Respiratory Flashcards
Differentiate between early and late/severe, signs of respiratory distress/respiratory failure.
Early signs
7
-tachypnea
-tachycardia
-irritability, restlessness
-nasal flaring
-retractions
-Expiratory grunting
-hypertension
Late/severe signs of respiratory distress
-depressed respirations (retain CO2)
-bradycardia
Somnolence (lethargic, drowsy)
-cyanosis
-hypotension
Review Croup (acute laryngotracheobronchitis)
Viral
6 months-6 years of age
Fever,
Pharyngitis,
Coryza prior to onset of croup
Abrupt onset, most commonly at night
Characterized by hoarseness, “barking” cough, inspiratory stridor, fever, and respiratory distress.
Can be life threatening and progress quickly
treatment of croup
Racemic epinephrine nebulizer
oral steroids (reduces laryngeal mucosal edema)
cool mist vaporizer
IV fluids if unable to take fluids due to tachypnea, oxygen if needed.
Oxygen if O2 sat < 92% : Blow-by oxygen most effective.
Review care of the child with a tracheostomy including decannulation and checking/changing of trachea ties.
May be temporary or long term
Emergency care—accidental decannulation
Always have two extra tracheostomy tubes at the bedside: one same size and one smaller
Tracheostomy Ties Snug but Allow Finger to Be Inserted
Change trachea ties with 2 people
Epiglottitis
Occurs in what age?
Bacteria?
What vaccine to prevent?
Inflammation of the epiglottitis
-Occurs predominantly in ages 2-5, but can occur from infancy to adulthood
-Most common cause is the bacteria Haemophilus influenzae type B
-Prevention: Haemophilus influenzae type B vaccine
symptoms of epiglottitis five
-Drooling
-Sore throat
-Stridor
-Tripod position
-Fever
Treatment of epiglottitis
Primary (A-B-C)
-Airway management (intubation) - if possible in the operating room
Secondary
-IV antibiotics
-IV corticosteroids
RSV
Viral
Children at risk for severe illness:
-Premature infants
-Children younger than 2 years old with chronic lung disease or congenital heart disease
-Palivizumab (Synagis) prophylaxis -monthly IM injections during RSV season (Fall-Spring).
-Synagis is not a vaccine
RSV vaccine
What vaccine for pregnant women?
When should they be immunized?
RSV vaccine (Abrysvo) for pregnant women.
Immunization 32-36 weeks gestation.
Antibodies developed against RSV will be passed to the fetus to protect infant for the first 6 months of life.
Diagnostics of RSV
Nasopharyngeal washes or Nasal viral swab
management of RSV
Symptomatic care
Respiratory
monitoring (e.g., O2 sats)
Nasopharnyx suction
Nutrition, hydration
Group A beta hemolytic Streptococci Pharyngitis diagnosis
Group A β-hemolytic streptococci (GABHS)
Diagnostic evaluation-throat culture
Risk for serious consequence if strep A is untreated?
Acute rheumatic fever
Acute glomerulonephritis
Scarlet fever
Treatment of group A strep
antibiotics-take complete course of treatment
Nursing—Post-Op Tonsillectomy
What indicates bleeding?
Airway
-Positioning
Bleeding
-Observation—frequent swallowing may indicate bleeding
-Maintain quiet environment
-Minimize agitation/crying
-NO suctioning
Comfort
asthma patho
- Constriction of smooth muscle around Bronchi
- Inflammation-response by eosinophils, Mast, neutrophils
- Secretions-mucous plugging
Risk factors for asthma
Family History-genetic susceptibility
Allergies (environmental, food)
Exposure to smoke
Frequent respiratory infections (RSV, influenza)
Obesity
clinical manifestations of asthma
4 symptoms
Shortness of breath (dyspnea)
Cough (often worse at night)
Chest tightness
Wheezing
Diagnostic Evaluation of asthma
FEV1 : Forced Expiratory Volume in 1 second
-Decreased value indicates airway obstruction
Peak Expiratory Flow
-Measures how fast air is expelled from the lungs during forceful expiration.
Rescue Drug Therapy for asthma
What quick relief drug is used?
Rescue (Quick Relief) medications
-Short-acting b2-agonists bronchodialators Bronchial constriction
–Albuterol 2.5mg per nebulizer treatment
-Corticosteroids-Inflammation
-Prednisolone (oral)
-Methylprednisolone (Solumedrol) IV
Maintenance Drug Therapy for Asthma
Long-term control meds (Maintenance)
-Inhaled corticosteroids (e.g., Pulmicort),
-long-acting b2-agonists and Inhaled Corticosteroids(e.g., Advair)
-Leukotriene modifiers (e.g., Singulair).
–[Leukotriene modifiers block the action of leukotrienes which cause inflammation associated with allergies].
Discuss the management of Status Asthmaticus.
What Is status asthmaticus?
what are the first lines of treatment?
Asthma unresponsive to repeated courses of beta-agonist therapy. (no air movement.. NOT GOOD)
IV Epinephrine and Corticosteroid (Solu Medrol) first line of treatment.
Cystic firbrosis
What kind of disorder is it?
Cystic fibrosis is an autosomal recessive disease due to mutations in cystic fibrosis transmembrane regulator (CFTR) gene.
If both parents are carriers there is a 1 in 4 (25%) chance of each child having CF.
2000 mutations in CFTR gene
CF occurs across the world and in people of all races and ethnicities. 95% known cases occur in White people. (African American, Hispanic, and others may be affected).
Chronic
Progressive
PATHO of cystic fibrosis
What gene?
Impaired secretion of what?
Abnormal what?
will have what?
CFTR gene
impaired secretion of chloride
abnormal thick mucous (will have clubbing of nails)
symptoms of respiratory system for cystic fibrosis what is heard upon auscultation?
Fever, increased coughing and shortness of breath, increased mucus production, and loss of appetite. Crackles at bases on auscultation.
treatment for cystic fibrosis
(respiratory)
Antibiotics (Tobramycin) aerosolized is the main treatment for Pseudomonas aeruginosa
Gastrointestinal system
cystic fibrosis
pancreas?
what does stool look like?
what is cf diabetes?
Pancreas- obstruction of pancreatic ducts -pancreatic enzymes blocked- malabsorption of proteins and fats.
Failure to Thrive- poor weight gain, poor growth
Large, loose, greasy, foul-smelling stools-(malabsorption of fat)
Cystic Fibrosis Diabetes - inflammation and scarring of pancreas - insulin
CF Presentation
earliest sign?
children taste what?
One of the earliest signs of CF is the
development of a Meconium ileus in a newborn (Meconium is the first stool passed by a newborn and should occur in the first 24 hours of birth) bowel obstruction due to thick meconium stool).
Parents report children taste “salty”
Diagnostic Evaluation cystic firbrosis
what kind of test?
result?
gentetic dna test?
Sweat chloride test-Gold Standard
-Chloride greater than 60 mmol/L is diagnostic for CF.
Genetic (DNA) testing: Positive for CFTR gene mutation.
