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Peds Exam 2 > Chronic Respiratory Conditions > Flashcards

Chronic Respiratory Conditions Flashcards

1
Q

What is the most common chronic disease of childhood?

A

Asthma

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2
Q

Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (_____) and the (________)

A

Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (bronchi) and the (bronchioles)

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3
Q

Asthma is a Chronic inflammatory disorder of the airways characterized by spasms in the (_____) and the (________), as well as an (______) in the (______) membranes

A

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

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4
Q

What is the strongest identifiable predisposing factor for developing asthma?

A

Atopy

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5
Q

What is Atopy?

A

The genetic predisposition to developing an IgE mediated response to an aeroallergen

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6
Q

What viral respiratory infection is believed to have a significant role in the development of asthma?

A

RSV
Respiratory Syncytial Virus

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7
Q

Give some examples about each risk factor presented for the development of Asthma:

-Atopy…
-Heredity
-Gender…
Smoking…
Ethnicity…
Weight…

A

-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)

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8
Q

Stimuli causes the (_________) (____) cells to release chemical (____________) mediators during Asthma.

A

Stimuli causes the (Bronchial) (Mast) cells to release chemical (Inflammatory) mediators during Asthma.

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9
Q

Mediators released by (____-_____) signal other inflammatory cells to migrate to (_______)

A

Mediators released by (mast-cells) signal other inflammatory cells to migrate to (airways)

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10
Q

A decrease in (_________) airflow is characteristic of Asthma

A

A decrease in (expiratory) airflow is characteristic of Asthma

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11
Q

Through smooth muscle contraction in bronchi/bronchioles, what happens to the airways due to Asthma?

A

Airways become narrow and obstructed

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12
Q

Air trapping is an issue in Asthma. What is air trapping?

A

In Air trapping, upon inspiration the bronchi dilate and elongate, and upon expiration they contract and shorten, and the lumens become narrow, trapping air.

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13
Q

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?

A

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

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14
Q

Chronic inflammation of the airways due to asthma can cause permanent damage to structures known as what?

A

Airway remodeling

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15
Q

What are 4 characteristics of an Asthma exacerbation?

A

-Progressively worsening SOB
-Cough
-Wheezing
-Chest tightness

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16
Q

What age ranges does the first asthma attack usually occur?

A

Between 3-8 years

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17
Q

Asthma symptoms include wheezing, a (____________) cough and a prolonged (________) phase

A

Asthma symptoms include wheezing, a (non-productive) cough and a prolonged (expiratory) phase

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18
Q

In infancy, an asthma attack usually follows a what?

A

Respiratory infection

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19
Q

An asthmatic episode usually begins with children feeling what 3 things?

A

-Uncomfortable
-Irritable
-Restless

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20
Q

If an asthma attack is related to allergies, what might some children experience prior to an attack?

A

Prodromal itching of the front of the neck, or upper back.

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21
Q

Prior to an asthma attack, what are 3 things a child may complain about experiencing?

A

-Headache
-Fatigue
-Tight chest

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22
Q

During an asthma attack, young children tend to assume what position?

What about older children?

A

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

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23
Q

What adventitious lung sounds are heard during an asthma attack?

A

Coarse Ronchi, and progressively high-pitched wheezing

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24
Q

During a severe spasm or obstruction during Asthma, what can happen to the lung sounds? What is this?

A

Crackles and wheezing can become inaudible.
THIS IS AN EMERGENCY
Inaudible lung sounds mean a lack of air movement

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25
Q

What happens to the thoracic cavity due to repeated asthmatic episodes?

A

Barrel-chest. The Thoracic cavity becomes fixed in a hyperaerated state

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26
Q

Barrel chest is a result of chronic (_______) episodes and is characterized by a depressed (___________), elevated (__________) and increased use of (_________________) to breath

A

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

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27
Q

In Dx Asthma, generally, a (_____) (_____) in the absence of infection, or (________) wheezing during expiration is sufficient for a Dx.

A

In Dx Asthma, generally, a (chronic) (cough) in the absence of infection, or (diffuse) wheezing during expiration is sufficient for a Dx.

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28
Q

What is the primary test for providing an objective method of evaluating the presence of a lung disease/Asthma?

A

A PFT (Pulmonary Function Test)

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29
Q

(_________________) is good for Dx asthma, but should not be used in children ages less than (______)

A

(Incentive spirometry) is good for Dx asthma, but should not be used in children ages less than (5-years-old)

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30
Q

What asthma test is categorized with the “Stoplight System”?

A

PEFR (Peak-Expiratory-Flow-Rate)

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31
Q

PEFR is the max amount of air that can be what?

How is it measured?

A

PEFR is the max amount of air that can be forcefully exhaled in 1 second.

Measured in L/min

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32
Q

The reliability of the PEFM (Peak Expiratory Flow Meter) is controversial because of its reliance upon what?

A

The child’s ability to use it and willingness to participate

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33
Q

What are the 3 PEFR levels?

A

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

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34
Q

When determining a PEFR, a child needs to establish their personal best value during a (_-_________) period.

A

When determining a PEFR, a child needs to establish their personal best value during a (2-3 week) period.

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35
Q

What are the 4 Asthma classifications?

A

-Intermittent
-Mild Persistent
-Moderate Persistent
-Severe Persistent

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36
Q

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%

A

Mild Persistent

37
Q

Match the Asthma classification with the symptoms:

-Continuous symptoms
-Frequent exacerbations
-Frequent night symptoms
-Limited physical activity
-PEFR<60%

A

Severe Persistent

38
Q

Match the Asthma classification with the symptoms:

-Daily symptoms
-Daily use of short acting inhaler
-Frequent night symptoms
-Limited physical activity
-PEFR> 60-80%

A

Moderate Persistent

39
Q

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%

A

Intermittent

40
Q

In Short-term “quick relief” asthma treatment, what 3 pharmacological drug classes are best?

A

-SABA’s
-Anticholinergics
-Systemic Corticosteroids

41
Q

Of the Asthma Pharm medications, which are bronchodilators?

A

-SABA’s
-Anticholinergics
-Methylxanthines

42
Q

What is Ipratropium?

A

Ipratropium is an Anticholinergic for quick0relief asthma tx

43
Q

Beclomethasone
Montelukast
Omalizumab

Which drug classes to these belong to?

A

Beclomethasone is a corticosteroid

Montelukast is a Leukotriene modifier

Omalizumab is an Immunomodulator of Monoclonal antibodies

44
Q

(___________) sodium is an effective long-term tx for Asthma

A

(Cromolyn) sodium is an effective long-term tx for Asthma

45
Q

Budesonide
Fluticasone

What are these drugs types?

A

Inhaled corticosteroids

46
Q

Theophylline

What asthma drug class is this?

A

Methylxanthine

47
Q

What does Cromolyn Sodium do for Asthma treatment?

A

Stabilizes Mast cell membranes and stops inflammation mediators from being released

48
Q

What is the primary Anticholinergic drug used in relieving acute bronchospasms?

A

Ipratropium/Atrovent

49
Q

How does Magnesium Sulfate fight Asthma attacks?

A

MG Sulfate is a muscle relaxant that lowers inflammation and improves pulmonary function

50
Q

A MDI - (____-_____-______) should always be attached to a (_______) when an inhaled (______________) is given to prevent (_____) infections in the (______)

A

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)

51
Q

(________) are important for children with asthma who have difficulty learning proper (_________) (_____________)

A

(Spacers) are important for children with asthma who have difficulty learning proper (Inhalation) (Technique)

52
Q

Status Asthmaticus is a respiratory EMERGENCY, characterized by what?

A

Respiratory distress despite therapeutic efforts, especially after albuterol or epinephrine is used.

53
Q

What respiratory acid-base imbalance occurs in Status Asthmaticus patients that needs correcting?

A

Respiratory Acidosis from too much trapped CO2

54
Q

(_________) oxygen for Status Asthmaticus is recommended and should be kept at a saturation greater than (__)%

A

(Humidified) oxygen for Status Asthmaticus is recommended and should be kept at an O2 saturation greater than (90)%

55
Q

What is the initial therapy for a status asthmaticus patient?

Step 1
Step 2
Step 3

A

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)

56
Q

Besides a corticosteroid, what medication can be given IV to treat Status Asthmaticus?

How does it help?

A

Magnesium Sulfate

MG Sulfate is a muscle relaxant that also lowers inflammation and helps pulmonary function/Peak Flow Rate

57
Q

Cystic Fibrosis is marked by (_________) gland dysfunction. This means thick, excessive (_______) secretion from the (_____) glands, the (_______) glands and the (_______) and pulmonary systems

A

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

58
Q

How is Cystic Fibrosis obtained in children?

What is the incidence rate?

A

Autosomal; Genetically

Child inherits a Autosomal gene from both parents with an incidence rate of 1.4

59
Q

Cystic Fibrosis is the most common lethal genetic illness among?

A

Caucasian children

60
Q

The PRIMARY factor of Cystic Fibrosis, the one responsible for many of the clinical manifestations of the disease, is what?

A

Mechanical obstruction caused by the increased viscosity of mucous gland secretions

61
Q

Small passages in which organs become obstructed due to cystic fibrosis?

A

The Pancreas and the Bronchioles

62
Q

In cystic Fibrosis, you will see elevations of what levels? Where do these increased elevations manifest in the body?

A

Sodium and Chloride levels increased in the sweat and saliva, at a rate of 2-5 times greater than normal

63
Q

What is the most reliable Dx procedure for Cystic Fibrosis?

A

A sweat chloride test, due to the elevated levels of sodium and chloride in the sweat and saliva (2-5 times greater than normal)

64
Q

A sweat-chloride level greater than (__) mEq/L is suggestive of Cystic Fibrosis

A level of (__) means Cystic Fibrosis

A

A sweat-chloride level greater than (40) mEq/L means Cystic Fibrosis

A level of (60) mEq/L means Cystic Fibrosis

65
Q

What are 3 tests (besides a sweat-chloride test) that are used to dx Cystic Fibrosis?

A

-CXR
-Pulmonary Function Test
-Barium enema

66
Q

Clinical manifestations of Cystic Fibrosis in Infants include Meconium (____) and what 4 symptoms?
(FARV)

A

Meconium (Ileus)

-Failure to pass stools
-Abdominal distention
-Rapid dehydration
-Vomiting

67
Q

Clinical manifestations of Cystic Fibrosis in Children include:
PLLAC

A

-Poor weight gain
-Low BMI
-Liver disease
-“Asthma”
Chronic pneumonia

68
Q

Cystic Fibrosis in adulthood can cause (__________) in men

A

Cystic Fibrosis in adulthood can cause (infertility) in men

69
Q

Unlike asthma, which has a (__________) cough, Cystic Fibrosis causes a (____________) cough and wheezing

A

Unlike asthma, which has a (Unproductive) cough, Cystic Fibrosis causes a (productive) cough and wheezing

70
Q

Acute exacerbations of Cystic Fibrosis are characterized by:
_______________ cough, _______pnea, _______pnea, general __________, _______ia, and weight loss

A

Acute exacerbations of Cystic Fibrosis are characterized by:
Productive cough, Tachypnea, Dyspnea, general malaise, anorexia, and weight loss

71
Q

Cystic Fibrosis patients may be in a state of chronic (__________) and obstructive (____________)

A

Cystic Fibrosis patients may be in a state of chronic (pneumonia) and obstructive (emphysema)

72
Q

In Cystic Fibrosis, thick secretions prevent (_________) enzymes from reaching the duodenum. This means that (__)% of CF patients develop (_________) insufficiency.

A

In Cystic Fibrosis, thick secretions prevent (pancreatic) enzymes from reaching the duodenum. This means that (90)% of CF patients develop (pancreatic) insufficiency.

73
Q

Due to the Impaired digestion & absorption of nutrients in Cystic Fibrosis patients, related to (________) insufficiency, what effect does this cause on the stools?

A

Due to the Impaired digestion & absorption of nutrients in Cystic Fibrosis patients, related to (pancreatic) insufficiency, Steatorrhea is made (fatty-greasy stools)

74
Q

What GI illness can occur due to Cystic Fibrosis?

A

GERD

75
Q

What is the most common complication associated with CF?

A

CFRD

Cystic Fibrosis Related Diabetes

76
Q

What is the shared effect that CFRD has on both type-1 and type-2 Diabetes?

A

CFRD decreases Insulin production AND Insulin resistance

77
Q

What percentage of individuals with CF develop CFRD by 20 years of age?

A

25%

78
Q

If a baby tastes salty, what do they most likely have?

A

CF, due to the excess sodium and chloride in their sweat (40-60 mEq/L)

79
Q

What are the 3 “Hypos” of CF-related manifestations?

A

-Hyponatremia (no salt in body, just sweat)
-Hypoalbuminemia
-Hyperchloremic alkalosis (No chloride in body, just sweat)

80
Q

Reproductive manifestations of CF in both men and women that is shared is what?

A

Delayed puberty

81
Q

Men with CF can become (________), but not (__________)

Women can have their (__________) affected by the viscous (__________) secretions

A

Men with CF can become (infertile), but not (impotent)

Women can have their (fertility) affected by the viscous (cervical) secretions

82
Q

In CF, you can improve aeration and remove secretions by doing what physical nursing intervention?

A

Chest Physiotherapy

83
Q

What is a ThAIRapy vest used for?

A

The ThAIRapy vest is indicated to promote airway clearance and produce bronchial drainage via vibration and nebulization to collect for dx of CF

84
Q

What is a Flutter mucus clearance device?

A

A small handheld plastic pipe with a steel ball on the inside that helps remove mucus

85
Q

What does an Acapella device do?
(HFCC)

A

An Acapella device provides high-frequency auscultation, as well as PEP (Post-Exposure Prophylaxis)

86
Q

What breathing exercise is recommended to loosen secretions in CF?

A

“Huffing”: Forced expiration

87
Q

What is CPPD?

A

Chest Percussion Postural Drainage

88
Q

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

A

-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

Peds Exam 2 (4 decks)

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