resp Flashcards

Question

3 progressions to resp failure/arrest

Answer 1

-5 cardinal signs (during resp distress) 1 restlessness 2 tachypnea 3 tachycardia 4 diaphoresis 5 pallor -early decompensation (less obvious) retractions nasal flaring grunting (exp) Head bobbing exertional dyspnea increased WOB wheezing/prolonged exp headache CNS symps (and, confusion, restless, irritable, decreased LOC) mood changes HTN Anorexia -severe hypoxia cyanosis: ominous late sign bradycardia hypotension decreased resps bradypnea/dyspnea stupor and coma

Answer 2

are generalized and can be a lot of other things (ex a child can just be scared)

Answer 3

No, resp arrest first but then heart eventually fails Heart failure= poor prognosis

Answer 4

child attempts to compensate for O2 deficit and airway blockage. The O2 supply is inadequate= behaviour and VS reflect compensation and beginning hypoxia

Answer 5

child uses accessory muscles to assist O2 intake. Hypoxia persists and efforts now waste more O2 than obtained

Answer 6

O2 deficit is overwhelming and beyond spontaneous recovery. Cerebral oxygenation is dramatically affected = CNS changes are ominous

Answer 7

the pressure of gas the child exerts like a concentration Shift LEFT caused by increase pH, decrease temp, decrease PaCO2 Shift RIGHT caused by decrease pH, increase temp, increase PaCO2, increase 2,3 DPG

Answer 8

-Acute streptococcal pharyngitis (ASP) -Tonsilitis -Croup syndromes 3 subgroups of croup: Laryngotracheobronchitis Epiglottitis Bacterial tracheitis

Answer 9

aka strep throat group A B-hemolytic streptococcus having ASP increases risk of: Acute rheumatic fever and acute glomerulonephritis rheumatic fever: inflamm disease that inflames body's joints and heart, CNS. appears 18 days after ASP so ask WHEN it started Acute glomerulonephritis usually appears 10 days after ASP and can be fatal ASP onset: abrupt, lasts 3-5 days ASP manifestations: tonsils and pharynx inflamed and covered with white exudate Direct contact or large droplet Noninfectious to others after 24 hours of antibiotic dosing Nursing care: -cold or warm compress -warm saline gargle -soft diet

Answer 10

chronic throat infection can lead to acute tonsilitis tonsilitis manifestations: -diff swallowing, drooling -enlarged adenoids -mouth breathing -mouth odor -impaired taste, smell -muffled and nasal voice -persistent cough -otitis media, hearing diff Tx: tonsillectomy adenoidectomy T&A is needed but controversial at a young age because lymph tissue can regrow. -needs surgery if airway is blocked T&A contraindications: -very young -blood disorders Nursing care Post tonsillectomy: -position upright to facilitate drainage -careful suctioning prn -discourage coughing,clearing throat/sneeze -ice collar -regular analgesia 24-48hrs -NPO until alert, able to swallow w/o signs of hemorrhage *do not give codeine post-op: it converts to morphine in the body and children either metabolize it too slowly = no effect OR too quickly = can become a high concentration and outcome is unpredictable *do not give Aspirin post op = risk of bleeding Signs of hemorrhage: -frequent clearing of throat, swallowing -vomit/secretions with bright red blood -pallor -tachycardia -drooling -coughing up blood -avoid giving red food because you won't be able to tell if vomit has blood in it

Answer 11

the eustachian tube equalizes air pressure and allows for drainage <2 yrs old, the tube has less angle/ more horizontal = decreased drainage chronic ear infections = hearing loss most are viral tx: myringotomy(put tubes in ears to equalize pressure) Nursing care: supportive instead of surgery -soft/liquid diet -cool mist vaporizer warm saltwater gargle -throat lozenges -analgesic-antipyretic drugs

Answer 12

swelling of epiglottis/larynx, extends to trachea/bronchi viral or bacterial characterized by: hoarseness barking brassy cough Stridor (Insp) resp distress Mild croup: occasional barking cough no stridor at rest no retractions Moderate croup: frequent barking cough audible stridor at rest no agitation or distress no cyanosis Severe croup: frequent barking cough retractions stridor (Insp) tachypnea no cyanosis but lethargic *beware of quiet child

Answer 13

viral: parainfluenza type 1,2,3, RSV, influenza A or B, adenovirus bacterial: mycoplasma pneumoniea children <5yrs boys>girls LTB manifestations: -URI for several days, progresses to cough and hoarseness -low fever -tachypnea -barking cough -stridor (isp) tx: -humidification, cool mist -encourage fluids -supp. O2, oximetry -rest, parental reassurance meds: steroids = usually respond quickly -epinephrine -corticosteroids ex dexamethasone obstruction can still occur in LTB

Answer 14

cause: parainfluenza virus signs of inflammation are absent or mild hx of previous attacks lasting 2-5 days followed by uneventful recovery 1-3 yrs management: at home, cool mist

Answer 15

potentially life-threatening and requires immediate attention inflammation of epiglottis caused by haemophilus influenza or group A B-hemolytic streptococcus prevention: vaccines Sudden onset with high fever >39 4 classic signs (4 D's) of epiglottitis: D - drooling D - dysphagia D - dysphonia D- distressed resp effort (tripod) dx: lateral neck x-ray tx: intubation Abx O2 antipyretics for severe and sore throat Nursing care: ****DO NOT INSPECT MOUTH AND THROAT unless prepared to intubate - because the slightest movement or inhale can cause a full obstruction *******!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! -quiet environment -try to minimize crying, emotional support -fluids -droplet isolation for 24 hrs after initiation of effect abx -prophylactic abx tx of household

Answer 16

Serious cause of airway obstruction with features of both LTB & epiglottitis cause: staphylococcus aureus 5-7yrs old tracheitis manifestations: -croupy cough &stridor -high fever >39 for several days -thick purluent secretions - THIS IS THE DIFFERENCE because of the BACTERIAL cause -requires ventilations support Differences between bacterial tracheitis and LTB, croup: bacterial cause -thick purulent secretions -child prefers lying flat instead of sitting up

Answer 17

Serious cause of airway obstruction with features of both LTB & epiglottitis cause: staphylococcus aureus 5-7yrs old tracheitis manifestations: -croupy cough &stridor -high fever >39 for several days -thick purulent secretions - THIS IS THE DIFFERENCE because of the BACTERIAL cause -requires ventilation support Differences between bacterial tracheitis and LTB, croup: bacterial cause -thick purulent secretions -child prefers lying flat instead of sitting up

Answer 18

Bronchitis Bronchiolitis (RSV) Asthma

Answer 19

inflammation of large airways (trach & bronchi) usually viral associate with URTI Bronchitis manifestations: -dry, hacking, nonprod. cough -worse at night -becomes productive in 2-3 days mild: self limiting symptomatic tx

Answer 20

inflammation of large airways (trach & bronchi) usually viral associated with URTI Manifestations: -dry, hacking, nonprod cough -worse at night -becomes productive in 2-3 days mild self-limiting, tx symptoms

Answer 21

inflammation & obstruction of bronchioles 2-6 months, reinfection in 2nd year of life most severe in infants <6months males> females hyperrinflated airways = O2 can enter but CO2 can't get out -> pH decreases = resp acidosis direct contact with resp secretions w/ a eye/nose/mucous membrane can survive for hours on surfaces and 30 min on skin incubation 2-8 days; viral shedding can last several weeks Resp. syncytial virus RSV most common cause Patho: -virus invades mucosal cells lining bronchioles -infected cell membranes fuse to form giant cells with multiple nuclei = creates "syncytia" or streaks at cellular level -invaded cells die when virus bursts from inside cell to invade adjacent cells -cell debris clogs and obstructs bronchioles & irritates airway -> cells lining airway swell & produce excessive mucous = partial airway obstruction & bronchospasm Air can come in but not out = wheezes, crackles, air trapping Risk for resp failure = beware of quiet breath sounds High risk groups: -Premature: dt absence of maternal antibodies and smaller airways -Bronchopulmonary dysplaaasia (BPD) = chronic lung disease dt bronchial hyper-responsiveness and reduced ling capacity -Cardiac disease dt pulm. vascular hyper-responsiveness and increased pulm. blood flow -Neuromuscular disease dt decreased resp muscle strength/endurance and anything that interferes with muscles to breathe -Immune deficiency dt decreased host defences and impaired capacity to eliminate virus clinical manifestations: -initally ill with URTI (nasal stuffiness, +- cough) -progresses to deeper/more frequent cough -laboured breathing -fever >39 -shallow, rapid RR -nasal flaring -retractions -appear sick, not playful, not eating -infants may spit up thick, clear mucus dx: -chest x-ray* nasopharyngeal wash (NPW) or nasopharyngeal swab (FLOQ swab) - for RSV antigen detections and other viral infections *chest x-ray not recommended for bronchiolitis because hard to distinguish between RSV and asthma

Answer 22

Signs of severe resp distress: -RR >60, indrawing grunting -supp O2 to keep sats >90% -dehydration or hx of poor fluid intake -cyanosis or hx of apnea -infant at high risk for severe disease (mentioned above: premature, BPD, hemodynamically signif. cardiopulmonary disease, neuro, immunodeficiency) -family unable to cope -CBC (generally not helpful in routine cases) -ABG's - only if concerned about resp failure -Bacterial culture (blood, urine, CSF) - not routinely; may be indicated based on clinical judgment tx: supp O2 hydration IV or PO Equivocal therapies: -epinephrine nebulizer nasal suction combined epinephrine and dexamethasone

Answer 23

IM inj, given monthly during RSV season 55% reduction in RSV-related hospital stays does not interfere with routine immunizations expensive $5000-9000/infant/year must be < 2 yrs old **** look in your ppt for more criteria

Answer 24

-Tachypnea and WOB improved -Maintain O2 sats >90% w/o supp. O2 OR stable for home O2 therapy -adequate oral feeding -education provided and appropriate follow-up arranged

Answer 25

chronic inflammatory disorder of the airways characterized by: -recurring symptoms -airway obstruction (reversible spontaneously or with tx) -bronchial hyper-responsiveness to stimuli, constriction most common childhood illness, major cause of school absences, ER visits, and hosp admissions 1/10 children males>females 80-90% have symptoms before 4-5 yrs old 2 main types: 1) recurrent wheezing in early childhood; RSV cause 2) chronic asthma associated w/ allergy persisting into later childhood and adulthood

Answer 26

ages 5-11 Step 1: intermittent asthma symps <2days/week Step 2: mild persistent asthma symps >2 times/week but

Answer 27

multifactorial: genetic, immunologic, environmental, infectious, endocrine, psychological, biochemical factors allergy influences persistence and severity Strongest identifiable predisposing factor for developing asthma: -Atopy (IgE-mediated response to common areoallergens => increased propensity to hypersensitivity reactions Risk factors for asthma: -atopy (including hx of allergies or atopic dermatitis (eczema) -heredity (parents, sibling) -gender (male>female until adolescence) -smoking or 2nd hand exposure -maternal smoking during pregnancy -ethnicity (African-American) -LBW -high BMI Asthma triggers: -allergens (plants, pollen, air pollution, dust mites, dust, mold, smoke, sprays) -occupational chemicals -physical exercise -cold air -weather/temp changes -environmental change -cold/infections (bacterial or viral) -animals (cats, dogs, rodents, horses)

Answer 28

initial release of inflammatory mediators from bronchial mast cells, macrophages, and epithelial cells migration and activation of other inflam cells alterations in epithelial integrity and autonomic neural control of airway tone Increase in airway smooth muscle responsiveness -> wheezing, dsypnea, eventual obstruction -inflammation narrows the airway and increases production of mucus -Alveoli may become hyperinflated or collapse because of obstruction, leading to decreased perfusion of the alveolar capillaries and impaired gas exchange. Impaired expiration leads to air tapping, hyperinflation, and dyspnea. -inflammation and edema of mucous membranes -accumulation of secretions = mucous plug -spasm of smooth muscle bronchi and bronchioles -hyperinflation of alveoli, collapse -> impaired gas exchange

Answer 29

allergy is the strongest risk factor for chronic morbidity and mortality IgE is the most active antibody in allergic reactions IgE mediates hypersensitivity reaction in bronchial mucosa ->specific tissue binding Release of chemical mediators histamine leukotrienes prostaglandins serotonin platelet-activating factor major effect of these: -increased permeability of BV -contraction of smooth muscle -stimulation of mucous secretion

Answer 30

balance of vagal (parasymp. rest/digest) & sympathetic nerve influences maintenance of bronchial smooth muscle tone irritant receptors react to triggers => stimulate reflex bronchospasm (constriction - vagal) normal response, BUT IN ASTHMA, this is abnormally severe sympathetic = dilate vagal (parasymp) = contsrict

Answer 31

Increased airway resistance: -forced expiration -> air trapping, air trap -> WOB, fatigue WOB, fatigue -> ineffective resps, increased O2 consumption decreased O2 avail-> ineffective cough dysnpea, cyanosis, tachypnea

Answer 32

depends on ratio of poorly ventilated/hyperextended alveoli VS. well-ventilated alveoli as severity of obstruction increases -> reduced alveolar ventilation CO2 retention, resp acidosis, hypoxemia, resp failure

Answer 33

episodes of progressively worsening SOB, cough, wheezing, chest tightness Decreases in expiratory airflow -airways narrow because of bronchospasm -mucosal edema and mucous plugging -> air trapping behind narrowed airways Hyperinflation: keeps airways open and permits gas exchange Hypoxemia: ventilation/perfusion mismatch

Answer 34

classic: dyspnea (SOB), wheezing, coughing other: prodromal itching (front neck, upper back) mood changes like irritability, restlessness feeling tired headache chest tightness hacking, paroxysmal, irritative, nonproductive cough which becomes productive as secretions accumulate coughing at night

Answer 35

SOB increased RR, HR, shallow prolonged expiratory resps pallor -> cyanosis anxious diaphoresis position - tripod retractions VOICE CHANGES - short, panting, broken phrases

Answer 36

air entry wheezing O2 sat Suprasternal retractions scalene muscle contraction

Answer 37

-increased susceptibility to infections - dt break in mucosal membrane -Atelectasis: deflated alveoli, filled w/ fluid -Emphysema: damaged alveoli, inner walls of alveoli weaken and rupture = creating large spaces instead of small ones appear barrel-chested -Status asthmatics (rare): long-lasting severe asthma attack that does not respond to normal tx -Pneumothorax (rare): air leaks into lung and compresses

Answer 38

Green zone (PEFM rate) 80-100% -good asthma control, relatively free from symptoms -follow asthma management plan and take usual meds Yellow zone (PEFM rate) 50-80% -caution -asthma is worsening -contact HCP to adjust tx Red zone (PEFM rate) <50% -danger -management plan is not controlling symptoms -use inhaled bronchodilator -if peak flow readings do not return to at least yellow, contact HCP figure out triggers, track with diary allergen control: house dust mites, cockroaches drug therapy breathing exercises hypo-sensitization exercise

Answer 39

current symptoms medications triggers family hx of asthma or allergies compare attack, look at differences chest assessment: 1) Observation: color rythym, tachypnea accessory muscles indrawing posture fever/cold s&s cough, wheeze 2) Auscultation: air entry breath sounds movement of air wheezing, crackles changes w/ coughing, meds 3) Tests: CXR PEFR ABG's O2 sats

Answer 40

maintain patent airway humidified O2 positioning - raise HOB to sit upright rest and stress reduction quiet environment, group care tasks fluid - warm, may need IV fluids avoid triggers reassurance discharge planning and teaching MEDICATIONS 1) Beta-2 agonists - "rescuers" "relievers" -Salbutamol (Ventolin), salmeterol (severvent), terbutaline(bricanyl) 2) Corticosteroids - anti-inflammatories -inhaled: "preventors" ex. fluticasone (Flovent), budesonide, beclomethasone -oral: prednisone (relieve swelling), prednisolone, dexamethasone -IV: methylprednisolone 3) Anticholinergics -prevent constriction but not as fast acting ex Ipratropium (Atrovent) 4) Magnesium sulfate "rescuer" -bronchodilator -used in severe/life-threatening exacerbations -immediate effects, given IV 5) Methylzanthines "rescuer" -used primarily in emerg when unresponsive to other tx 6) Mast cell inhibitors "preventor" -cromolyn sodium (intal), nedocromil (tilade) 7) Leukotriene receptor antagonists "preventor" -accolate, singular -more for kids with allergic response

Answer 41

-if using puffer >2x/week = need preventative meds preventor meds stop inflammation -After taking steroids, rinse mouth to prevent thrush -best way to admin is MDI with spacer better than a nebulizer because lots gets wasted