Chronic Respiratory Flashcards
Asthma
Chronic inflammatory airway disorder; Consists of airway obstruction, bronchial irritability, edema of mucous membranes, congestion, and spasms of smooth muscles of the bronchi and bronchioles
Asthma Patho
- type 1 hypersensitivity immune response
- IgE mediated. Mast cells release histamine and leukotrienes that result in diffuse obstructive and restrictive airway disease from inflam and edema of mucus membranes, accum of secretion from mucus glands, spasm of smooth muscle of bronchi and bronchioles
How is asthma classified?
frequency and severity of sx (mild intermittent, mild, moderate, severe persistent) and level of control (controlled or partly controlled)
Asthma triggers
pets, exercise, pollen, bugs in home, chemical fumes, cold air, fungus spores, dust, smoke, strong odors, pollution, anger, stress
Asthma risk factors
age, heredity, gender, obesity, ethnicity; allergens, infection, tobacco smoke, indoor/outdoor air pollution, presence of food allergies
Asthma CM
- 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
Asthma Diagnosis
- Can be hard to establish, may call it bronchitis; usually diagnosed by medical hx, physical exam, lab results (no specific test to determine tho)
- PFTs helpful in confirming diagnosis and evaluating response to tx
- peak expiratory flow rate (PEFR)
Peak expiratory flow rate (PEFR)
- measured with peak expiratory flow meter
- maximum flow of air that can be forcefully exhaled in 1 sec and measure in L/min
- each child needs to determine personal best during 2-3wk period when asthma is stable; recorded at least 2x/day and determines severity of sx
- used for short and daily long-term monitoring, managing exacerbation
- NOT used to diagnose asthma severity
Green zone
80-100% personal best; well-controlled asthma
Yellow zone
50-79% personal best; recognize which sx to pay attn to and add or inc meds accordingly
Red zone
under 50% personal best; recognize sx of asthma emergency–rescue meds and call 911; take bronchodilators
Asthma action plan (AAP)
Helps treat and prevent asthma attacks
Therapeutic management of asthma
enviro control, dec triggers, humidity btwn 35-50%, use A/C, dec underlying inflam, chest physiotherapy, patient edu
Drug therapy for asthma
Controllers (Preventer medications)
– Corticosteroids: QVAR, pulmicort, flovent
– Long Acting Beta 2 adrenergic agonists: Advair, Serevent
– Mast cell stabilizers: cromolyn
– Leukotriene inhibitors; singulair
– Methylxanthines (not used much- theophylline b/c of easy toxicity)
– Omalizumab is a monoclonal antibody used for patients with moderate to severe
persistent allergic asthma whose asthma symptoms are not controlled by inhaled
corticosteroids.
Relievers (Rescue medications)
– Short Acting Beta 2 adrenergic agonists/ Bronchodilators: Proventil, xopenex, albuterol
– Magnesium sulfate: acts to decrease inflammation and improves pulmonary function and
peak flow rate. Used in the ED or ICU with moderate to severe asthma.
How to assess outpatient asthma?
- precipitating factors
- tx
- physical assessment
- meds admin properly?
- UTD AAP (revew q6M)
- modify enviro
- UTD immunizations
- URI prevention
- pulmonary exercises
Asthma exacerbation
- progressively worsening shortness of breath, cough, wheezing, chest tightness
- Airways narrow because of bronchospasm, mucosal edema, and mucus plugging, with air being trapped behind occluded or narrowed airways
- Functional residual capacity rises because breathing uses total lung capacity; hyperinflation enables the child to keep the airways open and permits gas exchange
- Hypoxemia can occur because of the mismatching of ventilation and perfusion. This is seen with increasing carbon dioxide tension and decreasing oxygen tension levels
Interventions for asthma exacerbation
- High Fowler’s Position
- Assessment
- Oxygen and monitoring O2 and HR and
BP monitoring - Teach child to use diaphragm to pull in
and expel air - Control Panic, maintain calm approach
- May need IV Access
- Administer Rescue Drugs
- Transition to regular meds
PRAM
pediatric respiratory assessment measure; captures asthma severity
Exercise induced bronchospasm (EIB)
- Asthma
- self-terminating airway obstruction that develops during or after vigorous activity
- peaks in 5-10 minutes
- sx: cough, SOB, chest pain or tightness, wheezing, endurance prob
- children should NOT be excluded from sports
- pre-medicate to prevent exacerbation
Cystic fibrosis
- most common lethal inherited disease in Caucasians
- every child with one parent carrier has 25% chance of having
- autosomal recessive
CF Patho
- Disrupts the normal functions of the exocrine glands
related to sodium & chloride transport via the cystic
fibrosis transmembrane regulator (CFTR) protein. - Mutation on long arm of chromosome 7
- impaired sodium-chloride regulation
- abnormally thick exocrine secretions.
- Gene mutations differ in severity.
- Life Expectancy increasing
GI tract effects of CF
- small intestine; intestinal obstructions
- pancreatic ducts—degeneration of pancreas, pancreatic acrylic, malabsorption syndrome, diabetes
- s/s—appetite chx, steaorrhea, azotorrhea, wt loss, tissue wasting, distended abdomen, sallow skin, anemia
Pulmonary effects of CF?
- repeated episodes of bronchitis and chronic bronchial pneumonia
- generalized obstructive emphysema
- s/s—wheezy cough, inc dyspnea, thick rattling productive cough, cyanosis, pneumonia, polyps in nose, clubbed digits, chronic sinusitis
Endocrine effects of CF
- Isles of Langerhans may Dec in number as pancreatic fibrosis develops and progresses
- incidence in CF-related diabetes (CFRD) greater in kids which may be cause by chx in pancreatic architecture and dec blood supply over time
- high chance of having type 2 DM
Hepatic effects of CF?
- bile ducts—biliary fibrosis—biliary cirrhosis—portal hypertension
- s/s—ascites, GI bleed, jaundice
Reproductive and fluid effects of CF
- Reproductive system—delayed puberty, infertility (males especially)
- salivary and sweat glands—electrolyte loses, salty sweat, dehydration, hyponatremia, heat stroke
How is CF diagnosed?
- prenatal diagnosis–DNA analysis of chorionic villi or amniotic fluid samples
- newborn screening
- Pilocarpine electrophoresis (sweat chloride test) over 60mEq/L
- stool for fecal fat
CF prognosis and life extension
- dec life expectancy (around 50)
- maximize health potential with nutrition, pulmonary hygiene, prevention/early aggressive tx of infection
Goal of CF therapy
- Prevent or minimize pulmonary
complications - Ensure adequate nutrition for growth
- Encourage appropriate physical
activity - Promote a reasonable quality of life.
Medical management of CF
- in future, gene therapy, activation of mutant CFTR, protein replacement therapy
- for now CFTR modulation, aggressive pulm toilet, nutritional therapy, antibiotic use
Respiratory management of CF
- aggressive airway clearance (BID)–percussion manually, with positive expiratory pressure (PEP mask), vest, airway oscillators like Flutter device
- airway clearance therapy
- postural drainage
- breathing exercises
- physical exercise
- oxygen (caution in kids bc can develop chronic O2 retention
- aerosols, nebulizers
Drugs for CF
- bronchodilators
- Mucolytics–Dornase Alfa (Pulmozyme)
- Chloride channel activators and sodium channel blockers
- antibiotic therapy–therapy prophylactics
CFTR Modulators
Meds that improve function of defective CFTR protein–regulate sodium and fluids in cells, dec chance of developing sticky mucus
GI management of CF
- pancreatic enzymes by mouth
- fat-soluble vitamins (A, D, E, K)
- PRN stool softeners
- NaCl tablets added to diet in hot weather
- oral iron supplements
- monitor blood gluocse
Other management of CF
- anti-inflam agents and protease inhibitors
- immunizations UTD including yearly flu
- lung transplant
NC for child with CF
- resp assessment and vigilance on chest PT and resp tx
- constant assessment of IV site and admin of antibx
- enzyme replacement
- exercise and fun
- isolation? from other CFers
- high cal food and shakes, nutritional eval
- impact of chronic condition on fam
