ch 40: respiratory infections of LR tract Flashcards
EXAM 2 content
what are the lower airways considered? is cartilaginous support developed?
the reactive portion
- bronchi & bronchioles
- cartilaginous support NOT fully developed until adolescence
- constriction of airways
bronchitis, LR tract infection – what do we need to know?
aka tracheobronchitis
- mild & self limiting
- shorter bronchioles = faster infection
- manifestations: cough, fever, congestion & miserable
nursing care:
- cough suppressants for older kids
- fluids
- rest
- swab test for cause of infection
- antipyretics
- education about spread (closed spaces) of infection & hygiene
respiratory syncytial virus & bronchiolitis, LR tract infection – what do we need to know?
MOST COMMON
- acute & viral
- comes in winter & early spring
- prevent & prophylaxis
s/s
- runny nose & coughing
- fever
- wheezing
- cant breath –> suction
- cant eat
nursing care
- neonatal suction
- no antibx
- fluids for hydration
- educate parents –> saying no to ppl holding their baby & no kissing bby
pneumonias, LR tract infections – what do we need to know?
cause: inhaled organisms & bloodstream infections, bacterial, viral, mycoplasmal, pneumococcal
- lobar pneumonia = pneumonia in one or more lobes in lung
- pneumonitis = inflammation of lungs w/o infection
- support & symptomatic care, vaccines
s/s
- cough
- respiratory distress
- fever
- congestion
pertussis, LR tract infection – what do we need to know?
aka - WHOOPING COUGH
- cause: bordetella pertussis
- occurs in kids w/o immunization
- spring & summer
- highly contagious
- risk to infants –> VACCINES
s/s
- very intense coughing episodes
- continual cough
- cant breath
–> support & vaccines
tuberculosis, LR tract infection – what do we need to know?
- cause: mycobacterium tuberculosis
- transmitted: urban, low income nonwhite pop
- diagnosis: PPD test
- prognosis & prevention: same treatment as adults, monitor & track
- support care & antibx + fluids
foreign body aspiration, LR tract – what do we need to know?
risk to 1-3 yo
- small objects: beads, paper clips, hotdogs, peanuts, popcorn, marbles, balloons, coins, & BUTTON BATTERIES –> be seen IMMEDIATELY
- diagnosis: imaging
- management: depends where it is & what is swallowed
- nursing care: education & monitor
aspiration pneumonia, LR tract infection – what do we need to know?
- risk for kids with feeding difficulties
- feeding techniques & positions
- speech lang pathologist
- avoid aspiration risks – think about SAFETY: hydrocarbons, lipids, solvents, & talcum powder
exposure to environmental tobacco smoke – what do we need to know?
passive second hand smoke
- car, house, clothes – stain environment
- effects growing fetus & children
- older kids when experiencing: vape, tobacco, marijuana
educate parents even IF they’re doing a lot of precautions
asthma, LR tract – what do we need to know?
chronic inflammations disorder of airways, hyper inflammation of alveoli
- recurring symptoms
- bronchial hyperresponsiveness
- airway obstruction
- limited airflow/obstruction that can REVERSE spontaneously or with treatment – back to BASELINE
risk factors
- allergies
- smoking
- RSV
- hospitilizations
- mold
- boys more likely to have
how do we classify of asthma?
INTERMITTENT
- symptoms < 2 days a week
- 0 night time awakenings
- using SABA < 2 days a week
- no interference with activities
MILD
- symptoms > 2 days a week but NOT daily
- 1-2 night time awakenings
- using SABA > 2 days a week but not daily
- minor interference with activities
MODERATE
- daily symptoms
- 3-4 night time awakenings
- using SABA daily
- some limitation in activities
SEVERE
- symptoms throughout the day, everyday
- > 1 week night time awakenings
- using SABA several times per day
- extremely limited in doing activities
how do we diagnose & manage asthma?
- diagnosis: pulmonary function test (assessing how their air moves, real diagnosis) + skin testing for allergens
management
- goal: maintain norm activity levels
- prevent exacerbations
what are the drugs that we use for asthma?
- long term control medications
- quick relief medications = acute symptoms
- metered dose inhalers
- corticosteroids for increased inflammation
- cromolyn sodium
what specific drugs do we use for asthma?
- ALBUTEROL (most common), METAPROTERENOL, TERBUTALINE
- long term bronchodilators: SALMETEROL
- THEOPHYLLINE –> monitor serum lvls
- LEUKOTRIENE MODIFIERS
classify first –> choose what to do
what are some interventions for asthma?
- exercise
- breathing exercises
- CPT
- hyposensitization: exposing them to allergen –> decrease reaction
- prognosis: make it as close to intermittent as possible
what is a peak flow rate? what does green, yellow & red mean?
max flow rate that can be generated during a forced expiration (L/min), their personal best
- green = 80-100
- yellow = 50-80, take medication
- red = < 50, call MD & seek care immediately –> anxious, scared, nothing is working, cant breath, education
what is status asthmaticus? what do we need to know?
the RED ZONE of peak flow rate, going into hospital
- MEDICAL EMERGENCY
- respiratory distress even w therapeutic measures
- concurrent infection
- uncomfortable, tripod, cant breath, using accessory muscles
- respiratory failure if no intervention
intervention
- improved ventilation
- medications
- intubation if nebulizer not working
what are the goals of asthma management?
- prevent exacerbation, avoid allergens
- provide acute asthma care
- relieve bronchospasm
- monitor with peak flow meter –> make sure they have an action plan
- master self management of inhalers, devices & activity regulation – EDUCATION
cystic fibrosis, LR tract infection – what do we need to know?
EFFECTS THE WHOLE BODY
- increased viscosity of mucous gland secretions
- increase sweat electrolytes
- increase enzyme in saliva
- ANS abnormalities
a defective gene inherited from both parents, rate of 1:4 ppl –> genetic counseling
how does increased viscosity of mucous gland secretion worsen cystic fibrosis?
–> mechanical obstruction
- mucoprotein accumulates, dilates, precipitates & coagulates –> concentrates in glands & ducts
- resp tract & pancreas are affected
how do we diagnose cystic fibrosis?
newborn screening: will come up for risk of cystic fibrosis, uses SWEAT CHLORIDE TEST to confirm
- DNA identification of mutant genes
- abnormal measurement of nasal potential difference
- expensive tests
how will cystic fibrosis show in respiratory system?
- wheezing, dry nonprod cough
- generalized obstructive emphysema
- patchy atelectasis
- cyanosis
- clubbing
- repeated bronchitis & pneumonia – esp in the hospital
how will cystic fibrosis show in GI system?
- delayed meconium if newborn
- meconium ileus
- distal intestinal obstruction syndrome
- excretion of undigested food in stool –> incr bulk, frothiness, & foul odor
- wasting of tissues
- prolapse of rectum
how does cystic fibrosis AFFECT GI tract?
- thick secretions –> blocks ducts –> cystic dilation, degeneration, & diffuse fibrosis
- prevents pancreatic enzymes from reaching duodenum
- impaired digestion/absorption of fat –> steatorrhea
- impaired digestion/absorption of protein –> azotorrhea
pancreas
- endocrine function INITIALLY stays same
- EVENTUALLY pancreatic fibrosis –> diabetes
- focal biliary obstruction –> multilocular biliary cirrhosis
- pancreatic enzyme deficiency
- sweat gland dysfunction
- failure to thrive
- increase WEIGHT LOSS w increased APPETITE
