Peds Exam 2 - C. Res

Question 1

asthma (reactive airway disease)

Answer 1

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

Question 2

what type of immune response is asthma & how is it mediated

Answer 2

-hypersensitivity type 1
-IgE: mast cells release histamine & leukotrienes

Question 3

how is asthma classified

Answer 3

1) frequency and severity of symptoms: severe, moderate, mild persistent, mild intermittent
2) levels of control: controlled, partly controlled, uncontrolled

Question 4

asthma triggers

Answer 4

-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

Question 5

asthma risk factors

Answer 5

age, heredity, gender, obesity, ethnicity

Question 6

clinical manifestations of asthma

Answer 6

dyspnea, expiratory wheezing, cough
-diaphoresis
- hacking cough -> rattling w/ clear sputum
-anxious & restlessness
-prolonged expiratory phase
-rhonchi

Question 7

diagnosis of asthma

Answer 7

-med hx
-physical exam
-lab results
-PEFR

Question 8

PEFR

Answer 8

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

Question 9

goal of asthma mgt

Answer 9

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

Question 10

drug therapy for asthma

Answer 10

-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

Question 11

what do you use if a child cannot take all their inhaler meds & hold their breath for 10 seconds

Answer 11

a spacer & a face mask if cannot make good seal around the spacer
can also give rescue meds through a neb

Question 12

nursing considerations for asthma in outpatient setting

Answer 12

-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

Question 13

asthma exacerbation

Answer 13

episodes of progressively worsening shortness of breath, cough, wheezing, chest tightness or a combo of these changes
red zone

Question 14

nursing interventions for asthma exacerbation

Answer 14

-high fowlers
-assessment
-O2 & vitals monitoring
-teach
-control panic & stress
-IV access
-administer rescue drugs then transition to regular meds

Question 15

how do children with asthma prepare for sports

Answer 15

do rescue medicine before
bronchodilators

Question 16

how to take asthma inhaler

Answer 16

sit up, shake med, breath out, seal, push down and breath in, hold breath for 10 sec
wait 1 min between puffs

Question 17

environmental control of allergens

Answer 17

-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

Question 18

asthma classification: mild persistent

Answer 18

symptoms more than 2x / wk but less than 1x / day, night symptoms 1-2x / month & rescue meds more than 2x / wk but not daily

Question 19

asthma classification: mild intermittent

Answer 19

goal
-symptoms less than 2 days a week
-night symptoms less than 2x / month
-rescue meds less than 2 day / wk

Question 20

asthma classification: moderate persistent

Answer 20

daily symptoms, nighttime symptoms 3-4x / month, uses beta agonist daily

Question 21

asthma classification: severe persistent

Answer 21

continual symptoms throughout the day, frequent nighttime symptoms, have to use short acting beta agonist for symptom control several times a day

Question 22

what is CF

Answer 22

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

Question 23

what type of disorder is CF

Answer 23

autosomal recessive
if both parents carry the gene, child has 25% chance of having CF

Question 24

nursing considerations in a CF child

Answer 24

-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

Question 25

pulmonary effects of CF

Answer 25

-bronchitis -generalized obstructive emphysema -S/s: wheezy cough, increased dyspnea, thick rattling, cyanosis, pneumonia, polyps in nose, clubbed digits, chronic sinusitis

Question 26

endocrine effects of CF

Answer 26

islets of langerhans cell may decrease in number -> malabsorption **50% of CF pts develop DM**

Question 27

GI effects of CF

Answer 27

-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

Question 28

hepatic effects of CF

Answer 28

bile ducts -> biliary fibrosis -> biliary cirrhosis - portal HTN -S/s: ascites, GI bleeding, jaundice

Question 29

reproductive system effects of CF

Answer 29

-delayed puberty -infertility **95% of males are sterile**

Question 30

salivary & sweat glands effects of CF

Answer 30

-electrolyte losses -salty sweat -dehydration -hyponatremia -heat stroke

Question 31

diagnosis of CF

Answer 31

-prenatal diagnosis: DNA analysis of chorionic villi or amniotic fluid samples -new born screening -pilocarpine electrophoresis (sweat chloride test) >60mEq -stool for fecal fat

Question 32

factors of maximizing health potential of CF pts

Answer 32

-pulmonary hygiene (use meds, vest, & low infections) -nutrition -prevention/early aggressive treatment of infection

Question 33

treatment of CF

Answer 33

CFTR modulation, aggressive pulmonary toilet, nutritional therapy and antibiotic use

Question 34

non pharm medical mgt of CF

Answer 34

-anti inflammatory agents & protease inhibitors -immunizations including yearly influenza vaccine -lung transplant will give 5-10 more years

Question 35

what electrolytes does CF cause a problem with

Answer 35

sodium and chloride

Question 36

CFTR modulators

Answer 36

**just know they exists** helps with the sodium and chloride -> regulate the flow of sodium & chloride and helps reduce the effects on organs

Question 37

aggressive airway clearance for CF (need to know)

Answer 37

-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

Question 38

drugs for CF

Answer 38

-bronchodilators -mucolytics -chloride channel activators & sodium channel blockers -antibiotic therapy

Question 39

what do CF pts take before meals

Answer 39

pancreatic enzymes by mouth (only consumes in graduals)

Question 40

how would you give pancreatic enzymes to an infant

Answer 40

sprinkle on a food like applesauce **does not dissolve in water**

Question 41

supplements for CF pts

Answer 41

-fat sol vit -stool softeners prn -NaCl tabs when hot out -oral iron sups