resp part 3 Flashcards
what is asthma
- chronic inflammatory disorder of the airway
- increased airway responsiveness to stimuli
- bronchial constriction
- airway inflammation causes obstruction
whats going on with asthma
- exposure to triggers causes cells in the airway to release proinflammatory chemical mediators (histamine, prostaglandins, and leukotrienes)
- the airways overreact to the triggers and an acute asthma episode occurs
- bronchospasm, inflammation, and mucous production occurs
what are some symptoms associated with asthma
- dypnea and tachypnea
- inspiratory and expiratory wheezing
- use of accessory muscles and retractions
- cough (will be dry and persistent at first, then moist but non productive)
- c/o feelings of discomfort, irritability, restlessness, and anxiety
- chest feeling tight
what retractions are seen in mild distress
subcostal, substernal, intercostal
what retractions are seen in moderate to severe distress
suprasternal and supraclavicular
what are some possible asthmatic triggers
- exercise
- food additives
- emotions
- temp changes
- smoking
- bacteria and viruses
- dust
- environmental
diagnosis of asthma includes…
- symptoms of wheezing or airflow obstruction
- improvement of wheezing and airway obstruction with short acting beta adrenergic and oral corticosteroid meds
- exclusion of an alernative diagnosis
- PFTs (spirometry) assesses airway function (older than 5-6yrs)
- there also classification of asthma severity
describe status asthmaticus
- doesnt respond to normla treatment
- high risk for respiratory failure
what med is given first with asthma exacerbation and decsribe it
beta adrenergic: albuterol
- bronchodilator, soothes smooth muscle
- provides quick relief, onset 5-10min
- given nebulized or MDI
- AE: tachycardia, nervousness, nausea, HA
describe the use of corticosteroids for asthma
- oral or IV
- prednison/prednisolone orally
- methylprednisolone: IV solmedrol
- decreases inflammation to clear up mucus production and obstruction
- most effective long term control therapy
- rinse mouth after use d/t risk for thrush
describe using albuterol in a nebulizer
- med is put in the little clear cup
- tubing is connected to air
- takes about 10min to finish 1 treatment
describe using albuterol with MDI with spacer
- shake vigorously for 30 secs before using
- place mouthpiece in mouth, closing lips around it ot place mask over nose and mouth
- press and release the med one puff, then have child breathe deeply and slowly
- watch for them to take 6 breaths
- wait 30 secs between puffs, allows time for lungs to bronchodilate
whats the purpose of albuterol
relax bronchial smooth muscle
describe using anticholinergics for asthma
- inhibits bronchoconstriction
- short term MDI with exacerbation of asthma
- the onset of action is 30-90 mins
describe using leukotriene receptor antagonist (montelukast) for asthma
- prevents asthmatic episodes
- daily controller med
whats the purpose of leukotriene receptor antagonists
prevent asthmatic episodes
is asthma common in infants and young children?
nope, their wheezing is usually caused by resp infections
usually diagnosed pre-k and school age
whats the plan of care for asthma exacerbations
- all assessments
- oxygen with humidifier
- meds: albuterol and steroids
- IV therapy- hydration/ I+O
- pulse ox
- semi fowlers position
- labwork
- calm attitude
- rest
- group nursing care
- parental and child support and education
whats a pediatric asthma score
- obtained prior to treatment
- standardized asthma score
- objectove assessment of signs and symptoms
- score obtained related to rep rate, oxygen, retractions, dyspnea, and auscultation
- score determines treatment
what should be included in asthma discharge instructions
- asthma action plan
- education essential
- meds
- environmental control
- no smoking
- avoid allergens
- regular health care visit every 1-6mo
describe and asthma action plan
- joint commission standard that every child diagnosed with asthma is discharged with an individualized asthma action plan
green zone: no symptoms
yellow zone: experiencing symptoms and outlines steps to take when to contact HCP
red zone: interventions not working and are experiencing and exacerbation, seek care ED or HCP office
describe exercise induced bronchospasm
- history of coughing, breathlessness, chest pain, or wheezing during and after exercise
- beta adrenergic agents (albuterol) immediately prior to exercise prevents and provides relief for 2-4 hours
what is BPD
- bronchopulmonary dysplasia
- akso known as chronic lung disease
- affects newborns, mostly premature
- need for supplemental oxygen for at least 28days after premature birth
- fewer and larger alveoli with less functional area for gas exchange
- fibrosis of alveoli
- abnormal development of cappillaries in alveolar region
how is the severity of BPD determined
- resp support interventions required at birth and long term (oxygen and vent)
- more premature = loger dependence = persisten inflammation of lungs = bad
what are some clinical manifestations of BPD
- persistent signs of increased resp effort
- tachypnea and duspnea
- retractions
- nsala flaring
- grunting
- irritability
- wheezing/crackles
- pulmonary edema
- failure to thrive
whats the clinical therapy for BPD
- symptomatic treatment that support rep function
- good nutirition which helps accelerate lung maturity
- infants with BPD may ougrow it with lung development or if BPD is severe, they will have chronic lung disease
- treatment focuses on preventing complications and further damage and providing support
describe home care for BPD
- depending on severity of the BPD, the infant may need some or all of the following at home: oxygen, meds, apnea monitor, tube feedings
- oxygen
- multiple meds
- nutirition: high calorie, NG/PO
- home nursing
- early intervention
- emotional support/financial support
- synagis
- BPD clinic every 6mo
- normal activities create increased oxygen demands that are difficult for the infant to meet
- oxygen may be needed with sleeping or wih eating
what med may be used for BPD
- bronchodilators
- corticosteroids: dcrease inflammation
- diuretics: remove excess fluid from lungs if they have pulmonary edema
describe the genetics of cystic fibrosis
- autosomal recessive trait: affected child inherits the defective gene from both parents
- incidence of 1:4
- survival rates: 1966: 12yrs, 2023: mid 40s
- gender is not a factor
- progressive and incurable
describe diagnosing cystic fibrosis
- newborn screening high for immunoreactive trypsinogen (IRT) (available in all 50 states)
- second IRT may be done at 2-3wks
- sweat chloride test by pilocarpine iontophoresis is gold standard for diagnosis (stimulating the production of sweat to collect and measure chloride level)
- genetic testing for adults with positive family history, partners of individuals with CF and couples to identify carriers as prenatal testing
what are some clinical manifestations of cystic fibrosis in the resp system
- secretions very thick
- decreased ciliary action in resp tract
- increased obstruction with mucous
- moist but ineffective cough
- frequent resp infections
- wheezes and crackles
- clubbing of fingers later on with chronic hypoxia
what are some clinical manifestations of cystic fibrosis in the GI system
- foul smelling stools and flatus
- excess stool fat (steatorrhea)
- difficulty maintaining weight
- meconium ileus
- constipation
what body systems does cystic fibrosis effect?
eventually all of em
describe hoe cystic fibrosis effects the pancreas
- thickened mucous damages pancreatic ducts and obstructs enzymes to digest fats, fat soluble vitains, and proteins
- deficiency of ADEK (fat soluble vitamins)
- pancreas becomes damaed and fails to produce adequate insulin
- development of CF related DM
- failure to thrive
- delayed puberty
what kind of diet is everyone with cystic fibrosis on?
high calorie
how does cystic fibrosis effect the female reproductive system
- normal fallopian tubes and ovaries
- feritlity inhbited due to thick cervical secretions and dereased cervical secretions
how does cystic fibrosis effect the male reproductive system
sterile due to blockage or absence of vas deferens
how does cystic fibrosis effect the sweat glands
- skin salty due to high sodium and chloride in the sweat
- excessive oss of elctrolytes in perspiration, saliva, and muscous secretion
- at risk for hyponatremia
describe bronchial hygiene therapy
- performed before meals
- 1-3 times a day
- facilitates removal of secretions from the lungs
chest physiotherapy: for infants and toddlers, percussion and vibration on multiple areas of lung in different positions
therapy vest: for 4 and older, provides high frequency chest wall oscillation
takes about 20-30mins
name and describe the aerosol meds for cystic fibrosis in order per the cystic fibrosis foundation
- bronchodilator
- hypertonic 7% NS: mobilize mucous and improve airway clearance
- dornase alfa (pulmozyme): thins secretions
- bronchial hygiene therapy
- inhaled antibiotics: tobramycin for chronic pseudomonas infection, given every other month twice daily
- inhaled steroid
whats the plan of care for cystic fibrosis
- physical assessment
- oxygen with humidification/pulse ox
- bronchial hygiene therapy: before eating
- sputum culture and sensitivity
- labwork
- IV antibiotics
- Ivacaftor (improves regulation of water and salt)
- ibuprofen (slows rate of pulm decline)
- acid suppression meds (preven reflux)
- nutritional needs
- management of CF related DM
- physical and exercise as tolerated
- contact and droplet isolation: gown, gloves, and mask
- psychosocial and developmental assessment
- discharge planning/CF team
what nutritional suppleentation is essential for cystic fibrosis patients?
will need enzyme supplements prior to any meals or snacks
also will need vitamin ADEK and multivitamin supplements
will two CF patients ever share a room?
nope
