Asthma and Respiratory Flashcards
Define Asthma
a chronic airway inflammatory disease characterized by the infiltration of airway T cells, mast cells, basophils, macrophages, and eosinophils.
The interaction among the cells and chemicals in the inflammatory process associated with asthma cause what 4 things?
- bronchial muscle constriction
- mucous secretion
- swelling of the bronchial tube inner lining
- and coughing.
What characterizes asthma?
Airflow obstruction
1. bronchial hyper-responsiveness
2. airway edema
3. mucous production
What occurs in the early phase response of asthma?
“Allergies” for 1-2 hours
Eosino and basophils cause bronchocontriction
Easily reversible and not very long
What occurs in the late phase/delayed reaction of asthma?
Secondary infiltration of cells persisting for hours-days that can cause damage to smooth muscles
What characterizes silent asthma?
Frequent coughing, especially at night due to pooling of secretions
What characterizes severe persistent asthma?
- Symptoms throughout day
- Waking up more than once/week
- Uses SABA/Ventolin several times a day
- Normal activity severely limited
What is the prevalence of asthma amongst Canadian children?
10-20%
What are reasons for the increase in the incidence of asthma?
- increased urbanization and air pollution
- second/third hand smoke
- increased technology/lack of physical activity
- more accurate diagnosis
What are symptom triggers of asthma and give examples?
Usually end up as early phase response/easier to control
- exercise
- smoking
- hot/cold air
- strong fumes
What are examples of inflammatory triggers of asthma?
- Viral resp infections
- animal
- moulds
- pollens
- air pollutants
What is the most common cause of an asthma exacerbation?
Respiratory infections
What are protective factors against asthma?
*related to exposure immunity
- large family
- later birth order
- childcare attendance
- dog in family
- living on farm
What 4 things does the PRAM (Pediatric Respiratory Assessment Measure) primarily assess?
- Oxygen Saturation
- Use of accessory muscles
- Air entry in both lungs
- Wheezing
What are the additional indicators used as assessments on the PRAM?
- nasal flaring
- reduced activity level, inability to feed/speak in full sentences
- decreased level of alertness, mental agitation, drowsiness or confusion
Define the scores for a mild, moderate, and severe PRAM
Mild: 0-3
Moderate: 4-7
Severe: 8-12
Define the following characteristics someone would need to be rated 0-3 PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow
- normal
- normal activity/exertional dyspnea
- normal
- minimal intercostal retractions
- moderate wheeze
- > 94%
- > 80%
Define the following characteristics someone would need to be rated 4-7 PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow
- slightly agitated
- decreased activity or feeding
- in phrases
- intercostal and substernal retractions
- loud pan- expiratory and inspiratory wheeze
- 91-94%
- 60-80%
Define the following characteristics someone would need to be rated 8-12 PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow
- agitated
- decreased, stops feeding
- in words
- all accessory muscles, nasal flaring, paradoxical thoraco-abd
- 91-94%
- <60%
What 6 tests are used to diagnose asthma?
- Pulse Ox
- Chest X Ray
- Blood Gases
- Pulmonary Function Tests
- Peak Expiratory Flow Rate
- Allergy Testing
Define the following characteristics someone would need to be rated impending respiratory failure on PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow
- drowsy/confused
- unable to eat
- unable to speak
- marked distress at rest
- chest is silent/absent wheeze
- < 90%
- unable to perform task
What is the treatment of an asthma patient with a mild PRAM?
- Keep O2 > 92%
- Salbutamol q 30-60min x 1-2 doses
- Consider oral steroids
What is the treatment of an asthma patient with a moderate PRAM?
- Keep O2 > 92%
- Salbutamol q30 min x 2-3doses
- Oral Steroids
- Consider Ipratropium
What is the treatment of an asthma patient with a severe PRAM?
- Keep O2 > 92%
- Salbutamol + Ipratropium q20 min x3doses
- Oral steroids
- Consider IV methylprednisolone
- Consider continuous SABA
- Consider IV Magnesium sulphate
What is the use of magnesium sulphate for asthma patients?
IV magnesium sulfate may be considered for patients with severe exacerbations not responding to initial treatment. Magnesium sulfate is not recommended for routine use
What is a SABA for asthma?
Short acting beta agonist
Salbutamol or Atrovent
Rescue Medication
What is a LABA for asthma?
Long acting beta agonist
Salmeterol
Used for long term maintenance alongside inhaled corticosteroids
Pre-exercise
What are anticholinergics used for in asthma therapy? and give example
Ipratropium or Atrovent: inhibits bronchoconstriction and decreased mucous production; Inhaled ipratropium bromide can be used as an add-on therapy to ß2-agonists
What is the first line daily maintenance medication therapy for children > 5
budesonide or fluticasone
Inhaled corticosteroids are the first-choice long-acting maintenance inhalers for asthma. They are usually the first type of maintenance inhaler taken daily to help control asthma symptoms for mild-to-moderate asthma.
When are oral corticosteroids used in asthma therapy?
in “bursts” to manage uncontrolled asthma; Children who have a moderate to severe asthma exacerbation should receive systemic steroids as part of their initial treatment. This medication should be administered as early in the ED visit as feasible
What is a consideration when using oral vs inhaled steroids?
Oral will have more systemic effects
What would you assess for the CNS of a patient in an asthma exacerbation?
LOC (agitation, drowsiness)
ability to speak/cry
temperature (febrile? With inflammatory process)
What would you assess for the CVS of a patient in an asthma exacerbation?
HR
colour (central cyanosis with low sats)
capillary refill
What would you assess in the respiratory system of a patient in an asthma exacerbation?
rate, coughing, air entry, accessory muscle use
What would you assess for GI/GU of a patient in an asthma exacerbation?
appetite, hydration (in and out), air trapping cause distended abdomen putting increased pressure to breath
What type of breathers are infants?
Abdominal and nose
Describe the structure of the trachea of a child under 8
shorter, angle of right bronchus more acute (smallest at cricoid)
How does the trachea develop in the first 5 years of life?
Increases in length, not diameter
When do children reach respiratory maturity
12-13
What is the most common cause of lower respiratory tract infections?
Respiratory Syncytial Virus (RSV)
By which age will all children contract RSV?
3
RSV is the leading cause of what 2 severe conditions in infants?
Pneumonia and Bronchiolitis
What condition plays a major role in the pathogenesis of asthma?
RSV
At which ages are pneumonia and bronchiolitis most prevalent in?
2-6 months
Common symptoms of RSV
Rhinorrhea
Coughing
Wheezing
Irritability
Which test is done to differentiate between viral infections?
Nasopharyngeal swabs
What is the management/treatment of viral infections focussed on and how is it accomplished?
What is the management/treatment of viral infections focussed on and how is it accomplished?
Symptom management
- position
- oxygen
- suction
What medications are used for RSV?
Ventolin (albuterol SABA)
Ribovarin: only given if very ill + decreased respiratory function
What is Palivizumab (Synagis )Immunoglobulin
drug used to prevent severe RSV in high risk children. Found not effective to reduce hospitalizations in low-risk infants.
How do infection rates vary between covid and the flu
covid: 2-5 people
flu: 1
What rare covid complication only effects children?
multisystem inflammatory syndrome - inflammation of all organs
What is the youngest age the COVID vaccine is available to and how is it dosed?
for children 6 mos-18 (2-3 doses recommended at 8-week intervals)
What are the most common side effects of the COVID vaccine?
- local reaction (sore arm)
- system effects: fatigue, headache, muscle pain, chills
no cases of myocarditis
What does the influenza cause?
both upper and lower respiratory infections, including bronchitis, croup, and pneumonia.
Clinical Signs of Influenza
fever, cough, runny nose, sore throat, shortness of breath, wheezing, fatigue
Treatment of Influenza
- symptom management
- prevention through vaccine
What is croup?
Laryngotracheobronchitis: viral infection causing swelling in the trachea and larynx
Who is croup most commonly seen in?
3 months - 4 years
What are the signs of croup?
- tachypnea
- stridor
- seal like barking cough
What is pertussis?
Whooping cough; highly contagious bacterial disease
What is the treatment of croup?
- oxygen
- racemic epinephrine
- PO or IV corticosteroids
What are the initial symptoms of pertussis?
Cold like symptoms: runny nose, fever and mild cough
What do pertussis symptoms progress to?
Severe coughing followed by a high -pitched whoop/crowing sound, and/or gasp for air
Intense coughing caused by pertussis can lead to
Young children become apneic, turn dusky, cough so hard they vomit.)
Vomiting after a coughing spell or an inspiratory whooping sound on coughing, almost doubles the likelihood that the illness is pertussis
Prevention for pertussis
Immunization-Acellular pertussis vaccine is 71-85% effective; given at 2 months and vaccine offered to mother before birth. With one vaccine - not fully protected, boosted at 4, 6, and 18 months
When should antibiotics be started for pertussis
within 3 weeks of initial symptoms
Respiratory Nursing Diagnosis Examples (6)
- Ineffective breathing patterns
- Ineffective airway clearance
- Altered blood gases
- Maintain patent airway
- Promote adequate air exchange
- Potential for promoting increased oxygen exchange
Respiratory Nursing Intervention Examples (5)
- Repositioning for maximization of airway
- Supply oxygen
- Assure functioning suction equipment/suction as needed
- Medications (Ventolin, ABX, treat fever)
- Adjust feeds based on coughing/IV for hydration
When is the MMR vaccine given and why?
At 12 months because babies still have placental immunity
Why do some vaccines require a booster?
Initial exposure to antigen creates a primary immune response, but a secondary exposure to antigen helps great a larger, faster secondary immune response
If a child is in hospital with a mild runny nose/sickness, can a vaccine still be given?
Yes
