Respiratory Flashcards
What is asthma?
Inflammation/Edema, spasms, and mucus
What are the triggers? 13 of them
anger and stress pet dander pollen and molds exercise cold air strong odors pollution smoke dust chemicals bugs in the home
What are the risk factors for asthma?
Host Factors–
Age– Heredity– Gender– Obesity– Ethnicity
Environmental Factors–
Allergens– Infection– Tobacco Smoke– Indoor/outdoor air pollution– Diet
What are the clinical manifestations of asthma?
Dyspnea, Cough
Expiratory wheezing, Prolonged expiratory phase
Diaphoresis
Anxious expression, restlessness
Setting position
Signs of respiratory distress; nasal flaring, cyanosis, intercostal retractions, coarse rhonchi
Paroxysmal, hacking, & nonproductive cough at onset; becomes rattling and productive of clear sputum
How do we prevent asthma attacks?
avoid triggers - environmental allergens
- air conditioning
- -humidify air 30-50%
What are maintenance drugs for asthma?
cortico steroids- QVAR, Pulmicort, flovent
Long acting beta adrenergic agonists - advair, serevent
Mast cell stabilizers - cromolyn
Leukotriene inhibitors - singulair
What are the rescue medications for asthma
short acting beta 2 adrenergic agonists/bronchodilators - proventil, xopenex, albuterol
What does stop light mean?
monitors FEV compared to personal best
Green light FEV is between 80 - 100%
Yellow light FEV between 79 - 50%
Red light 50 % or below
yellow means monitor more closely, be aware of s/s you may need more medication
Red means you need to use rescue medications and call the provider
What are Nursing Interventions For Asthma Exacerbations?
High Fowler’s Position
O2
Teach child to use diaphragm to pull in and expel air Control Panic
Administer Rescue Drugs
What do we teach parents and children about using an inhaler?
Sit up tall shake the medication exhale completely put mouth to device compress it and inhale deeply, hold for 10 sec.,repeat rinse out your mouth
When should you use a spacer?
When patient lacks dexterity to compress the canister and breath deeply simultaneously, they do not need to hold for 10 second just take 10 good breaths through he spacer
When do you use a face mask?
When the child cannot form a good seal around the mouthpiece of the device
What test Dx CF?
Pilocarpine electrophoresis sweat chloride test result greater than 60 is positive can also test stool for fat DNA of chorionic villi or amniotic fluid prenatally
What does CF do at the cellular level?
It disrupts the normal function of the exocrine glands related to NaCL and fluid balance.
CFTR cystic fibrosis transmembrane protein function is disrupted.
Results in impaired fluid secretion and abnormally thick secretions
Where are the effects to the body?
bronchi - PNE, obs. emphysema
sinuses - chronic infection
small intestines - obstruction in newborns
pancreatic ducts - malabsorption syndrome, DM
bile ducts - portal hypertension
clubbed fingers
Reproductive infertility
What are the recommendations related to the vest?
Wear it twice a day before meals or two hours after meal
What meds do they take?
Oxygen therapy cautiously r/t chronic CO2 retention
Aerosols, nebulizers, Bronchodilators, Mucolytics; Dornase Alfa (Pulmozyme)
Pancreatic enzymes by mouth Fat-soluble vitamins (A, D, E, K) Stool softeners PRN NaCl tablets added to diet in hot weather Oral iron supplements Monitor blood glucose
Chloride channel activators &
Sodium channel blockers
Gene therapy, activation of
mutant CFTR, Protein replacement therapy.
Antibiotic therapy; therapeutic & prophylactic
What is recommended for their diet?
high calorie, high protein and high fat
give pancreatic enzymes in applesauce
too little enzymes causes steatorrhea
What do we need to know about chest physiotherapy?
Aggressive airway clearance (BID) – Percussion • Manual • Positive expiratory pressure (PEP mask) • High frequency chest percussion vest • Airway oscillators like the Flutter device. – Postural drainage – Breathing exercises – Physical exercise
What precautions do you take with bronchiolitis?
Droplet
What URI s/s do older kids get?
Fever Irritability Restlessness Sneezing Vomiting &/or diarrhea
What URI s/s do younger kids get?
Dryness & irritation of nose & throat – Edema & vasodilatation of mucosa – Sneezing – Chilling – Muscular aches – Cough
What can we do for infants under 6 months when they get a cold?
comfort measures and rest watch for respiratory distress watch for dehydration tylenol as needed prevent the spread to others nasal suctioning
What medications can we give older kids?
tylenol or IBU if over age 6 months old
decongestants
cough suppressants with caution
Do we give cough and cold preparations to kids under 3 years old?
No
Should we give antihistamines or expectorants for URI?
No
What are basic nursing interventions for URI?
C-Comfort symptoms
O-Offer fluids
L- Look for complications
D-Decrease disease spread
Is blood tinged sputum after a tonsillectomy ok?
yes
What does excessive swallowing indicate after a tonsillectomy?
bleeding
Other than bleeding, what are we assessing for after a tonsillectomy?
swelling and airway compromise, aka stridor
How long after tonsillectomy does the scab come off?
10 days, monitor for s/s of bleeding then as well, teach parents to watch for it
Nursing considerations after tonsillectomy
Observe for signs and symptoms of excessive bleeding
• Positioning?
• Avoid suctioning if possible-drooling is ok.
• Discourage straws, coughing, laughing, or crying.
• Diet - avoid milk and red dyes
• Swelling and airway compromise
– Watch for stridor
• Comfort Ice Collar
• Cool mist vaporizer
What are the s/s of otitis media?
Ear pain (otalgia) • Infants get irritable • Child holds or pulls at ear • May roll head from side to side • May have fever up to 104 • Ruptured tympanic membrane • If Chronic may lead to hearing loss!
How can OM be prevented?
-breast feed
-sit upright to feed
-no smoking
no bottle in bed
-immunize
-lose the paci
-treat allergies-zyrtec
What is the teaching for myringotomy with pressure equalization (PE) tympanostomy tubes?
No diving, jumping, or prolonged submersion.
– No swimming in lakes, rivers
– Avoid pressure postoperatively
What can you do at home for croup?
AKA viral croup
cool mist, stand in front of freezer
hot shower, damp basement
go outside if it is humid or cool
encourage hydration
tylenol
When do you go to the ER with croup?
when you see s/s of stage 2 Stage II – Continuous stridor – Lower lip retraction – Retraction of soft tissue of the neck – Use of accessory muscle of respiration – Labored breathing
How do you recognize epiglottitis?
Sitting forward and drooling
Abrupt onset, starts with sore throat
– High fever, mouth open, tongue protruding,agitation.
– Looks very sick,
– Sore red inflamed throat, difficulty swallowing
– Muffled voice, inspiratory stridor, No spontaneous cough
What do you do if you suspect epiglottitis?
Keep calm, get the crash cart, and call the provider!
Maintain the airway– NO tongue blades! Don’t look in the throat – Avoid x-ray and transport – Let parents be with child – Prepare for sedation & intubation
What does RSV look like?
Its all about getting the mucus out
Apnea may be first sign in infancy • Rhinorrhea • Pharyngitis • Coughing/sneezing • Wheezing, crackles, decreased breath sounds • Possible eye and ear infection • Intermittent low-grade fever • Difficulty feeding • Irritability
What are the nursing interventions for RSV?
Good I & o’s and airway maintenance
Consistent hand-washing • Encourage parental participation • Supportive care –*** Measures to keep airways open – Saline drops & bulb suction – Increased humidity (mist tent or vaporizer) – Adequate fluid intake (NPO if RR > 60) – Rest – Humidified Oxygen – Antipyretics – Monitor pulse Ox – Monitor hydration & Encourage PO intake of clear fluids
What is pertussis?
whooping cough
How do we treat pertussis?
Treatment; Erythromycin**** • Infants < 6-mos may need ventilator support. • Humidified oxygen • Maintain Hydration • Watch for and prevent pneumonia
