to cooperate
o Acetaminophen or ibuprofen for fever and pain
o Throat lozenges or hard candy
o Cool mist humidity
o Ingest popsicles, cool liquids, or ice chips for hydration
-epiglottitis: nursing management and assessment
• Assessment
o Carefully assess the child with suspected epiglottitis. Note sudden onset of
symptoms and high fever
o The child has an overall toxic appearance
o He or she may refuse to speak or may speak only with a very soft voice
o The child may refuse to lie down and may assume the characteristic position:
sitting forward with the neck extended. Drooling may be present
o Note anxiety or a frightened appearance
o Note the child’s color
o Cough is usually absent
o A lateral neck radiograph may be performed to determine whether epiglottitis is
present. This is done cautiously, so as not to induce airway obstruction with
changes in position of the child’s neck
• Management
o Do not leave the child unattended
o Keep the child and parents as calm as possible
o Allow the child to assume a position of comfort. Do not place the child in a supine
position, as airway occlusion may occur
o Provide 100% oxygen in the least invasive manner that is acceptable to the child. If
the child with epiglottitis experiences complete airway occlusion, an emergency
tracheostomy may be necessary
o Ensure that emergency equipment is available and that personnel trained in
intubation of the pediatric occluded airway and percutaneous tracheostomy are
notified of the child’s presence in the facility
o Epiglottitis is characterized by dysphagia, drooling, anxiety, irritability, and
significant respiratory distress. Prepare for the event of sudden airway occlusion
-tonsillectomy/adenoidectomy: post-op care and assessment
• Tonsillectomy (surgical removal of the palatine tonsils) may be indicated for the child
with recurrent streptococcal tonsillitis or massive tonsillar hypertrophy or for other
reasons
