Respiratory Flashcards
ASTHMA patho, cause, s/s, nursing management
patho: inflammation of airway -> obstruction -> decreased gas exchange
Cause: genetic, environmental (pollution, allergens)
s/s: wheezing, fatigue, DOB/SOB, anxiety, tight chest, cough (moist, rattling). cyanosis
nursing management:
- Assess respiratory status
- Administer charted oxygen or nebuliser
- Position patient for max. vent and airway patency
- Administer meds (steroids, bronchodilators)
- Suction airway if needed
- Comfort measures
- Reassure child and family
ASTHMA prevention strategies/ improving outcomes
- Smoke exposure
- Housing
- Income
- Health literacy
- Adherence
- Asthma action plan
- Access
- Ambulance
- Influenza vaccine
- Reletionships
ASTHMA medication
- Short-acting beta agonist (SABA)
- all children with asthma
- bronchodilators; quick relief of symptoms
a. salbutamol
b. terbutaline
- Inhaled corticosteroids (ICS)
- suppress airway inflammation by activation or repression of target genes involved in inflammatory process
a. Beclomethasone diproprionate- low 200; Std 400-500
b. Beclomethasone dipropionate ultrafine- low 100; std 200
c. Budesonide- low 200; std 400
d. Fluticasone propionate- low 100; std 200-500
- Montelokast
-CysLT1 receptor antagonist and acts to reduce bronchoconstriction and mucous secretion in response to allergens.
- for poorly controlled LABA/ICS
- dosing: 4mg under 5yo and 5mg over 5yo. - Long-acting beta agonists + inhaled corticosteroids (LABA/ICS)
- maintenance with SABA as reliever 5-11yo.
- contraindicated: under 4yo - Anti-inflammatory reliever therapy (AIRs)
- using budesonide/formoterol as monotherapy or with regular budesonide/formeterol.
PNEUMONIA
DEFINE:
- inflammation and build up of fluid in the lower respiratory tract affecting alveoli
CAUSES: viral, bacterial, fungal
DIAGNOSTIC:
- Bronchiocospy
- Chest xray
- sputum culture
S/S:
- lung sound (crackles)
- SOB
- increased WOB
- fever
- coughing
- loss of appetite
- lethargy
TREATMENT:
- meds: antiviral, antibiotic, antifungal
CYSTIC FIBROSIS
define: an autosomal recessive gene disorder that damages your lungs, digestive tract and other organs.
effect on organs:
1. intestine
Mucus block duct tube transporting enzymes out of pancreas to small intestine => decreased food digestion, nutrient absorption; difficulty gaining weight and malnutrition. Also decreased insulin production and inflammation of pancreas
- Mucus blocks bile duct => scar tissue and damage to liver => poor liver function
- Bacteria thrives in airways => repeated bacterial chest infections
s/s: repeated chest infection
management:
NO CURE BUT
1. devices, massage and techniques to move mucus and unblock airways (e.g. nebuliser)
2. antibiotics
3. anti-inflammatory meds (e.g. prednisone)
4. meds for facilitation of digestion and increase vitamin absorption
5. vitamin supplements
6. chest physio/chest percussion
TENSION PNEUMOTHORAX
Define: a life-threatening emergency wherein a large air collection in the pleural space compromises respiration and cardiac function
Patho:
=> air enters pleural space
=> tension pneumothorax: air cant leave
=> pressure on lung, trachea, heart and other structures
Causes:
A. Spontaneous/simple: without underlying lung disease (primary) or with underlying lung disease (secondary)
B. Traumatic
s/s:
- SOB
- Acute chest pain
- Low BP
- Low SPO2
- High HR
Treatment: needle decompression, fowler, oxygen, 3-sided semi-occlusion dx
TUBERCULOSIS treatment, tests, issues
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs but can spread to other organs.
test:
- tuberculin skin test
- TB blood test
s/s:
- a cough lasting 3 weeks or more
- coughing up thick mucus or blood
- tiredness
- night sweats
- loss of appetite
- weight loss
- swollen glands, usually in your neck
- chest pain.
complication:
- meningitis
- major bleeding (haemorrhage) from the lungs or other organs
- widespread tuberculosis
nodules (disseminated tuberculosis)
death.
- renal, joint infection, pericarditis
treatment: antibiotics (combination) for 6 months
Oxygenation- masks, use etc
- Nasal cannula:
- 1-6L/min.
- 24-40% - simple face mask:
- 5-10L/min
- 40-60% - partial rebreather mask:
- 6-10L/min
- 60-80% - non-breather mask:
- 10-15L/min
- up to 95% - venturi mask:
- interchangeable adapters to adjust flow
COPD
Define:
Umbrella term for complications associated decreases airflow in the lungs
Two types: Emphysema and bronchitis
Causes:
- Smoking
- Exposure to environment irritants
- Decrease in or anti-trypsin (emphysema)
S+S: coughing (productive), SOBUE, wheezing, tight chest, accessory muscle breathing, pursed lips, barrel chest, cyanosis, nostril flaring
Diagnosis
* Symptoms
* History of exposure to irritants
* Lung function test (spirometry- measures speed and airflow)
Treatments:
* Stop smoking and/or improve air quality
* Medication:
○ Bronchodilators: beta 2 agonists (salbutamol), anticholinergics (ipratropium), theophylline
○ Steroids
* Vaccination: flu, pneumonia
* Oxygen therapy
* Pulmonary rehabilitation
* Surgery: bullectomy, lung reduction, transplant
COPD- EMPHYSEMA
Definition: inflammation in alveoli.
=> Breakdown of alveolar walls and elastin leading
=> enlargement of the alveolar air spaces
=> hyperinflation and decreased gas exchange
Cause of Chronic inflammation in alveoli:
1. Increased oxidative stress
2. Increased proteases
= tissue breakdown (alveolar walls pulm. capillary walls, elastic fibres)
Enlarged air spaces result to:
1. Air retention -> hyperinflation -> affects on thoracic cavity and changes in lung volumes (increased lung capacity and residual volumes) -> increased work of breathing
2. Decreased Alveolar surface area -> decreased gas exchange -> decreased O2 in tissue (hypoxia) and increased CO2 in tissue (hypercapnia) -> acidosis and pulmonary hypertension -> respiratory failure
s/s:
- barrel chest
- use of accessory muscles
- cyanosis (from metabolic acidosis)
- respiratory acidosis
- risk of infection
management:
1. beta antagonist
- anticholinergic
- corticosteroids
- oxygen therapy
COPD- BRONCHITIS
Definition: inflammation in bronchioles/bronchi
Complication:
- Bronchial swelling/oedema
- Increased mucous production
- Impaired cilia function
narrowed airway + thick mucus
= increase airway resistance
= reduced ventilation
= increased infection susceptibility
S/S:
- productive cough for >3/12 months in 2 years
