Lower Respiratory Tract Disorders Flashcards
What is Bronchopulmonary Dysplasia?
Chronic respiratory disorder in preemies requiring mechanical ventilation d/t scarring b/c of O2 toxicity and surfactant issues.
Describe the assessment findings for Bronchopulmonary Dysplasia.
Increased work of breathing and use of respiratory muscles. Wheezing. Circumoral cyanosis and cyanosis of nail beds. Malnourished. Decreased air movement on auscultation.
CXR indicates overinflation, inflammation & atelectasis (indicating fibrotic scarring).
Describe the potential complications of Bronchopulmonary Dysplasia.
Feeding and activity intolerance. Malnutrition, failure to thrive, arrested growth & development.
Describe the treatment for Bronchopulmonary Dysplasia.
Intubation –> Administer medications –> Extubation.
Corticosteroid to reduce inflammation. Bronchodilator by nebulizer to improve respiratory function.
O2 support
Severe cases may require tracheostomy & mechanical ventilation.
Describe the interventions for Bronchopulmonary Dysplasia.
Monitor respiratory status.
Monitor nutrition and fluid intake closely (especially if vent dependent).
Cluster care w/ hands off approach.
What is Cystic Fibrosis?
Autosomal recessive genetic disorder of the exocrine glands causing excessive mucous and sweat production.
Describe how mucous production r/t Cystic Fibrosis affects the pancreas.
The exocrine gland of the pancreas produces digestive enzymes. The overproduction of mucous blocks the glands and prevents secretion of the digestive enzymes. Pt is unable to breakdown foods in the GI system resulting in diarrhea, vitamin deficiency, dehydration, malabsorption and malnutrition. Pt will have a varacious appetite & steatorrhea (fatty stools).
Describe how mucous production r/t Cystic Fibrosis affects the lungs.
The overproduction of mucous contributes to secondary bacterial infections which leads to chronic/recurrent infections and ultimately respiratory failure.
Describe how Cystic Fibrosis affects the sweat glands.
Cystic Fibrosis leads to an over production of sweat which will have a high abundance of NaCl- (very salty sweat).
Describe the assessment findings for Cystic Fibrosis.
H/o recurrent infections.
Appearance: protuberant abdomen, small, thin frame, clubbed fingers.
Respiratory: cough, hyperresonnant chest, wheezing, rhonchi, atelectasis.
GI: steatorrhea (fatty stools), strong appetite, vitamin deficiency, malnutrition
Integ: Salty skin.
Meconium ileus in newborns. Stool is so thick it cannot pass.
Diagnosed typically within 7-10 days after birth d/t lack of weight gain
What tests are used to diagnose Cystic Fibrosis?
Pre-natal genetic testing at 7-8 weeks.
PKU screening at birth
CXR
PFTs
Describe the nursing interventions for Cystic Fibrosis.
Aerosolized inhalers & dornase ALPHA Incentive spirometry, cough/DB Chest PT Postural drainage Interdisciplinary communications esp w/ pulm and RT
DO NOT ADMINISTER ANTIHISTAMINES.
Why shouldn’t you administer antihistamines for Cystic Fibrosis?
Antihistamines have a drying effect which makes it difficult to expectorate mucous out of airways.
Describe the therapeutic/medical management for Cystic Fibrosis.
Prioritize respiratory interventions: Aerosolized inhalers (promote airway clearance) Dornase ALPHA (pulmonary enzyme to thin mucous and promote airway clearance)
Digestive Interventions:
Increase fat-soluble vitamins (ADEK)
HIGH PROTEIN DIET (HIGH CALORIE)
Pancreatic enzyme PO w/ snacks/meals (45-60 min prior)
What type of diet is recommended for Cystic Fibrosis
High protein, High calorie
What medications are used for Cystic Fibrosis?
Aerosolized inhalers Dornase Alfa (Pulmicort)
What is Bronchitis/Bronchiolitis?
Acute inflammation of the lower airways, specifically bronchi (large airways) and bronchioles (smaller airways) triggered by a virus or bacteria. Typically by RSV, influenza, edenovirus, etc.
Describe s/sx of Bronchitis/Bronchiolitis
Fever, cough, nasal congestion, fatigue, sputum.
Describe the assessment findings for Bronchitis/Bronchiolitis.
Rhonchi and coarse crackles, wheezing. Paroxysmal, dry cough. Shallow respirations. Increased AP of chest. Fatigued, anxious.
Describe interventions and treatments for Bronchitis/Bronchiolitis.
Maintain hydration/F&E: IV fluids.
Treat symptoms: O2 support
If source is RSV, admin antiviral (Palivizumab)
For how long do preemies receive prophylactic RSV antiviral treatments?
5 months
Describe asthma
Chronic airway condition involving airway edema and narrowing, excessive mucous production, and inflammation.
What allergies correlate with asthma?
Eggs and tree nuts
What triggers asthma?
Cold air, smoke, viral infections, pet dander, stress, exercise, environmental allergies, food allergies
What medical emergency results from untreated asthma?
Status asthmaticus
What is status asthmaticus (aka severe acute asthma exacerbation)?
A medical emergency resulting from untreated asthma or asthma that is unresponsive to traditional treatment. May lead to respiratory failure.
Describe the treatments for asthma.
Continuous nebulization w/ an inhaled B2 agonists.
ST relief: SABAs, corticosteroids, anticholinergics.
LT relief: ALS, ALBAS, glucotryine inhibitors.
Describe treatments for status asthmaticus.
Close cardiopulmonary monitoring.
Magnesium sulfate, terbutaline shots.
Smooth muscle relaxers.
ET intubation and Mechanical ventilation
Describe the assessment findings for asthma.
Acute respiratory distress Elevated RR and HR Altered LOC Anxious appearing Wheezing or limited breath sounds
Possible acidosis: O2 sat and PO2 are low, PCO2 is high
Describe paroxysmal coughing.
An episode or “paroxysm” consists of a series of coughs in rapid succession with increasing intensity.
Assessment finding(s) of asthma in infants.
Head bobs
