Peds Exam 2 - C. Res Flashcards
asthma (reactive airway disease)
a chronic inflammatory airway disorder which consists of airways obstruction, bronchial irritability, edema of mucous membranes, congestion & spasms of smooth muscles of the bronchi and bronchioles
what type of immune response is asthma & how is it mediated
-hypersensitivity type 1
-IgE: mast cells release histamine & leukotrienes
how is asthma classified
1) frequency and severity of symptoms: severe, moderate, mild persistent, mild intermittent
2) levels of control: controlled, partly controlled, uncontrolled
asthma triggers
-stress
-pets if allergic
-exercise
-pollen
-bugs in house
-chemical fumes
-cold air
-fungus spores
-dust
-smoke
-strong odors
-pollution
-anger
eliminate to control, very important
asthma risk factors
age, heredity, gender, obesity, ethnicity
clinical manifestations of asthma
dyspnea, expiratory wheezing, cough
-diaphoresis
- hacking cough -> rattling w/ clear sputum
-anxious & restlessness
-prolonged expiratory phase
-rhonchi
diagnosis of asthma
-med hx
-physical exam
-lab results
-PEFR
PEFR
tells us how much air pt can exhale in 1 second & tells us how well asthma is controlled + care to give (meds or ER)
green zone (80% of personal best), yellow zone (50-79%), red zone (<50%, ER) -> tract multiple times a day and then have action plan for results
goal of asthma mgt
maintain normal activity levels, pulmonary function, prevent chronic symptoms, provide optimal drug therapy and assist child in normal life
do this by controlling the environment & making life be low allergen
drug therapy for asthma
-controllers: start w/ cort steroids then can add long acting beta 2s or leukotriene inhibs (singulair)
-relievers (rescue): short acting beta 2 / bronchodi’s (albuterol, proventil, xopenex) & mag sulfact
give through inhaler
what do you use if a child cannot take all their inhaler meds & hold their breath for 10 seconds
a spacer & a face mask if cannot make good seal around the spacer
can also give rescue meds through a neb
nursing considerations for asthma in outpatient setting
-general, environmental & physical assessment
-review meds
-review action plan every 6mo
-plan regular check up & immunizations up to date
-prevent URI
-regular exercise
discuss how much missed school
asthma exacerbation
episodes of progressively worsening shortness of breath, cough, wheezing, chest tightness or a combo of these changes
red zone
nursing interventions for asthma exacerbation
-high fowlers
-assessment
-O2 & vitals monitoring
-teach
-control panic & stress
-IV access
-administer rescue drugs then transition to regular meds
how do children with asthma prepare for sports
do rescue medicine before
bronchodilators
what type of disorder is CF
autosomal recessive
if both parents carry the gene, child has 25% chance of having CF
pulmonary effects of CF
-bronchitis
-generalized obstructive emphysema
-S/s: wheezy cough, increased dyspnea, thick rattling, cyanosis, pneumonia, polyps in nose, clubbed digits, chronic sinusitis
endocrine effects of CF
islets of langerhans cell may decrease in number -> malabsorption 50% of CF pts develop DM
GI effects of CF
-15 to 20% of newborns w/ CF will develop a meconium ilius (earliest sign)
-appetite changes
-malabsorption, wt loss
-distended abdomen
-sallow skin
-anemia
-oily stools
hepatic effects of CF
bile ducts -> biliary fibrosis -> biliary cirrhosis - portal HTN
-S/s: ascites, GI bleeding, jaundice
reproductive system effects of CF
-delayed puberty
-infertility
95% of males are sterile
salivary & sweat glands effects of CF
-electrolyte loses
-salty sweat
-dehydration
-hyponatremia
-heat stroke
diagnosis of CF
-prenatal diagnosis: DNA analysis of chorionic villi or amniotic fluid samples
-new born screening
-pilocarpine electrophoresis (sweat chloride test) >60mEq
-stool for fecal fat
factors of maximizing health potential of CF pts
-pulmonary hygiene (use meds, vest, & low infections)
-nutrition
-prevention/early aggressive treatment of infection
treatment of CF
CFTR modulation, aggressive pulmonary toilet, nutritional therapy and antibiotic use
non pharm medical mgt of CF
-anti inflammatory agents & protease inhibitors
-immunizations including yearly influenza vaccine
-lung transplant will give 5-10 more years
nursing considerations in a CF child
-careful respiratory assessment
-constant assessment of IV site
-enzyme replacement
-exercise & fun
-possible isolation CF pts cannot mix w/ other CF pt
-high cal, full fat foods & nutrition evals
-family impact
-hospital & home care
-picc line care
asthma classification: moderate persistent
daily symptoms, nighttime symptoms 3-4x / month, uses beta agonist daily
asthma classification: severe persistent
continual symptoms throughout the day, frequent nighttime symptoms, have to use short acting beta agonist for symptom control several times a day
asthma classification: mild persistent
symptoms more than 2x / wk but less than 1x / day, night symptoms 1-2x / month & rescue meds more than 2x / wk but not daily
asthma classification: mild intermittent
goal
-symptoms less than 2 days a week
-night symptoms less than 2x / month
-rescue meds less than 2 day / wk
how to take asthma inhaler
sit up, shake med, breath out, seal, push down and breath in, hold breath for 10 sec
wait 1 min between puffs
environmental control of allergens
-remove house dust mites
-impermeable covers on pillows & mattresses
-cock roach control
-wash linens in hot water 2x/wk
-vacuum weekly
-have animal free zones in the house
-AC & avoid wood heat
what is CF
disrupts the normal function of the exocrine glands related to sodium & chloride transport via the cystic fibrosis transmembrane regular (CFTR) protein
the gene mutation is located on the long arm of chromosome 7
what electrolytes does CF cause a problem with
sodium and chloride
CFTR modulators
just know they exists
helps with the sodium and chloride -> regulate the flow of sodium & chloride and helps reduce the effects on organs
aggressive airway clearance for CF (need to know)
-percussion by manual, PEP mask and vest
-airway clearance therapy
-postural drainage
-breathing exercises
-physical exercise
-oxygen therapy & nebs only if needed bc hard to wean
-isolation while in hospital
drugs for CF
-bronchodilators
-mucolytics
-chloride channel activators & sodium channel blockers
-antibiotic therapy
what do CF pts take before meals
pancreatic enzymes by mouth (only consumes in graduals)
supplements for CF pts
-fat sol vit
-stool softeners prn
-NaCl tabs when hot out
-oral iron sups
how would you give pancreatic enzymes to an infant
sprinkle on a food like applesauce
does not dissolve in water
