Ch. 12 Flashcards
What are some signs of ARDS?
• Increased RR
• Retractions
• Grunting
• Pulmonary edema
• Pink frothy secretions
What are some symptoms of ARDS?
• Anxiety
• SOB
• Inspiratory crackles
What is the first phase of ARDS?
Patient becomes dyspneic and tachypneic for latent pulmonary capillary leak into interstitial space surrounding a small number of the alveoli.
How will the CXR present in the first phase of ARDS?
Normal
How will the O2 sats and status present during the first phase of ARDS?
Normal
What is the second phase of ARDS?
Alveolar damage begins
How long does the second phase of ARDS occur?
With 12-24 hours characterized by interstitial edema
How will the CXR present during the 2nd phase of ARDS?
Diffuse infiltrates begin appearing
What happens during phase 3 of ARDS?
A larger portion of the alveolar/capillary membranes are overwhelmed with fluid, resulting in accumulation in the alveoli and distal airways.
What else happens during phase 3 of ARDS?
Respiratory failure develops with worsening hypoxemia, hypercarbia (CO2 > 60mmHg) and acidosis.
How will the CXR present in phase 3 of ARDS?
Diffuse infiltrates will appear along with development of air bronchograms.
What is the 4th phase of ARDS?
Describes as progressive respiratory failure, fibrosis of the lungs, and recurrent, resistant pneumonias.
How do you treat ARDS?
Support the injured lungs (using low stretch protocols) to maintain normal physiologic function, that is, giving them time to heal.
What are the 3 strategies for the tx of ARDS?
- Correction of physiologic derangements
- Suppression of alveolar inflammation
- The prevention of complications
The patient suffering from asthma will have a hx of what?
• Wheezing
• SOB mingled with periods of no symptoms at all
What are the signs of asthma?
Depends on the degree of the attack
What are the signs for a mild asthma attack?
• Dry hacking cough
• Little presence of wheezing
What are the signs for a moderate asthma attack?
• Productive cough
• Tachypnea
• Audible wheezing
• Tachycardia
• Possible cyanosis
What are the signs for a severe asthma attack?
• Diminished breath sounds
• Retractions
• Rapid shallow respirations
• Pt may be stuporous and lethargic from hypoxia and hypercapnia
What is the 1st phase of acute asthma?
Blood gases are within normal limits
What is the second stage of acute asthma?
CO2 begins to decrease and the pH becomes alkalotic.
There may or may not be signs of hypoxemia
What is stage three of acute asthma?
Shows a normal CO2 and pH in a fatigued hypoxemic patient
* These patients should be admitted to the ICU and observe closely*
The __________ may be increased in atopic asthma?
IgE levels
The use of _______ can be used to determine the extent of airway obstruction and responsiveness to BD therapy.
Peak expiratory flow (PEF)
What are some other causes of wheezing that are often misdiagnosed for asthma?
• left ventricular failure
• endobronchial lesions
• vocal cord dysfunction
• bronchitis obliterans organizing pneumonia (BOOP)
What is the tx for asthma?
Avoiding the precipitating factors that trigger the attack
What are the 2 phases of asthma?
- Acute phase
- Inflammatory phase
What happens during the acute phase?
The presence of triggering stimuli on the airways causes rupture or degranulation of the mast cell
What happens during the inflammatory phase?
Mediators are released by eosinophils, neutrophils, macrophages, and lymphocytes. These mediators initiate the inflammatory response by swelling and in bronchoconstriction of the airways.
What are the two onset patterns of asthma?
• Sudden onset
• slow onset
Younger CF patients are commonly affected with_________?
Staph aureus
Older CF patients are commonly infected with ________?
Pseudomonas aeruginosa or serratia marcesans
The survival rate of females with CF is ________that of males?
Less than
due to contracted mucoid P. aeruginosa 1.7 years earlier the males
What is another bacteria that causes pneumonia in CF patients and is associated with poor outcomes?
Burkholderia cepacia
What are some respiratory complications of CF?
• Chronic rhinosinusitis
• Nasal polyposis
• Pneumothorax
• Hemoptysis
_________ is often present as a result of chronic hypoxia and result in increased pulmonary vascular resistance
Cor pulmonale
When does werdnig Hoffman paralysis usually manifest?
At birth with the most apparent feature, being inactive (or non-vigorous) term neonate.
T or F Werdnig Hoffman paralysis is the most common and most severe form of the spinal muscular atrophy diseases?
TRUE
With werdnig Goodman paralysis the infant lies in what type of position that limits movement of the arms and legs?
Frog-like
How is werdnig Hoffman paralysis diagnosed?
Electromyography
What is electromyography?
A test which evaluates the electrical activity of skeletal muscles
When does kugelberg-welander disease appear?
Later in childhood or adolescence
Kugelberg-Welander disease has a __________?
Slow progression
What are the first muscles affected by juvenile spinal muscular atrophy?
•Pelvic girdle
•arms
•legs
What is the first stage of Reye’s syndrome?
Vomiting, lethargy, drowsiness, liver dysfunction, type, 1 EEG follow commands, brisk pupillary reaction
What is the second stage of Reye’s syndrome?
Disorientation, combativeness delirium,
hyperventilation, hyperactive reflexes, appropriate responses to painful stimuli, evidence of liver dysfunction type one EEG, sluggish pupillary reaction
What is stage 3 of Reye’s syndrome?
Obtunded coma, hyperventilation, decorticate rigidity, preservation of pupillary light reaction, vestibule-ocular reflex (all though sluggish).
What is stage 4 of Reye’s syndrome?
Deepening coma, decerebrate rigidity (arms extending away from the body), loss of oculocephalic reflexes, large and fixed pupils, loss of doll’s eye reflex, loss of corneal reflexes; minimal liver dysfunction;
What is stage 5 of Reye’s syndrome?
Seizures, loss of deep tendon reflexes, respiratory arrest, flaccidity; Type IV EEG, usually no evidence of liver dysfunction.
What are the 3 factors that favor in utero infection?
- Prolonged rupture of the amniotic membranes usually more than 24 hours
- Prolonged labor even in the presence of intact membranes
- Excessive obstetrical manipulation
What are the most causative organisms of perinatal infection?
Enteric organisms such as E. coli and group B streptococcus
What are some causes of postnatal pneumonia?
• contamination of the neonates airway by infected humidifier reservoirs
• poor hand washing
• contaminated incubators and other equipment
What are the most common organisms that cause postnatal pneumonia?
S. aureus & S. Epidermis
What are some other organisms that can cause postnatal pneumonia?
• Klebsiella pneumonia
• Type b. H influenza
• P. Aeruginosa
• Candida albicans
How will the infant appear with postnatal pneumonia?
• Flaccid
• Pale
• Cyanotic
• tachycardic
• showing signs of distress
How will the amniotic fluid appear during postnatal pneumonia?
Foul smelling (which indicates presence of infection)
What will the WBC count be for postnatal pneumonia?
< 5000 cells or > 15,000 cells
How will the x-ray present with postnatal pneumonia?
Unilateral or bilateral streaky densities or consolidation in the perihilar region of the chest
What is bronchiolitis?
An upper airway infection that typically starts with a runny nose, cough, and mild fever that last 2 to 3 days
A patient less than three years with bronchiolitis will begin to show what?
Signs of small airway obstruction and congestion
What is the antibiotic used to treat RSV?
Ribavirin
What are some drugs that may be used to help reduce bronchospasm and improve ventilation until infection clears in bronchiolitis?
Theophylline and sympathomimetic drugs
