Module 3 Part 2: Asthma, bronchiolitis, RSV Flashcards
what is bronchiolitis?
inflammation of the fine bronchioles and small bronchi - lower respiratory tract infection
what is bronchiolitis usually caused by?
viruses, particularly respiratory syncytial virus (RSV)
who is at a higher risk of bronchiolitis? (theres a looot)
- those who are immunocompromised
- those who live in colder areas of the world (inc. risk in the winter seasons)
- born in winter months (Nov, Dec, Jan)
- children with siblings in daycare
- low birth weight
- males
- formula fed
- eczema family history
what is the most frequent cause of hospitalization in children under 2 years?
RSV
which group is RSV more prominent in in Canada?
Indigenous populations in Northern Canada
what other respiratory disease is RSV linked to?
asthma
how long can RSV live on the surface? what about the hands?
surface: several hours
hands: 30 mins
what are the initial mnfts of RSV?
- rhinorrhea (nasal cavity filled with lots of mucus)
- phayngitis
- coughing
- wheezing
- eye/ear drainage
- intermittent fever
what are the progressive mnfts of RSV?
- increased coughing and wheezing
- tachypnea and retractions
- cyanosis
what are the severe mnfts of RSV? what should you do if these occur?
- tachypnea (over 70bpm)
- listlessness (inactivity)
- apnea
- poor air exchange
- decrease breath sounds
- **YOU MUST TAKE THEM TO EMERGENCY **
what do you assess for with RSV?
- colour
- movement
- work of breathing
- auscultations
- secretions
- hydration
- caregivers??
- intake/output
- weight
- resps greater than 55/min?
- nutritional status
what movement would you assess for RSV?
head bob
what would you assess for work of breathing for RSV?
- resp rate
- nasal flare
- tracheal tug
- in drawing/retractions
- seesaw breathing
- sounds - grunting, coughing, crying
what would you auscultate for during you RSV assessment?
- stridor
- wheeze
what vital signs would you do for RSV?
- HR
- RR
- temp
- BP
- O2
- *weight
how is the diagnosis done for RSV?
- nasopharyngeal swab - RSV antigen
- chest x-ray hyperinflation
- arterial blood gases
- CBC, electrolytes
what are non-pham treatment for RSV?
- treat sympt
- adequate fluids
- a/w management
what are pharm management for RSV?
- cool humidified O2
- antipyretics
- supplemental humidified oxygen
- bronchodilator epinephrine nebs
- 3% NS nebs
what are some nursing interventions for RSV?
- droplet precautions
- grouping other RSV patients together
- nurses with RSV patients, limit contact with non-RSV pts
- frequent monitoring
- health promotion
- meds
what is a good health promotion topic for parents with children with RSV?
limit smoking in the home
what is the pharmacological goal for RSV?
- prevent and control symptoms -reduce freq and severity of exacerbations
- improve health status
- improve exercise tolerance
what are nursing considerations for the pharmacology of RSV?
- pre/post resp assessment
- adverse effects
- patient teaching
- lifespan considerations
what is a pulmonary function test (PFT)?
a test done to assess respiratory function
what are PFTs used?
- to stage COPD (1-4)
- to determine whether obstruction or restrictive condition
- to determine if treatment is effective
- may be used with patient history, ABGs, and chest x-ray for diagnoses
what is forced expiratory volume (FEV1)?
volume of air forcibly blown out in one second after a full inspiration
what is forced vital capacity (FVC)?
volume of air that can be forcefully blown out after a full inspiration
what is one example of when you would use FVC?
discharging a patient with asthma
what is FEV1/FVC? (divide the two)
percentage of your forced vital capacity that is expelled in 1 sec?
what do restrictive lung conditions cause?
-difficulty in lung expansion
what are examples of intrinsic restrictive lung conditions?
- pneumonia
- fibrosis
- lobectomy
what are examples of extrinsic restrictive lung conditions?
- pregnancy
- obesity
- ascites
what do obstructive lung conditions cause?
- difficulty exhaling
- narrowing of a/w
what conditions are an example of obstructive lung conditions?
- COPD
- asthma
is FEV1 and FEV1/FVC low or high in COPD? what is this used for?
low - this is used to stage the progression
is FEV1/FVC low or high in asthma?
low - but improves significantly after receiving a bronchodilator
what are predisposing factors of asthma?
- female
- atopy
what are causal factors of asthma?
- exposure to indoor and outdoor allergens
- occupational sensitizers
what are contributing factors of asthma?
- resp infections
- air pollution
- active/passive smoking
- other (diet, small size @ birth)
describe BRIEFLY the patho of asthma
hyper-responsiveness to airways which leads to airway limitation
what are the symptoms of asthma?
- wheezing
- cough
- dyspnea
- chest tightness
what are the risk factors for asthma exacerbations?
- allergens
- resp infect
- exercise and hyperventilation
- weather changes
- exposure to sulphur dioxide
- exposure to food, additives, medications
- stress
- gastroesophageal reflux
what are the S&S of asthma exacerbations?
- may begin abruptly
- often proceeded by increasing symptoms over the previous few days
- inc. effort with expiration
- diaphoresis
- tachycardia
- severe hypoxia is rare, but lit threatening
what are possible complx of asthma?
- status asthmaticus
- resp failure
- pneumonia
- atelectasis
- a/w obstruction, especially in acute episodes
what are the short-term meds for asthma?
Aziz mentioned to MAKE SURE you know these
-short-acting beta adrenergic agonists
wha are the long-acting meds for asthma?
Aziz mentioned to MAKE SURE you know these
- inhaled corticosteroids
- long-acting beta1-adrenergic agonist
- anticholinergics
- xanthins
- leukotriene modifiers
what are the goals for care with patients with asthma?
- participate in ADLs, including exercise and other physical activity
- normal to near-normal pulmonary function
- asthma under control
- as few SE from meds as possible and take the lowest dose required
- possess knowledge and skills to manage their asthma
what is the nursing management for patients with asthma?
- asthma education
- environmental control
- self-monitoring and action plans
- monitor resp status: severity of sympt, breath sounds, peak flow, O2 sats, VS
how does asthma differ from other resp diseases?
- largely reversible
- spontaneous
what age is asthma most common at?
can occur at any age - most common in childhood
what are the most common allergens that cause asthma?
- seasonal
- perennial (eg. mold, dust)
when are asthma attacks most common? why do we think this is?
late at night or early in the morning. possibly d/t circadian rhythm
does wheezing happen during inspiration or expiration with asthma?
at first it’s with expiration, then with inspiration as well
what are the S&S of exercise induced asthma?
- worse during exercise
- no nocturnal symptoms
- a choking feeling during exercise
what histories are important for diagnosing asthma?
- family
- environmental
- occupational
what skin conditions may also present with asthma?
- rashes
- eczema
- temporary edema
what type of WBC may be elevated in asthma?
eosinophils
what antibody may be elevated with asthma?
IgE (if caused by allergies)
what prevention techniques can be used for asthma?
-identification of substances that precipitate the sympts and avoid them
why is immediate intervention during an exacerbation required?
because the continuing and progressive dyspnea leads to increased anxiety, aggravating the situation
what is status asthmaticus?
- complx of asthma
- severe and persistent asthma that does not respond to conventional therapy
- can happen with little to no warning and progresses fast
