Chronic Respiratory Conditions Flashcards
What is the most common chronic disease of childhood?
Asthma
Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (_____) and the (________)
Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (bronchi) and the (bronchioles)
Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (_____) and the (________), as well as an (______) in the (______) membranes
Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (bronchi) and the (bronchioles), as well as an (edema) in the (mucous) membranes
What is the strongest identifiable predisposing factor for developing asthma?
Atopy
What is Atopy?
The genetic predisposition to developing an IgE mediated response to an aeroallergen
What viral respiratory infection is believed to have a significant role in the development of asthma?
RSV
Respiratory Syncytial Virus
Give some examples about each risk factor presented for the development of Asthma:
-Atopy…
-Heredity
-Gender…
Smoking…
Ethnicity…
Weight…
-Atopy (Hx of allergies or atopic dermatitis)
-Heredity (Parent or siblings with asthma)
-Gender (Boys get asthma more when children, but this fact flips in adolescence)
-Smoking (Second hand or maternal)
- Ethnicity (A. A’s at greatest risk)
-Weight (LBW or obesity)
Stimuli causes the (_________) (____) cells to release chemical (____________) mediators during Asthma.
Stimuli causes the (Bronchial) (Mast) cells to release chemical (Inflammatory) mediators during Asthma.
Mediators released by (____-_____) signal other inflammatory cells to migrate to (_______)
Mediators released by (mast-cells) signal other inflammatory cells to migrate to (airways)
A decrease in (_________) airflow is characteristic of Asthma
A decrease in (expiratory) airflow is characteristic of Asthma
Through smooth muscle contraction in bronchi/bronchioles, what happens to the airways due to Asthma?
Airways become narrow and obstructed
Air trapping is an issue in Asthma. What is air trapping?
In Air trapping, upon inspiration the bronchi dilate and elongate, and upon expiration they contract and shorten, and the lumens become narrow, trapping air.
Due to the decreased expiratory airflow in Asthma, there is reduced alveolar ventilation of (___) as well. In what 3 ways does this manifest as serious symptoms?
Due to the decreased expiratory airflow in Asthma, there is reduced alveolar ventilation of (CO2) as well. This manifests as:
-Hypoxemia
-Respiratory Acidosis
-Respiratory failure if untreated
Chronic inflammation of the airways due to asthma can cause permanent damage to structures known as what?
Airway remodeling
What are 4 characteristics of an Asthma exacerbation?
-Progressively worsening SOB
-Cough
-Wheezing
-Chest tightness
What age ranges does the first asthma attack usually occur?
Between 3-8 years
Asthma symptoms include wheezing, a (____________) cough and a prolonged (________) phase
Asthma symptoms include wheezing, a (non-productive) cough and a prolonged (expiratory) phase
In infancy, an asthma attack usually follows a what?
Respiratory infection
An asthmatic episode usually begins with children feeling what 3 things?
-Uncomfortable
-Irritable
-Restless
If an asthma attack is related to allergies, what might some children experience prior to an attack?
Prodromal itching of the front of the neck, or upper back.
Prior to an asthma attack, what are 3 things a child may complain about experiencing?
-Headache
-Fatigue
-Tight chest
During an asthma attack, young children tend to assume what position?
What about older children?
Young children assume the “Tripod” position
Older children sit upright, shoulders hunched. hands on a bed or chair, and arms braced to use their accessory muscles to breath
What adventitious lung sounds are heard during an asthma attack?
Coarse Ronchi, and progressively high-pitched wheezing
During a severe spasm or obstruction during Asthma, what can happen to the lung sounds? What is this?
Crackles and wheezing can become inaudible.
THIS IS AN EMERGENCY
Inaudible lung sounds mean a lack of air movement
What happens to the thoracic cavity due to repeated asthmatic episodes?
Barrel-chest. The Thoracic cavity becomes fixed in a hyperaerated state
Barrel chest is a result of chronic (_______) episodes and is characterized by a depressed (___________), elevated (__________) and increased use of (_________________) to breath
Barrel chest is a result of chronic (asthma) episodes and is characterized by a depressed (diaphragm), elevated (shoulders) and increased use of (accessory muscles) to breath
In Dx Asthma, generally, a (_____) (_____) in the absence of infection, or (________) wheezing during expiration is sufficient for a Dx.
In Dx Asthma, generally, a (chronic) (cough) in the absence of infection, or (diffuse) wheezing during expiration is sufficient for a Dx.
What is the primary test for providing an objective method of evaluating the presence of a lung disease/Asthma?
A PFT (Pulmonary Function Test)
(_________________) is good for Dx asthma, but should not be used in children ages less than (______)
(Incentive spirometry) is good for Dx asthma, but should not be used in children ages less than (5-years-old)
What asthma test is categorized with the “Stoplight System”?
PEFR (Peak-Expiratory-Flow-Rate)
PEFR is the max amount of air that can be what?
How is it measured?
PEFR is the max amount of air that can be forcefully exhaled in 1 second.
Measured in L/min
The reliability of the PEFM (Peak Expiratory Flow Meter) is controversial because of its reliance upon what?
The child’s ability to use it and willingness to participate
What are the 3 PEFR levels?
Green: 80%-100%: Asthma is controlled
Yellow: 50%-79%: Caution; Asthma not well controlled. Maintenance may need to be increased
Red: <50%: Medical alert! SABA should be given
When determining a PEFR, a child needs to establish their personal best value during a (_-_________) period.
When determining a PEFR, a child needs to establish their personal best value during a (2-3 week) period.
What are the 4 Asthma classifications?
-Intermittent
-Mild Persistent
-Moderate Persistent
-Severe Persistent
Match the Asthma classification with the symptoms:
-Symptoms greater than 2 times per
week, but no more than once per day
-Exacerbation affect activity
-Night symptoms greater than 2 times
per month
-PEFR>80%
Mild Persistent
Match the Asthma classification with the symptoms:
-Continuous symptoms
-Frequent exacerbations
-Frequent night symptoms
-Limited physical activity
-PEFR<60%
Severe Persistent
Match the Asthma classification with the symptoms:
-Daily symptoms
-Daily use of short acting inhaler
-Frequent night symptoms
-Limited physical activity
-PEFR> 60-80%
Moderate Persistent
Match the Asthma classification with the symptoms:
-Symptoms 2 or less times per week
-Brief exacerbations
-Night symptoms 2 or less times per
month
-PEFR>80%
Intermittent
In Short-term “quick relief” asthma treatment, what 3 pharmacological drug classes are best?
-SABA’s
-Anticholinergics
-Systemic Corticosteroids
Of the Asthma Pharm medications, which are bronchodilators?
-SABA’s
-Anticholinergics
-Methylxanthines
What is Ipratropium?
Ipratropium is an Anticholinergic for quick0relief asthma tx
Beclomethasone
Montelukast
Omalizumab
Which drug classes to these belong to?
Beclomethasone is a corticosteroid
Montelukast is a Leukotriene modifier
Omalizumab is an Immunomodulator of Monoclonal antibodies
(___________) sodium is an effective long-term tx for Asthma
(Cromolyn) sodium is an effective long-term tx for Asthma
Budesonide
Fluticasone
What are these drugs types?
Inhaled corticosteroids
Theophylline
What asthma drug class is this?
Methylxanthine
What does Cromolyn Sodium do for Asthma treatment?
Stabilizes Mast cell membranes and stops inflammation mediators from being released
What is the primary Anticholinergic drug used in relieving acute bronchospasms?
Ipratropium/Atrovent
How does Magnesium Sulfate fight Asthma attacks?
MG Sulfate is a muscle relaxant that lowers inflammation and improves pulmonary function
A MDI - (____-_____-______) should always be attached to a (_______) when an inhaled (______________) is given to prevent (_____) infections in the (______)
A MDI - (Meter-Dose-Inhaler) should always be attached to a (Spacer) when an inhaled (Corticosteroid) is given to prevent (Yeast) infections in the (mouth)
(________) are important for children with asthma who have difficulty learning proper (_________) (_____________)
(Spacers) are important for children with asthma who have difficulty learning proper (Inhalation) (Technique)
Status Asthmaticus is a respiratory EMERGENCY, characterized by what?
Respiratory distress despite therapeutic efforts, especially after albuterol or epinephrine is used.
What respiratory acid-base imbalance occurs in Status Asthmaticus patients that needs correcting?
Respiratory Acidosis from too much trapped CO2
(_________) oxygen for Status Asthmaticus is recommended and should be kept at a saturation greater than (__)%
(Humidified) oxygen for Status Asthmaticus is recommended and should be kept at an O2 saturation greater than (90)%
What is the initial therapy for a status asthmaticus patient?
Step 1
Step 2
Step 3
Step 1: Humidified O2 via nebulizer with an O2 saturation of >90%
Step 2: Then 3 treatments of SABA spaced 20-30 minutes apart
Step 3: Systemic corticosteroid (Beclomethasone/Qvar)
Besides a corticosteroid, what medication can be given IV to treat Status Asthmaticus?
How does it help?
Magnesium Sulfate
MG Sulfate is a muscle relaxant that also lowers inflammation and helps pulmonary function/Peak Flow Rate
Cystic Fibrosis is marked by (_________) gland dysfunction. This means thick, excessive (_______) secretion from the (_____) glands, the (_______) glands and the (_______) and pulmonary systems
Cystic Fibrosis is marked by (exocrine) gland dysfunction. This means thick, excessive (fluid) secretion from the (sweat) glands, the (salivary) glands and the (digestive) and pulmonary systems
How is Cystic Fibrosis obtained in children?
What is the incidence rate?
Autosomal; Genetically
Child inherits a Autosomal gene from both parents with an incidence rate of 1.4
Cystic Fibrosis is the most common lethal genetic illness among?
Caucasian children
The PRIMARY factor of Cystic Fibrosis, the one responsible for many of the clinical manifestations of the disease, is what?
Mechanical obstruction caused by the increased viscosity of mucous gland secretions
Small passages in which organs become obstructed due to cystic fibrosis?
The Pancreas and the Bronchioles
In cystic Fibrosis, you will see elevations of what levels? Where do these increased elevations manifest in the body?
Sodium and Chloride levels increased in the sweat and saliva, at a rate of 2-5 times greater than normal
What is the most reliable Dx procedure for Cystic Fibrosis?
A sweat chloride test, due to the elevated levels of sodium and chloride in the sweat and saliva (2-5 times greater than normal)
A sweat-chloride level greater than (__) mEq/L is suggestive of Cystic Fibrosis
A level of (__) means Cystic Fibrosis
A sweat-chloride level greater than (40) mEq/L means Cystic Fibrosis
A level of (60) mEq/L means Cystic Fibrosis
What are 3 tests (besides a sweat-chloride test) that are used to dx Cystic Fibrosis?
-CXR
-Pulmonary Function Test
-Barium enema
Clinical manifestations of Cystic Fibrosis in Infants include Meconium (____) and what 4 symptoms?
(FARV)
Meconium (Ileus)
-Failure to pass stools
-Abdominal distention
-Rapid dehydration
-Vomiting
Clinical manifestations of Cystic Fibrosis in Children include:
PLLAC
-Poor weight gain
-Low BMI
-Liver disease
-“Asthma”
Chronic pneumonia
Cystic Fibrosis in adulthood can cause (__________) in men
Cystic Fibrosis in adulthood can cause (infertility) in men
Unlike asthma, which has a (__________) cough, Cystic Fibrosis causes a (____________) cough and wheezing
Unlike asthma, which has a (Unproductive) cough, Cystic Fibrosis causes a (productive) cough and wheezing
Acute exacerbations of Cystic Fibrosis are characterized by:
_______________ cough, _______pnea, _______pnea, general __________, _______ia, and weight loss
Acute exacerbations of Cystic Fibrosis are characterized by:
Productive cough, Tachypnea, Dyspnea, general malaise, anorexia, and weight loss
Cystic Fibrosis patients may be in a state of chronic (__________) and obstructive (____________)
Cystic Fibrosis patients may be in a state of chronic (pneumonia) and obstructive (emphysema)
In Cystic Fibrosis, thick secretions prevent (_________) enzymes from reaching the duodenum. This means that (__)% of CF patients develop (_________) insufficiency.
In Cystic Fibrosis, thick secretions prevent (pancreatic) enzymes from reaching the duodenum. This means that (90)% of CF patients develop (pancreatic) insufficiency.
Due to the Impaired digestion & absorption of nutrients in Cystic Fibrosis patients, related to (________) insufficiency, what effect does this cause on the stools?
Due to the Impaired digestion & absorption of nutrients in Cystic Fibrosis patients, related to (pancreatic) insufficiency, Steatorrhea is made (fatty-greasy stools)
What GI illness can occur due to Cystic Fibrosis?
GERD
What is the most common complication associated with CF?
CFRD
Cystic Fibrosis Related Diabetes
What is the shared effect that CFRD has on both type-1 and type-2 Diabetes?
CFRD decreases Insulin production AND Insulin resistance
What percentage of individuals with CF develop CFRD by 20 years of age?
25%
If a baby tastes salty, what do they most likely have?
CF, due to the excess sodium and chloride in their sweat (40-60 mEq/L)
What are the 3 “Hypos” of CF-related manifestations?
-Hyponatremia (no salt in body, just sweat)
-Hypoalbuminemia
-Hyperchloremic alkalosis (No chloride in body, just sweat)
Reproductive manifestations of CF in both men and women that is shared is what?
Delayed puberty
Men with CF can become (________), but not (__________)
Women can have their (__________) affected by the viscous (__________) secretions
Men with CF can become (infertile), but not (impotent)
Women can have their (fertility) affected by the viscous (cervical) secretions
In CF, you can improve aeration and remove secretions by doing what physical nursing intervention?
Chest Physiotherapy
What is a ThAIRapy vest used for?
The ThAIRapy vest is indicated to promote airway clearance and produce bronchial drainage via vibration and nebulization to collect for dx of CF
What is a Flutter mucus clearance device?
A small handheld plastic pipe with a steel ball on the inside that helps remove mucus
What does an Acapella device do?
(HFCC)
An Acapella device provides high-frequency auscultation, as well as PEP (Post-Exposure Prophylaxis)
What breathing exercise is recommended to loosen secretions in CF?
“Huffing”: Forced expiration
What is CPPD?
Chest Percussion Postural Drainage
Place these steps of CF respiratory therapy in order:
-Inhaled Antibiotic: Tobramycin
-Pulmonize to thin secretions
Airway clearance: vest, flutter, CPPD
-Cough and expectorate mucus
-Hypertonic saline: thin and liquefy
secretions
-Bronchodilator - albuterol
-Inhaled corticosteroids to clean lung tissue
-Bronchodilator- albuterol
-Hypertonic saline: 10 minutes after
bronchodilator to thin and liquefy
secretions
-Airway clearance: vest, flutter, chest
percussion postural drainage (CPPD)
-Pulmozyme to thin secretions
-Cough and expectorate mucus
-Inhaled corticosteroids to clean lung
tissue
-Inhaled Antibiotic: possibly tobramycin
