Respiratory Flashcards
What is Respiratory Syncytial Virus (RSV)?
RSV is a highly contagious virus that causes inflammation and obstruction of the lower respiratory tract.
Why is RSV clinically significant in pediatrics?
It is the leading cause of hospitalization in infants under 12 months, especially dangerous for preterm infants and those with chronic lung or heart disease.
What are hallmark clinical manifestations of RSV in infants and young children?
- Nasal congestion, rhinorrhea
- Fever (low-grade)
- Harsh cough, wheezing
- Tachypnea, retractions, nasal flaring
- Apnea (especially in infants <6 weeks)
- Cyanosis, poor feeding
- Irritability, lethargy
What is a key respiratory complication associated with RSV in infants?
Apnea is often the first sign in young infants and can precede other respiratory symptoms.
What diagnostic tests are used to confirm RSV?
- RSV antigen testing via nasopharyngeal swab (ELISA or PCR)
- Pulse oximetry for oxygenation
- Chest X-ray (only if needed)
- CBC may show mild leukocytosis
- ABGs in moderate-to-severe cases
What is the primary management strategy for RSV?
Supportive care including oxygen therapy, suctioning of secretions, hydration, antipyretics, and close respiratory monitoring.
Which medications are used or considered in RSV?
- Ribavirin (aerosolized): Rarely used
- Palivizumab (Synagis): Preventive IM injection for high-risk infants
- Bronchodilators: Not routinely recommended
Who qualifies for Palivizumab prophylaxis?
- Preterm infants <29 weeks gestation
- Infants <12 months with chronic lung disease or hemodynamically significant congenital heart disease
What are nursing priorities when caring for a hospitalized infant with RSV?
- Elevate HOB to promote lung expansion
- Administer humidified oxygen
- Implement contact and droplet precautions
- Educate parents on hand hygiene and RSV transmission
- Monitor for signs of impending respiratory failure
What are high-priority nursing diagnoses for RSV?
- Ineffective airway clearance related to mucus production
- Impaired gas exchange related to bronchiolar obstruction
- Risk for fluid volume deficit due to fever and decreased oral intake
- Anxiety (parental) related to infant’s respiratory distress
What collaborative team members assist in RSV management?
- Pediatrician: Medical management
- Respiratory therapist: Oxygen therapy, suctioning support
- Infection control nurse: Prevention of nosocomial spread
- Social worker: Discharge planning, home care needs
What is bronchiolitis?
Bronchiolitis is an acute viral infection of the lower respiratory tract, affecting the bronchioles, mostly caused by RSV.
What are early clinical signs of bronchiolitis?
- Mild upper respiratory symptoms: nasal congestion, cough, low-grade fever
- Decreased appetite
- Mild respiratory rate elevation
What are severe/progressive clinical manifestations of bronchiolitis?
- Tachypnea >60–70/min
- Intercostal/subcostal retractions, nasal flaring, grunting
- Wheezing, crackles on auscultation
- Apnea (especially in preterm or very young infants)
- Poor feeding, dehydration
- Cyanosis and signs of hypoxia
What diagnostic tools are used in bronchiolitis assessment?
- Clinical presentation is often sufficient
- Pulse oximetry to monitor oxygenation
- RSV swab to confirm viral source
- Chest X-ray if severe
- ABGs in cases of respiratory failure
Is bronchiolitis treated with antibiotics or corticosteroids?
No, antibiotics are not indicated unless secondary bacterial infection is present, and corticosteroids are not routinely recommended.
What are appropriate medications in bronchiolitis?
- Antipyretics for fever
- Nebulized 3% hypertonic saline (inpatient setting)
- Trial of bronchodilators may be attempted but are not consistently effective
When is hospitalization indicated for bronchiolitis?
- Persistent oxygen saturation <90%
- Signs of severe respiratory distress
- Dehydration or inability to feed
- Apnea or cyanosis
- Age <2 months or preterm status with comorbidities
What are high-priority nursing interventions for bronchiolitis?
- Elevate HOB and provide humidified oxygen
- Frequent nasal suctioning
- Encourage small, frequent feeds or use IV fluids
- Monitor respiratory rate, effort, and oxygen saturation
- Implement contact precautions
What are priority nursing diagnoses for bronchiolitis?
- Ineffective breathing pattern
- Impaired gas exchange
- Risk for fluid volume deficit
- Fatigue related to increased respiratory effort
- Parental anxiety
What collaborative therapies are involved in bronchiolitis management?
- Respiratory therapy: Assists with oxygen, suctioning, and aerosol treatments
- Nutrition support: Ensures adequate fluid/caloric intake
- Pediatric provider: Guides diagnostic and treatment decisions
- Case manager/social work: Assists with discharge planning and home resources
What are critical teaching points for parents of a child with bronchiolitis?
- Monitor breathing rate and effort
- Recognize signs of dehydration
- Use bulb syringe/suction for nasal secretions
- Maintain hydration and feeding
- Prevent spread: strict handwashing, limit contact with sick individuals
What is pleural effusion, and what are the main types?
Pleural effusion is the accumulation of fluid in the pleural space.
- Transudative: caused by systemic conditions like heart failure or cirrhosis (low protein content)
- Exudative: caused by inflammation or malignancy (high protein content)
What are the most common causes of transudative pleural effusion?
- Congestive heart failure (left-sided)
- Nephrotic syndrome
- Cirrhosis with ascites
- Hypoalbuminemia
What are common causes of exudative pleural effusion?
- Pneumonia (parapneumonic effusion)
- Tuberculosis
- Pulmonary embolism with infarction
- Malignancy (lung, breast, lymphoma)
- Pancreatitis
What are key clinical signs and symptoms of pleural effusion?
- Diminished breath sounds
- Dullness to percussion
- Dyspnea, orthopnea
- Pleuritic chest pain (worsens on inspiration)
- Decreased tactile fremitus
- Asymmetrical chest expansion
What diagnostic procedures confirm pleural effusion and help identify cause?
- Chest X-ray or CT: shows fluid level
- Ultrasound: guides thoracentesis
- Thoracentesis with pleural fluid analysis (appearance, protein, LDH, pH, cytology, cultures)
- Light’s Criteria: differentiates transudate vs. exudate
What are the priority pharmacologic interventions for pleural effusion?
- Diuretics (e.g., furosemide) for transudative effusions (HF-related)
- Antibiotics for infectious causes (e.g., pneumonia, TB)
- Chemotherapy or intracavitary agents (e.g., bleomycin) for malignant effusions
- Anti-inflammatories or corticosteroids in autoimmune-related effusions
What are potential complications of untreated or rapidly progressing pleural effusion?
- Empyema (infected pleural fluid)
- Pneumothorax post-thoracentesis
- Respiratory failure
- Pleural fibrosis
What are nursing interventions for a patient undergoing thoracentesis?
- Position patient upright, leaning forward
- Monitor for signs of pneumothorax post-procedure (sudden dyspnea, chest pain)
- Apply dressing and monitor for drainage
- Assess breath sounds before and after
High-priority nursing diagnoses for pleural effusion?
- Impaired gas exchange related to compression of lung tissue
- Ineffective breathing pattern related to decreased lung expansion
- Acute pain related to pleural inflammation
- Risk for infection (if secondary to pneumonia or TB)
What collaborative therapies are used in managing pleural effusion?
- Pulmonologist for thoracentesis/chest tube
- Infectious disease (if infectious cause)
- Oncology (for malignant effusion)
- Respiratory therapy for oxygen and incentive spirometry
What is a pulmonary embolism (PE), and how does it impair gas exchange?
A PE is a blockage of pulmonary arterial blood flow, usually from a thrombus. It results in ventilation-perfusion (V/Q) mismatch, decreased oxygenation, and potential right-sided heart strain or failure.
What are major risk factors for PE? (Think Virchow’s Triad)
- Venous stasis: immobility, bedrest, long flights
- Endothelial injury: surgery, trauma, central lines
- Hypercoagulability: pregnancy, estrogen therapy, cancer, thrombophilia (e.g., Factor V Leiden), COVID-19, dehydration
What are classic and atypical symptoms of pulmonary embolism?
- Sudden onset dyspnea
- Pleuritic chest pain
- Tachypnea, tachycardia
- Cough, hemoptysis
- Hypoxia, cyanosis
- Lightheadedness, syncope (massive PE)
- Fever, diaphoresis
- Feeling of doom/anxiety
What diagnostic tests are most specific and sensitive for PE?
- CT pulmonary angiography (CTPA) – gold standard
- V/Q scan – for patients who cannot tolerate contrast
- D-dimer – elevated but nonspecific
- Ultrasound of lower extremities – for DVT source
- ABG – respiratory alkalosis with hypoxemia
What ECG findings might be seen in a patient with PE?
- Sinus tachycardia (most common)
- S1Q3T3 pattern (rare but specific)
- Right bundle branch block
- T-wave inversions (V1–V3)
What pharmacological agents are used to treat or prevent PE?
- Heparin (IV) – immediate anticoagulation
- Enoxaparin (Lovenox) – subcutaneous LMWH
- Warfarin (Coumadin) – long-term anticoagulation (monitor INR 2–3)
- Direct oral anticoagulants (DOACs) – rivaroxaban, apixaban
- Thrombolytics (alteplase, tPA) – for massive or hemodynamically unstable PE
- Oxygen therapy – for hypoxia
- IV fluids and vasopressors – for hypotension
What is the antidote for heparin? For warfarin? For DOACs?
- Heparin: Protamine sulfate
- Warfarin: Vitamin K
- DOACs (e.g., apixaban): Andexanet alfa (if available)
What are signs that a PE is becoming life-threatening?
- Sudden drop in blood pressure
- Worsening hypoxia despite oxygen
- Loss of consciousness
- Silent chest (no breath sounds)
- Right-sided heart failure or shock
What are nursing interventions in acute PE management?
- Maintain airway and apply oxygen
- Keep HOB elevated
- Administer prescribed anticoagulants or thrombolytics
- Monitor for bleeding (gums, stool, urine, bruising)
- Minimize movement to prevent further embolization
- Reassure the patient and remain calm
- Ensure large-bore IV access for emergency meds
What are long-term preventative strategies for PE?
- Lifelong anticoagulation if recurrent
- IVC filter placement (if anticoagulation contraindicated)
- Early ambulation post-op
- Use of compression stockings
- Avoid oral contraceptives in high-risk patients
High-priority nursing diagnoses for PE?
- Impaired gas exchange
- Decreased cardiac output
- Anxiety related to hypoxia
- Risk for bleeding related to anticoagulant therapy
What are the roles of interprofessional collaborators in PE care?
- Cardiologist or pulmonologist: manage PE severity
- Hematologist: monitor and adjust anticoagulation
- Respiratory therapist: manage oxygen therapy
- Pharmacist: dose anticoagulants and monitor drug interactions
- Physical therapist: promote safe mobilization
