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N342 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are characteristics specific to children?

A
  • Infants 4-6 weeks are obligate nose breathers
  • Tongue is larger in proportion to the mouth
  • Smaller lung capacity
  • Higher respiratory rates and demands for O2
  • Airway is smaller at the cricoid
  • Smaller, narrower airway (airway obstruction)
  • Children rely on diaphragm for breathing
  • Lack of firm body structure makes child more prone to retractions in resp distress
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2
Q

What shows respiratory distress?

A
  • CREBS
  • Loss of ability to speak
  • Grunting
  • Tripod position
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3
Q

What is CREBS?

A

cough, rate/regularity, effort, breathing sounds, saturation

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4
Q

Assessment focuses with respiratory distress

A

Position of comfort?
Vital signs
Lung auscultation (bilateral, diminished, absent?, adventitious sounds?)
Respiratory Effort (stridor, grunting, laboured, accessory muscles, tachypnea, paradoxical)
Colour
Cough (dry, wet, brassy, croupy)
Behavioural change
Family history

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5
Q

Respiratory failure

A

after respiratory distress, it is when they can no longer maintain effective gas exchange (function or structural failure) EARLY RECOGNITION

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6
Q

Signs of respiratory failure

A
  1. Cardinal signs (restlessness, tachypnea, tachycardia, diaphoresis)
  2. Early decompensation (mood changes, nasal flaring, headache, CNS symptoms, retractions, grunting, wheezing, increased WOB, head bobbing)
  3. Severe hypoxia (hypotension, decreased RR, dyspnea, bradycardia, cyanosis, seesaw respirations)
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7
Q

Alveolar hypoventilation

A

O2 need exceeds O2 intake, airway partially occluded, transfer of O2 and CO2 in alveoli is disrupted

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8
Q

Head bobbing

A

sign of resp distress, using neck muscles (scalene and sternocleidomastoid muscles) to help with ventilation and since the muscles in the neck are not very strong compared to the other muscles, the head starts bobbing.

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9
Q

Seesaw respirations

A

really strong contraction of the diaphragm where is dominates the weaker abdominal chest muscles. Retraction of the chest and expansion of the abdomen

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10
Q

What does O2 sats read?

A

how much hemoglobin (carrier of oxygen) is attached to the RBCs. Indirect measurement

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11
Q

How to read a hemoglobin curve

A

Look at the whole picture. Are they working at breathing and their O2 sat is high? Do they have alkalosis or acidosis?

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12
Q

What is PaO2?

A

the pressure of the oxygen as it diffuses across the alveolocapillary membrane and dissolves in the plasma. It helps bind the oxygen to the hemoglobin molecules and then transported to the cells

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13
Q

What is PCO2

A

carbon dioxide produced by cellular metabolism is dissolved in the plasma. It travels back to the lungs where it diffuses across the alveolocapillary membrane

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14
Q

Hemoglobin curve shift to L

A

increased pH
decreased temp
decreased PCO2

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15
Q

Hemoglobin shift to R

A

decreased pH
increased temp
increased PCO
2,3 DPG

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16
Q

What are the upper respiratory tract infections?

A
  • Acute Streptococcal Pharyngitis
  • Tonsilitis
  • Croup Syndromes
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17
Q

What are the types of croup syndromes?

A

o Laryngotracheobronchitis
o Epiglottitis
o Bacterial tracheitis

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18
Q

What is acute streptococcal pharyngitis?

A

infection primarily affects the pharynx including the tonsils
most common in children 4-7

abrupt onset, lasts 3-5 days
tonsils and pharynx inflamed and covered with exudate

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19
Q

What is another name for acute streptococcal pharyngitis?

A

Strep throat

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20
Q

What are you at risk for with acute streptococcal pharyngitis?

A

Rheumatic fever (pain in joints, heart)
Acute glomerulonephritis (in kidneys)

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21
Q

Why do you get rheumatic fever with acute streptococcal pharyngitis

A

when you do not finish antibiotics

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22
Q

Tx of acute streptococcal pharyngitis

A

penicillin

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23
Q

Nursing care with acute streptococcal pharyngitis

A

cold or warm compresses, warm saline gargles, soft diet

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24
Q

Symptoms of Acute Streptococcal Pharyngitis

A

o Sore throat
o Minimal throat redness and pain
o Exudate
o Purulent drainage and white patches
o Difficulty swallowing, drooling, dehydration, resp distress

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25
Q

Tonsilitis

A

inflammation of palate tonsils

Infection of pharyngitis does not equal tonsilitis infection even though they both have inflammation of the tonsils

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26
Q

What can tonsilitis cause?

A

If adenoids enlarged: mouth breathing; Mouth odour, impaired taste & smell; Muffled & nasal voice; Persistent cough; otitis media or hearing difficulties

Hearing loss

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27
Q

Tonsilitis dx

A

Acute pain (inflammation of the pharynx)
Deficient fluid volume (inadequate intake)
Ineffective breathing patterns (obstruction by enlarged tonsils)
Impaired swallowing (inflammation and pain)
Knowledge deficit (parents)

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28
Q

Nursing care with tonsilitis

A

Soft to liquid diet
Cool-mist vaporizer
Warm saltwater gargles
Throat lozenges
Analgesic-antipyretic drugs
Post op
- position to facilitate drainage
- careful suctioning PRN
- discourage coughing, clearing throat, blowing nose
- regular analgesia for 24-48 hours
- NPO until able to swallow and no signs of hemorrhage
- observe for hemorrhage

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29
Q

Can you give codeine or aspirin to children?

A

NO
Codeine is converted to morphine and since metabolism is unpredictable in children, it can cause problems
Aspirin can cause Reye’s syndrome

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30
Q

How can we observe for hemorrhage

A

Direct observation, tachycardia, pallor, frequent clearing of throat or swallowing, vomiting or secretions with bright red blood

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31
Q

Croup syndromes

A

broad classification of upper airway illnesses that result from the inflammation and swelling of the epiglottis and larynx, usually extends to the trachea and bronchi

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32
Q

Bacterial croup

A

bacterial tracheitis & epiglottitis

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33
Q

Viral croup

A

spasmodic laryngitis & laryngotracheobronchitis (LTB)

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34
Q

Is bacterial or viral croup worse?

A

Bacterial

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35
Q

What are the airway changes in croup?

A

epiglottis swells occluding airway, trachea swells against cricoid cartilage resulting in restriction

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36
Q

What are the symptoms of croup?

A

o Hoarseness
o Seal-like “barking” or “brassy” cough
o Inspiratory stridor
o Varying degrees of respiratory distress

37
Q

Mild croup

A

Occasional barking cough, no stridor at rest, no retractions

38
Q

Moderate croup

A

Frequent barking cough, audible stridor at rest, no agitation or distress, no cyanosis

39
Q

Severe croup

A

Frequent barking cough, prominent inspiratory stridor, tachypnea, marked retractions, agitation &/or distress, no cyanosis, may be lethargic

40
Q

Impending resp failure with croup

A

Barking cough & stridor at rest less prominent, retractions may be less apparent, lethargy or decreased LOC, cyanosis

41
Q

What to do when there is impeding resp failure?

A

Dexamethasone
Epinephrine

42
Q

Acute Laryngotracheobronchitis (LTB)

A

Can be viral and bacterial

43
Q

Clinical manifestations of Acute Laryngotracheobronchitis (LTB)

A

URI for several days; progresses to cough & hoarseness; low-grade fever; tachypnea, inspiratory stridor; barking cough, hoarseness
Children < 5 years
Boys > girls

44
Q

Tx of Acute Laryngotracheobronchitis (LTB)

A

o Humidification, cool mist
o Medications
- Epinephrine
- Corticosteroids (dexamethasone)
o Encourage fluids; comfort measures
o Supplemental O2; oximetry
o Rest, parental reassurance

45
Q

Acute Spasmodic Laryngitis

A
  • Spasmodic croup, “midnight” croup
  • Paroxysmal attacks of laryngeal obstruction that occur chiefly at night
  • Signs of inflammation are absent or mild
46
Q

Acute Spasmodic Laryngitis management

A

managed at home with cool mist

47
Q

Acute Epiglottitis (Supraglottitis) **

A
  • Potentially life-threatening – requires immediate attention
  • Sudden onset of illness with high fever (>39)
48
Q

What are the classic signs of Acute Epiglottitis (Supraglottitis)

A

Dysphonia, Dysphagia, Drooling, Distressed respiratory effort (tripod position)

49
Q

Acute Epiglottitis (Supraglottitis) management

A

Lateral neck x ray
Intubate - Do not inspect mouth & throat unless prepared to intubate!!!
quiet environment; try to minimize crying!!; fluids, emotional support, droplet isolation for 24h after initiation of effective antibiotic therapy

antibiotics, O2, antipyretics for fever & sore throat

50
Q

What is the difference between other strands of croup and Acute Epiglottitis (Supraglottitis)?

A

swelling continues after med tx

51
Q

Bacterial Tracheitis

A

Serious cause of airway obstruction with features of LTB and epiglottitis

Croupy cough & stridor; High fever (>39) for several days; thick, purulent secretions

52
Q

Bronchitis

A

inflammation of the large lower airways (trachea and bronchi)
Dry, hacking, non-productive cough; worse at night; becomes productive in 2-3 days

53
Q

Bronchiolitis (RSV)

A

lower respiratory tract illness that occurs when an infecting agent causes inflammation and obstruction of the bronchioles

54
Q

Patho of RSV

A

Virus invades mucosal cells lining bronchioles; infected cell membranes fuse to form giant cell with multiple nuclei - creates “syncytia” at cellular level; invaded cells die when virus bursts from inside cell to invade adjacent cells
Cell debris clogs & obstructs bronchioles & irritates airway; airway lining swells & produces excessive mucous; results in partial airway obstruction & bronchospasms - air can move in but not out - wheezes & crackles, air trapping

55
Q

What is the initial signs of RSV

A

Initially ill with URI (nasal stuffiness, +/- cough); progresses to deeper & more frequent cough; more stressful, laboured breathing

56
Q

S&S of RSV

A

Fever <390 C
Rapid RR, shallow, nasal flaring, retractions
Appear sick, less playful, not eating
Infants may spit up with thick, clear mucous
Air trapping: Bronchioles constrict, alveoli enlarge, makes it harder for CO2 to leave the body, PH goes up, PaCO2 goes down

57
Q

What age is RSV most severe?

A

under 6 months

58
Q

Highest risk groups with RSV

A

Premature birth (Absence of maternal antibodies, smaller airways)
Bronchopulmonary Dysplasia (BPD) - Bronchial hyper-responsivesness, Reduced lung capacity
Cardiac Disease (Pulmonary vascular hyper-responsiveness, Increased pulmonary blood flow)
Neuromuscular disease( Decreased respiratory muscle strength & endurance
Immune Deficiency (Decreased host defences, impaired capacity to eliminate virus)

59
Q

Diagnosis of RSV

A

Chest X-ray – not recommended unless severity suggests alternative disorder
May be difficult to distinguish between RSV & asthma
Nasopharyngeal Wash (NPW) or Nasopharyngeal Swab (FLOQ Swab)
RSV antigen detection + other viral infections (e.g. COVID-19, rhinovirus, influenza, enterovirus)

60
Q

Guidelines for admission for RSV (CPS)

A

Signs of severe respiratory distress - e.g. indrawing, grunting, RR > 60/min.
Supplemental O2 to keep sats > 90%
Dehydration or history of poor fluid intake
Cyanosis or history of apnea
Infant at high risk for severe disease - Infants born prematurely (<35 weeks gestation), <3 months old, hemodynamically significant cardiopulmonary disease, immunodeficiency
Family unable to cope

61
Q

What therapies work with RSV

A

oxygen and hydration

62
Q

What is not recommended with RSV

A

Ventolin (Salbutamol)
Corticosteroids
Antibiotics
Antivirals
3% hypertonic saline nebulization
Chest physiotherapy
Cool mist therapies or aerosol therapy with saline aerosol

63
Q

What age group can be given synagis?

A

child has to be 2 or younger

64
Q

Criteria for discharge for RSV

A

Tachypnea & work of breathing improved
Maintain O2 sats >90% without supplemental O2 OR stable for home oxygen therapy
Adequate oral feeding
Education provided and appropriate follow-up arranged

65
Q

Pneumonia

A

inflammation or infection of the bronchioles and alveolar spaces of the lungs

Follows an upper respiratory tract infection with inhalation of organisms in the nasopharynx or organisms spread to the lung tissue

66
Q

Asthma

A

a chronic disorder in children characterized by bronchial constriction/obstruction, hyperresponsive airways, airway inflammation and reoccurring symptoms

67
Q

Asthma patho

A

Initial release of inflammatory mediators from bronchial mast cells, macrophages, & epithelial cells
Migration & activation of other inflammatory cells
Alterations in epithelial integrity & autonomic neural control of airway tone
Increase in airway smooth muscle responsiveness - wheezing, dyspnea, & eventual obstruction

68
Q

Obstruction symptoms (asthma)

A

Inflammation & edema of mucous membranes
Accumulation of tenacious secretions from mucous glands
Spasm of smooth muscle of bronchi & bronchioles - decreases caliber of bronchioles

69
Q

Immunologic factors (asthma)

A

Allergy is strongest epidemiologic risk factor for chronic asthma morbidity & mortality

  • IgE is most active antibody in allergic reactions
  • release of chemical mediators (histamine, leukotrienes, platelet-activating factor, prostaglandins, serotonin)
70
Q

What does IgE do?

A

Mediates hypersensitive reaction in bronchial mucosa - specific tissue binding

71
Q

Major effect of chemical mediators

A

o Increased permeability of blood vessels
o Contraction of smooth muscle
o Stimulation of mucous secretion

72
Q

Vagal stimulation (asthma)

A

Balance of vagal (constrict) & sympathetic (opens) nerve influences maintenance of tone of bronchial smooth muscle

causing…

Irritant receptors react to triggers & stimulate reflex bronchospasm - normal response but in asthma this is abnormally severe

73
Q

Ventilation (asthma)

A

Increased airway resistance - forced expiration - air trapping

74
Q

Gas exchange (asthma)

A

Depends on ratio of poorly ventilated & hyperextended alveoli to well-ventilated alveoli

As severity of obstruction increases - reduced alveolar ventilation.

75
Q

Signs of reduced alveolar ventilation (asthma)

A
  • CO2 retention
  • Hypoxemia
  • Respiratory acidosis
  • Respiratory failure
76
Q

Asthma exacerbation

A

Episodes of progressively worsening SOB, cough, wheezing, chest tightness
Decreases in expiratory airflow
* Airways narrow because of bronchospasm, mucosal edema, & mucous plugging - air trapped behind narrowed airways
Hyperinflation - keeps airways open & permits gas exchange
Hypoxemia - ventilation/perfusion mismatch

77
Q

Two types of asthma

A

Recurrent wheezing in early childhood; usually precipitated by viral infection (e.g. RSV)
Chronic asthma associated with allergy persisting into later childhood & often adulthood

78
Q

Steps of asthma

A
  1. intermittent asthma - symptoms less or equal 2 days/week
  2. mild persistent asthma - symptoms > 2 times/week, but < than once/day
    3/4. Moderate Persistent asthma - daily
    5/6. severe persistent asthma - several times a day
79
Q

Risk factors of asthma

A

Atopy (including hx of allergies or atopic dermatitis)
Heredity (e.g. parent/sibling)
Gender (boys > girls until adolescence then girls > boys)
Smoking or exposure to second-hand smoke
Maternal smoking during pregnancy
Ethnicity (African-American at greatest risk)
Low birthweight
Being overweight

80
Q

Asthma triggers

A

Allergens
Occupational chemicals
Physical exercise
Cold air
Weather or temperature changes
Environmental change
Colds & infections - viral or bacterial
Animals
Medications
Strong emotion
Conditions
Foods
Endocrine factors

81
Q

Manifestations of Asthma

A

Classic: Dyspnea, wheezing, & coughing
Prodromal itching (frontal neck or upper part of back)
Mood changes - feeling uncomfortable or irritable & increasingly restless
Headache, feeling tired, or chest feels “tight”
Breathing Changes - wheezing
Hacking, paroxysmal, irritative & non-productive cough which becomes productive as secretions accumulate
Coughing in absence of respiratory infection, esp. at night (interferes with sleep)

82
Q

What does it look like when asthma is getting worse?

A

SOB, prolonged expiratory phase, audible wheezing, - RR & HR, shallow breathing
Pale - cyanosis
Restless & apprehensive - anxious facial expression; irritability
Listlessness
Sweating
Position
Voice changes – short, panting, broken phrases
Retractions

83
Q

Asthma complications

A

o Increased susceptibility to infections
o Atelectasis
o Emphysema
o Pneumothorax (rare)
o Status asthmaticus (rare)

84
Q

Detailed history with asthma

A

Current symptoms - medications, triggers
History of attacks - seasonal, with colds, (hospitalization, intubated?)
Family History - asthma or allergies
Paint the picture (Compare attacks, look at differences)

85
Q

Therapeutic management of asthma

A

Allergen control (House dust mites, cockroach)
Drug therapy
Breathing exercises & physical training
Hypo-sensitization
Exercise

86
Q

Supportive care with asthma

A

Maintain patent airway - humidified O2; positioning (raise head of bed; sit up)
Rest & stress reduction - Group care; quiet environment
Fluids - warm, may need IV
Medications
Avoidance of triggers
Reassurance - child and family
Discharge planning & teaching

87
Q

Peek Expiratory Flow Meter (asthma)

A

Green = 80-100% - relatively free of symptoms
Yellow = 50-80% - Caution - worsening asthma
Red = Less than 50% - Danger - treatment not controlling symptoms

88
Q

Medications for asthma

A

Corticosteroids – anti-inflammatories
- inhaled - “preventors”
- oral
- IV
Beta2 agonists - “rescuers or relievers”
- salbutamol

OTHER MEDS MUST HAVE

Magnesium sulphate - “rescuer”
Methylxannthines
Mast cell inhibitors - “preventors”
Leukotriene receptor antagonists “preventors”

N342 (7 decks)

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