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Undeleted > Chronic Respiratory (peds) > Flashcards

Chronic Respiratory (peds) Flashcards

1
Q

1 chronic disease in children

A

asthma

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2
Q

asthma 3 classic characteristics*

A
  • spasm of bronchi and bronchioles
  • edema of mucous membranes
  • increased secretions
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3
Q

asthma is…

A
  • chronic inflammatory disorder of the airways characterized by increased responsiveness and inflammation
  • recurrent episodes of wheezing, SOB, chest tightness, cough
  • airway obstruction that is often reversible (spontaneously or with treatment) but can also result in irreversible (ex: chronic cognitive impairment)
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4
Q

asthma pathophysiology

A
  • stimuli causes bronchia mast cell to release chemical inflammatory mediator (over response)
  • mediators signal other inflam cells to migrate to airways
  • leads to epithelial injury *increased smooth muscle contraction, *mucous secretion, *edema
  • hyperactive bronchospasm
  • respiratory difficulty more pronounced during EXPIRATION. problem with air getting OUT (not in!!!)
  • air trapping!! increased CO2 => respiratory acidosis
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5
Q

asthma pathophysiology 3 components ALWAYS present*

A
  • increased smooth muscle contraction
  • mucous secretion
  • edema
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6
Q

portion of pulmonary function asthma impacts most

A

ventilation!

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7
Q

clinical manifestations of asthma

A

can develop abruptly or gradually!

  • cough: irritating, non-productive, often worse at night.
  • wheeze: can be inspiratory and expiratory
  • prolonged expiratory phase (LISTEN COMPLETELY)
  • increased work of breathing, decreased endurance (tripod sitting)
  • inaudible breath sound = OMINOUS SIGN
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8
Q

pulmonary function test is…

A

objective method to evaluate degree of obstruction and response to treatment
- spirometer: measures amount of air you can breathe in and out, also time to exhale COMPLETELY after deep breath; DIFFICULT IN CHILDREN < 5

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9
Q

mild intermittent asthma

A
  • symptoms x2 or less / week

- night symptoms x2 or less / month

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10
Q

mild persistent asthma

A
  • symptoms > x2 / week but NOT more than x1 / day
  • night symptoms > x2 / month
  • exacerbations affect activity
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11
Q

moderate persistent asthma

A
  • symptoms daily
  • night symptoms frequent
  • physical activity limited
  • short acting inhaler daily
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12
Q

severe persistent asthma

A
  • symptoms continuous
  • night symptoms frequent
  • exacerbations frequent
  • physical activity limited
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13
Q

peak flow meter

A

used for asthma daily monitoring, measures peak expiratory flow. similar to spirometer. helps us understand progression of symptoms.

green, yellow, red zones: green measured on healthiest days (blow out hard and fast)

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14
Q

RATTS

A 
Vanderbilt peds education for asthma!
R ecognize symptoms
A void further trigger contact
T reat symptoms with proper meds
T rack changes in symptoms
S eek medical help when necessary

self-management is critical for effective management

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15
Q

goal of pharm therapy with asthma

A

prevent and control symptoms, decrease exacerbations, reverse airway obstruction

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16
Q

therapeutic management of asthma: rescuer pharm

A
  • treat airway constriction, provide quick relief
  • doesn’t provide long term control

(usually albuterol)

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17
Q

therapeutic management of asthma: preventer pharm

A
  • treat asthma be controlling airway inflammation
  • does NOT provide quick relief

expensive but important and improves quality of life

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18
Q

metered dose inhaler

A

delivers a specific amount of medication to the lungs, in the form of a short burst of aerosolized medicine

19
Q

dry powder inhaler

A

delivers medication to the lungs in the form of a dry powder

20
Q

nebulizer

A

drug delivery device used to administer medication in the form of a mist inhaled into the lungs

21
Q

status asthmaticus

A

continued respiratory distress despite vigorous therapy; possible mortality

MEDICAL EMERGENCY

22
Q

status asthmaticus treatment

A

improve ventilation, correct dehydration, correct acidosis, treat infection

23
Q

racial distribution, asthma and cystic fibrosis

A

asthma: black, native american
CF: caucasian

24
Q

cystic fibrosis

A
  • progressive, incurable disease inherited (autosomal recessive)
  • exocrine gland dysfunction > multisystem disorder (sweat and salivary glands, digestive and pulmonary systems)
  • excessive production of thick, sticky mucous (leads to chronic airway obstruction/infection, maldigestion)
25
Q

cystic fibrosis etiology

A
  • inheritance of defective genes from both parents
  • cystic fibrosis transmembrane regulator (CFTR) gene
  • 700 possible mutations
26
Q

cystic fibrosis pathophysiology *

A
  • epithelial cells in airways, pancreas have decreased ability to transport chloride
  • overactive sodium pump
  • increase Na & Cl in sweat, saliva
  • increased viscosity of airway mucus leading to mechanical obstruction
27
Q

CF clinical manifestations (respiratory)

A
  • progressive, obstructive pulmonary disease leading to gradual deterioration of respiratory system
  • increased viscosity of bronchial mucus
  • decreased ciliary action
  • incomplete expectoration: OBSTRUCTION
  • retained mucus: INFECTION
  • decreased O2, CO2 exchange: CHRONIC HYPOXEMIA
  • chronic pneumonia, obstructive emphysema
  • persistent productive cough
  • acute exacerbations: increased cough, tachypnea, dyspnea, increased sputum production, malaise, anorexia, weight loss
  • sinus disease
  • BARREL CHEST, CLUBBING
28
Q

CF clinical manifestations: GI

A
  • thick secretions block pancreas ducts
  • prevents pancreatic enzymes from reaching duodenum (90% CF patients have pancreatic insufficiency; give every time patient eats)
  • impaired digestion and absorption of nutrients, esp: fats, proteins, carbs –> steatorrhea
  • weight loss, failure to thrive (can be initial presentation!)
29
Q

steatorrhea

A

increased fat in stools

30
Q

CF initial presentation can be

A

weight loss, failure to thrive

31
Q

CF clinical manifestations: GI - meconium ileus *

A

meconium ileus: earliest possible manifestation. with CF, meconium is thick, putty-like, tenacious and blocks lumen of small intestines.

leads to BOWEL OBSTRUCTION, abdominal distension, vomiting, no passage of meconium, bulky large foul smelling stools, rectal prolapse, GERD

32
Q

meconium

A

first feces of a newborn infant

33
Q

pancreatic disease & CF

A

most common gastrointestinal complication of CF

34
Q

CF related diabetes

A

mechanisms unique, share features with both Type I & II: both decreased insulin production AND resistance

25% of individuals with CF develop CFRD by age 20

35
Q

CF clinical manifestations: reproductive *

A
  • delayed puberty
  • female: fertility possibly impaired s/t viscous cervical secretions
  • male: many sterile but not impotent
36
Q

CF general clinical manifestations

A
  • salty skin
  • liver: focal biliary obstruction, fibrosis (increase over time) = multilobar biliary cirrhosis; fatty infiltration possible
  • bone disease: decreased mineral density, increased fracture rates, kyphosis
37
Q

CF diagnosis

A

sweat chloride test; genetics screen/newborn screen

38
Q

CF presentation of symptoms: infant

A

failure to thrive, meconium ileus

39
Q

CF presentation of symptoms: child

A

poor weight gain, low BMI, “asthma”, chronic pneumonia, liver disease

40
Q

CF presentation of symptoms: adult

A

infertility in men

41
Q

CF therapeutic management: non-pharm

A
  • care, not cure
  • chest physiotherapy (improve aeration, remove secretions)
  • chest percussion postural drainage (CPPD), thAIRapy vest, flutter mucus clearing device (acapella valve)
  • diet: high cal and protein, 150% of daily rec allowance required to meet growth needs, G tubes!!
  • exercise: increase lung function, effective habitual breathing patterns and coughing to clear secretions
42
Q

CF therapeutic management: pharm

A
  • pancreatic enzymes (ALL meals/snacks)
  • vitamins: water miscible ADEK
  • abx
  • nebulized pulmozyme (decreases mucus viscosity)
  • ibuprofen
  • NO ANTITUSSIVES
43
Q

CF respiratory therapy looks like

A
  • bronchodilator (albuterol)
  • hypertonic saline: 10 minutes after, thin/liquify secretions
  • airway clearance: vest, flutter, CPPD
  • pulmozyme: thin secretions
  • cough: expectorate mucus
  • inhaled corticosteroids: clean lung tissue
  • inhaled antibiotic (possibly tobramycin)
    80 minutes, multiple times a day!!!

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