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The Pediatric Case Studies Child With Oxygen Needs-Respiratory

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John Marsh
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Pediatric Case Studies/Study Guides: The Child with Oxygenation Needs
(Respiratory Disorders)

Purpose

To provide the student with the opportunity to assess an infant in respiratory distress, intervene to promote respiratory exchange.

Patient

Haley Medvedev is a 5-month-old Caucasian female who was admitted directly from the pediatrician’s office to the hospital with a diagnosis of bronchiolitis. Respiratory syncytial virus (RSV) is the suspected organism. Upon admission, Haley also showed signs of dehydration and her parents reported that her oral intake has been limited for several days. During this discussions, students will have the opportunity to assess and monitor the infant patient with respiratory distress and prioritize nursing interventions to optimize respiratory function.

1. Respiratory syncytial virus (RSV) is the causative agent in most cases of

2. What are the classic signs and symptoms of RSV?

3. What are the appropriate nursing interventions to prevent complications?

4. Briefly explain why RSV is so easily communicable

5. What should health care providers remember when administering ribavirin?

Bronchiolitis

1. Which statement regarding bronchiolitis in the pediatric population is not true?
A. Bronchiolitis occurs primarily in the winter and early spring.
B. Bronchiolitis is an acute infection which primarily affects the bronchiolar level of the lungs.
C. Bronchiolitis is a result of the seasonal influenza virus most of the time.
D. By the age of 3 years, most children will be affected by bronchiolitis at least one time.

2. Which best describes the pathophysiological process of bronchiolitis?
A. Exaggerated response of the bronchi to a trigger causing bronchospasm
B. Inflammation of the mucosa lining the larynx and trachea causing a narrowing of the airway
C. Inflammation of the primary parenchyma of the lungs
D. Edema and secretions of the lower respiratory tract causing gradual lower airway obstruction

3. A 3-month-old infant admitted with RSV is crying loudly during IV insertion and the mother of the infant is becoming upset. Which intervention would be most appropriate?
A. Return to complete the IV insertion at a different time when the infant is consoled
B. Ask the mother whether the infant is typically consoled with a pacifier and, if so, ask her to offer the baby one
C. Utilize verbal cooing or story-telling to console the infant while placing the IV
D. Continue with IV insertion, speeding up your process to minimize the time the child is in distress

4. A 5-month-old male infant admitted with a diagnosis of bronchiolitis has a respiratory rate of 38, a heart rate of 150, a capillary refill of greater than 3 seconds, a saturation of 88%, and clear secretions in his nasopharynx and oropharyx. The proper sequence for nursing interventions would be
A. to administer 100% oxygen, position the airway, and administer isotonic solution as ordered at 20 mL/kg IV.
B. to suction the airway, administer oxygen, and administer isotonic solution as ordered at 20 mL/kg IV.
C. to auscultate breath sounds, administer oxygen, and administer isotonic solution as ordered at 20 mL/kg IV.
D. to suction the airway, administer 100% oxygen, and encourage oral fluid intake.

5. The father of an infant admitted for respiratory distress asks the nurse how they will do the testing for RSV that the physician ordered. The nurse explains that RSV
A. is tested in the blood. The phlebotomist will perform a heel stick on the infant.
B. testing is similar to the testing done for strep throat. I will need to swab the back of the infant’s throat and her nose with
a special cotton stick applicator.
C. is tested through biopsy. The physician will do this by placing a flexible scope down the infant’s nose and obtaining a specimen.
D. is tested though nasal washing. I will squirt saline in the infant’s nose and then suck the contents into a container using a syringe.

6. Which medication might the nurse anticipate as part of the supportive therapy for a 7-month-old, full-term infant
diagnosed with bronchiolitis and RSV?
A. Synagis (palivizumab).
B. Rocephin (ceftriaxone).
C. Proventil HFA (albuterol).
D. Tylenol (acetaminophen).

7. The nurse knows that all of the listed options are appropriate ways to provide supplemental oxygen to a 2-month-old infant with a BP of 92/50, a cap refill of 2 seconds, a respiratory rate of 23, and a pulse oximetry reading of 88% on room air, except?
A. Nasal cannula
B. Oxygen tent
C. Face mask
D. Bag valve mask

8. A nurse has been repositioning an infant’s pulse oximetry probe every 3-4 hours. The nurse knows that the primary rationale behind this intervention is t:
A. Prevent skin breakdown.
B. Improve readings from the LED light.
C. Check capillary refill on the sight of the probe.
D. Prevent burning from the electrode.

9. A nurse is caring for an infant receiving maintenance IV fluid of dextrose 5% in ¼ normal saline through a peripheral IV. In which situation should the IV be shut off?
A. The infant’s blood glucose reads 118.
B. The infant’s creatine is 0.2 mg/dL.
C. The IV site is edematous and flushes with resistance.
D. The nurse is unable to draw blood work from the peripheral IV site.

Describe each of the following terms related to respiratory alterations.

1. Atelectasis:

2. Rhonchi:

3. Stridor:

4. Wheezing:

5. Nasal flaring (ala nasi):

6. Retractions:

Review Questions. Choose the correct answer.

1. A toddler is admitted to the hospital with croup. The child is tachypneic with substernal retracting and nasal flaring. The pulse oximetry reading on room air is 98%. Which of these nursing diagnoses would be most appropriate for the child at this time?
A. Ineffective Breathing Pattern.
B. Ineffective Airway Clearance.
C. Impaired Gas Exchange.
D. Separation Anxiety.

2. When teaching the parents of a child who has otitis media with effusion, which information should a nurse include in the teaching plan?
A. Baby aspirin may be given for pain and fever.
B. Decongestants will keep fluid from building up in the middle ear.
C. The full 14-day antibiotics course must be given even if symptoms improve.
D. Tympanostomy tubes will be required after this infection is cleared.

3. When preparing a 6-year-old girl for tonsillectomy, which of these measures should a nurse include in the preparation of the girl for surgery?
A. Directing the teaching at the girl’s parents.
B. Reassuring the girl that she will be able to talk after surgery.
C. Explaining that girl’s throat will be sore after surgery.
D. Explaining that the girl will have to drink a lot after surgery.

4. Parents bring their 8-month old son to the emergency room because he is breathing so fast that he can’t even eat. He’s so hot “. Physical examination reveals nasal flaring, intercostal retracting, and moderate expiratory wheezing. Based on the above findings, the nurse should suspect that the child most likely has which of these diagnoses?
A. Acute spasmodic croup.
B. Bronchiolitis.
C. Epiglottitis.
D. Foreign body aspiration.

5. A nurse is preparing a child for bronchoscopy. Which of these conditions would necessitate the child to have
bronchoscopy?
A. Apnea.
B. Bronchiolitis.
C. Foreign body aspiration.
D. Pneumonia.

6. Which of these medications would increase the central respiratory drive?
A. Symmetrel [(amantadine hydrochloride)
B. Adrenalin (epinephrine).
C. Cafcit (caffeine citrate).
D. Virazole (ribavirin)

7. A preschooler arrives in the emergency room. The child is very anxious, irritable and refuses to lie down to be examined. The child is sitting up, leaning forward on her hands, and drooling saliva. The child has audible stridor. Which of these actions should a nurse take first?
A. Take the child’s vital signs.
B. Notify the physician immediately.
C. Let the parents stay in the room.
D. Start an intravenous line.

8. An infant is hospitalized following an apparent life-threatening event (ALTE). The infant’s apnea monitor suddenly alarms. Which of these actions should a nurse take first?
A. Assess the infant.
B. Ask the parents about the triggering event.
C. Initiate CPR.
D. Reset the monitor.

9. Which of these manifestations in a child who has laryngotracheobronchitis (LTB), if observed, would require immediate attention by a nurse? Select all that apply.
A. Listlessness.
B. Increased heart rate.
C. Decreased stridor.
D. Flaring of the ala nasi.

10. A nurse is caring for a 6-year-old child who is admitted from the recovery room following a tonsillectomy. The child is awake but sleepy. Vital signs are: T: 98.6̊ F, P: 120/min, R: 32/min. BP: 120/70mmHg Which of these observations, if noted by the nurse, would substantiate that the child is actively bleeding post-tonsillectomy? Select all that apply.
A. Refusal to drink fluids.
B. Frequent swallowing.
C. Dark brown emesis.
D. Spitting light pink sputum.

The Child with Chronic Respiratory Disorders: Case Study

Purpose

To provide the student with the opportunity to assess a pediatric patient experiencing respiratory dysfunction secondary to acute asthma exacerbation.

Overview
Emilia Garcia is a 9-year-old Hispanic female with acute asthma exacerbation related to pet dander exposure. She was admitted to the hospital from her pediatrician’s office.
T = 99.5 F (37.5 C), BP = 110/70, P = 94, RR = 36, O2 Sat = 88% (1 L/min via nasal cannula)
• Lung sounds: Inspiratory and expiratory wheezing; hacking, non-productive cough
• Pulses: Normal. Color: Circumoral cyanosis
• Patient’s speech: Speaks in short phrases only

Review Questions

1. A child experiences bronchoconstriction 5 hours after an acute asthma attack. This is an example of which of kind of inflammatory response?
A. Immediate
B. Intermediate
C. Delayed
D. Late

2. When describing wheezing, which of these statements characterizes wheezing? Select all that apply.
A. It can sometimes be heard without a stethoscope.
B. Decreased wheezing may signal the inability to move air.
C. Increased wheezing may be indicative of improvement.
D. It is a major sign and symptom of the croup syndromes.

3. A child has a history of exercised-induced asthma. Which of these measures should a child take to prevent an exerciseinduced asthma?
A. Covering the nose and mouth with a scarf when exercising outside in the cold.
B. Inhaling a corticosteroid before exercise.
C. Inhaling through the mouth during exercise.
D. Taking prednisone before exercising.

4. What explanation should a nurse make how viral infections trigger asthma?
A. Producing mucoid irritants in the lower airway.
B. Creating an allergic response.
C. Acting as mechanical triggers of bronchospasm.
D. Releasing chemical mediators from mast cells in the airway.

5. When a child is experiencing an asthmatic attack, which of these medications should be prescribed? Select all that apply.
A. Ventolin (albuterol).
B. Brethine (terbutaline).
C. Intal (cromolyn sodium).
D. Aminophylline (theophylline).

6. When teaching a family about the use of pancreatic enzymes in the treatment of cystic fibrosis, which of these statements should a nurse include?
A. “Give the preparation three times a day and before bedtime.”
B. “Dissolve the enzymes in warm whole milk.”
C. “Increase the dosage if the child has loose, fatty stools.”
D. “Chewing the enzymes will increase their efficacy.”

7. Which of these diagnostic tests would confirm the diagnosis of cystic fibrosis?
A. RAST (radioallergosorbent test).
B. Sweat chloride.
C. Pseudomonas culture.
D. Tine test.

8. All of the following treatments are ordered for a child who has cystic fibrosis. Which of these treatments, should a nurse question?
A. Chest physiotherapy every 3 hours.
B. Intravenous antibiotics.
C. Cough suppressant medications.
D. Postural drainage.

PREVIEW

 

The Pediatric Client (NRBS 410) Case Studies Child With Oxygen Needs-Respiratory

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