Chronic Respiratory

Question 1

Asthma is what type of hypersensitivity?

Answer 1

Type 1: IgE

-Mast cells release histamine + leukotrienes

Question 2

Asthma RF:

Answer 2

1. Age
2. Genetics
3. Gender (Boys until puberty’, then women)
4. Obesity
5. Ethnicity (African American)

Question 3

Asthma Environmental Factors

Answer 3

1. Allergens
2. Infections
3. Tobacco smoke
4. Pollution
5. Diet

Question 4

Asthma: S/S

Answer 4

• Dyspnea
• Expiratory wheezing
• Cough
• Diaphoresis
• Paroxysmal, hacking, -nonproductive cough at onset; becomes rattling and productive of clear sputum
• Prolonged expiratory phase
• Anxious expression, restlessness
• Setting position
• Coarse rhonchi
• Signs of respiratory distress; nasal flaring, cyanosis, intercostal retractions

Question 5

Asthma Diagnosis

Answer 5

1. medial history
2. physical exam
3. lab results
4. PFT helpful in confirming and evaluating response to treatment
5. PEFR: Peak expiratory flow rate

Question 6

Peak Expiratory Flow Rate

Answer 6

Peak expiratory flow (PEF): amount of air that can be forcefully exhaled in 1 second

Question 7

Rescue Meds

Answer 7

–Short Acting Beta 2 adrenergic agonists/ Bronchodilators: Proventil, xopenex, albuterol

–Methylxanthines (not used much- theophylline b/c of easy toxicity)

Question 8

Controller meds

Answer 8

•Controllers (Preventer medications)

–Corticosteroids: QVAR, pulmicort, flovent (first line)

–Long Acting Beta 2 adrenergic agonists: Advair, Serevent

–Mast cell stabilizers: Cromolyn

–Leukotriene inhibitors: Singulair

Question 9

Corticosteroids

Answer 9

QVAR, pulmicort, flovent (first line)

Question 10

LABAs

Answer 10

Advair

Serevent

Question 11

Mast cells stabilizers

Answer 11

Cromolyn

Question 12

Leukotriene inhibitors

Answer 12

Singulair

Question 13

PEF

Answer 13

Green Zone: 80-100% of personal best

Yellow Zone: 50-79% of personal best (Give albuterol)

Red Zone: Below 50% of personal best (911, O2)

Question 14

Asthma: Nursing interventions

Answer 14

1. High fowler position
2. O2
3. Teach child to use diaphragm to pull in and expel air
4. Control panic
5. Administer rescue drugs

Question 15

Most common lethal inherited disease in Caucasians

Answer 15

CF

-Autosomal Recessive disorder

Question 16

CF: Etiology

Answer 16

• Disruption of normal function of exocrine glands related to sodium + chloride transport via cystic fibrosis transmembrane regulator protein (CFTR)
• Impaired fluid secretions cause very thick exocrine secretions (EVERYWHERE)
• Gene mutations differ in severity
• Life expectancy increasing

Question 17

CF: Lungs

Answer 17

1. Repeated episodes of bronchitis (bronchial PNA)
2. Generalized obstructive emphysema

•Signs/symptoms; wheezy cough, increasing dyspnea, thick rattling extremely productive cough, cyanosis, pneumonia, polyps in nose, clubbed digits, chronic sinusitis

Question 18

CF effects what organs?

Answer 18

1. Respiratory
2. GI
3. Reproductive
4. Hepatic

Question 19

CF: GI

Answer 19

Small intestines:

• Obstructions
• Meconium obstruction

Pancreatic Ducts:
-Pancreatic achylia: less digestive enzymes, malabsorption syndrome + diabetes

ADEK vitamin def (fat soluble)

Question 20

CF GI Symptoms

Answer 20

1. Appetite changes
2. Steatorrhea
3. azotorrhea (fowl stools)
4. weight loss
5. tissue wasting (nutrition)
6. Distended abdomen (ascites)
7. sallow skin (not healthy in complexion)
8. Anemia

Question 21

CF: Liver

Answer 21

Bile Ducts

1. Biliary fibrosis
2. Biliary cirrhosis
3. Portal hypertension

S/S:

• Ascites
• GI bleeding
• Jaundice

Question 22

CF: Major symptoms

Answer 22

1. Delayed puberty
2. Infertility
   - Male: Most
   - Female: 50%
3. Salivary + sweat glands
   - Electrolyte loss
   - Salty sweat
   - Dehydration
   - Hyponatremia
   - Heat stroke

Question 23

Testing for CF

Answer 23

Newborn: Pilcarpine electrophoresis (chloride sweat test) >60mEQ
+stool for fecal FAT

Prenatal: DNA of chorionic villi or amitotic fluid

Question 24

CF: Ways to maximize health potential

Answer 24

1. Pulm hygiene
2. Nutrition
3. Prevent/treat infection

Question 25

CF: gene therapy

Answer 25

Activation of mutant CFTR, protein replacement therapy

Question 26

TOP goals of CF

Answer 26

1. Prevent infection | 2. Nutrition

Question 27

CF: Treatment

Answer 27

•Aggressive airway clearance (BID) 1. Percussion - Before eating, will decrease vomiting and increase appetite * Manual * Positive expiratory pressure (PEP mask + flutter valve) * High frequency chest percussion vest * Airway oscillators like the Flutter device. 2. Postural drainage 3. Breathing exercises 4. Physical exercise 5. O2 Therapy: Caution like COPD patient (dependency) 6. Aerosols, Nebs - antibiotics nebs

Question 28

CF: drug therapy

Answer 28

1. Bronchodilators 2. Mucolytic - Dornase Alfa (Pulmozyme) 3. Chloride channel activators + Sodium channel blockers 4. Antibiotics - Therapeutic + Prophylactic (Z-pack)

Question 29

CF: drugs for GI

Answer 29

1. Pancreatic enzymes 2. Fat-soluble vitamins (A,D,E,K) 3. Stool softeners 4. NaCl tablets, in hot weather 5. Oral Iron supplements 6. Monitor blood glucose *High fat diet

Question 30

CF: Other treatments

Answer 30

1. Anti-inflammatory agents 2. Protease inhibitors 3. Immunizations including flu 4. Lung transplant

Question 31

CF: Nursing

Answer 31

* Careful respiratory assessment, vigilance on chest PT and respiratory treatments * Constant assessment of IV site and judicious administration of antibiotics * Enzyme replacement * Exercise and fun * Isolation? * High calorie, high protein, unrestricted fat foods and shakes, nutritional evaluation * Impact of chronic condition on the family