respiratory concerns Flashcards
what are the anatomical and physical differences in the airways of infants?
- infant is 4mm in diameter (5x less than the size of an adults)
- during first 5 years airway increases in length but not diameter
- infants are obligate nose breathers until 4 weeks of age
- bronchioles are fewer in number and don’t increase until about 8 years of age
- infants have a higher metabolic rate which uses more oxygen
what is a major way that uncontrolled asthma can disrupt normal development?
causing a child to miss school
what is asthma
- a chronic inflammatory disease of the lungs that makes it difficult to breath
- cannot be cured but can be managed
- inflammation of the airway occurs and an increase in mucus production
- constriction of bronchial smooth muscle causes spasm
what age does asthma generally develop prior to?
the age of 6
can develop at any time, but before 6 is most common
can children grow out of asthma?
-yes, but it may reappear in adulthood
what are complications associated with late diagnosis?
lots of missed school
missing out on normal activities
higher rates of obesity
what are symptoms of asthma?
- frequent episodes of breathlessness
- chest tightness
- wheezing
- coughing
- symptoms worse at night and in early morning
- symptoms improve with bronchodilators or corticosteroids
- symptoms develop with respiratory tract infection, after exercise, when exposed to allergens or irritants, after playing/laughing
- in infants, frequent respiratory infections
what is the operational diagnostic criteria for 1-5 year olds?
recurrent asthma-like symptoms or exacerbations with documentation of:
- airflow obstruction
- reversibility of airflow obstruction
- no clinical evidence of an alternative diagnosis
recurrent asthma-like symptoms or exacerbations with documentation of:
- airflow obstruction
- reversibility of airflow obstruction
- no clinical evidence of an alternative diagnosis
- family history of allergy or allergic disorders
- passive smoke exposure
- indoor air contaminants
- outdoor air pollutants
- recurrent viral infections
- low birth weight and respiratory distress syndrome
- obesity
what are the two factors that provoke asthma?
- triggers (cause tightening of airways // bronchoconstriction)
- inducers (cause inflammation of airways)
what are asthma triggers?
- things that when someone with asthma are exposed to, leads to exacerbation
- they DO NOT cause inflammation and therefore don’t cause asthma
what are some asthma triggers?
Indoor Air Trigger Strong fumes Scents Dust Mold Emotional upsets Smoke, 2nd and 3rd hand Cold Pets – often people will be told to get rid of pet, but this can cause emotional stress
Additional Triggers
Exercise
Aggravating conditions: rhinitis, GERD
o Post nasal drip can trigger coughing and drainage can settle into bronchioles
o May be more susceptible to pneumonia developing quickly
Menstrual cycle
what are asthma inducers?
- they are things that cause inflammation and airway hyper-responsiveness
- things like allergens and respiratory viral infections
what is meant by persistent asthma?
-symptoms that occur at least twice a week during the day and twice a month during the night
For children 6 years and older what are common medications for asthma?
for intermittent: short acting beta-agonist (bronchodilator)
for persistent: low dose inhaled corticosteroid and a long acting beta-agonist if needed
in more serious cases may introduce leukotriene receptor and systemic corticosteroid
for children between 1 and 5, what are common medications for asthma?
for mild exacerbations: short acting beta-agonists
for moderate to severe exacerbations: a short acting beta-agonist and a corticosteroid
why use a spacer for inhalers?
- to make it easier for someone to take in the dose (hard to do if you have small lungs or impaired capacity so spacer hold the dose while you take it in over a few breaths)
- less coordination is required
- oropharyngeal deposition is decreased
- more drug is deposited in lungs!
what is ventolin?
a bronchodilator used for prevention and relief of bronchospasm in those with asthma
why are inhaled medications used for asthma and generally prefered over oral?
- have a rapid onset of action
- less drug can be used
- often better tolerated with less side effects
- useful for acute symptoms treatment
- if someone is having trouble breathing, swallowing is probably really difficult
what is RSV
respiratory syncytial virus
- most common cause of lower respiratory tract infection in children worldwide
- virtually all children have had it by age of 3
- leading cause of pneumonia and bronchiolitis in infants
- may play a role in pathogenesis of asthma
what is para influenza?
- causes many pediatric respiratory infections, including upper respiratory tract infections, croup (laryngotracheobronchitis), bronchiolitis, pneumonia
- this virus is the major cause of croup
- virus that colonizes nose and nasopharynx then invades epithelium causing cell damage, edema, and loss of cilia
- fibrinous exudate develops with downward spread of cell damage and edema causing airway obstruction and laryngeal muscle spasm
what are symptoms of para influenza?
- low-grade fever
- nasal congestion
- sneezing
- sore throat
- cough (barking)
- inspiratory stridor
what is hemophilus influenza b?
- a bacterial infection that affects several body tissues and organs
- can cause meningitis and severe throat and/or lung infections
- 1 in 20 children who get it will die and 20-50% will suffer deafness and/or permanent brain damage
what are symptoms of hemophilus influenza b?
- meningitis
- fever
- stiff neck
- drowsiness
- extreme irritability
- sudden vomiting
- symptoms at a site of infection (can be skin or joint for example)
how can hemophilus influenza b be prevented?
vaccination
what is pertussis?
- a highly contagious bacterial infection
- affects respiratory system and produces coughing spasms that usually end in a high-pitched sounding deep inspiration (which is why it is called whooping cough)
- causes very thick sputum
how is pertussis diagnosed?
- a culture of secretions from mouth and nose
- a throat swab culture
- a CBC (usually elevated WBC and large number of lymphocytes)
- serologic (blood) test for Bordetella pertussis
- immunological tests
how can pertussis be prevented?
-vaccination
how is pertussis treated?
- if diagnosed very early, erythromycin may be used, but usually patients are only diagnosed after period of time when this would be effective
- oxygen tent with high humidity
- IV fluid
- suctioning of secretions
should cough suppressants be used in those with pertussis?
NO! cough suppressants can cause airway obstructions as secretions build
-secretions are often very thick and young patients may even need NG tube feeding because of how much it can impair swallowing
what is prevnar pneumococcal conjugate
- a bacterial infection spread by nasal droplets
- it is the leading cause of pneumonia and acute middle ear infections as well as childhood meningitis
- approximately 15 children under the age of 5 die in Canada each year because of this disease
what is the difference between active and passive immunization?
active is immunization with the bacteria/virus (even an inactivated form) that triggers an immune response
passive is protection against certain infections that is created by administration of antibodies derived from humans or animals
what is immune globulin?
- it is obtained from human plasma
- contains mainly IgG and small amounts of IgA and IgM
- contains antibodies that protect from disease
what are the two components of asthma?
- inflammation of the airways (accompanied by increase in mucous and increase in responsiveness to stimuli)
- constriction of bronchial smooth muscle that leads to spasm
what is the prevalence of asthma in Canada?
11-16% of Canadian Children
in Saskatchewan, approximately how many children have asthma?
- 3500
- works out to about 2 per classroom
what are risk factors for a child developing asthma?
- family history of allergy or allergic disorders
- passive smoke exposure
- indoor air contaminants (pet dander, mites…)
- outdoor air pollutants
- recurrent viral infections
- low birth weight and respiratory distress syndrome
- obesity
what can cause asthma?
- environmental exposure
- viral illnesses
- allergens
- genetic predisposition
*most influential at crucial time in development of immune system
can where someone lives decrease their risk of asthma?
-living in rural areas vs urban decreases risk for developing
what factors related to cigarette smoke can increase the risk of a child having physician diagnosed asthma?
- having a mother who smoked
- growing up in a smoky house
- having a grandmothers who smoked
- maternal smoking during childbearing years increases risk for asthma diagnosis and decreased lung function in child
What is third hand smoke?
- smoke left on hair, skin, fabric, carpet, furniture, walls
- babies can take 20 times more third hand smoke than adults
is smoking a trigger for asthma?
yes- both first hand, second hand, and third hand!
especially in children
what are some indoor air triggers for asthma?
- strong fumes
- scents
- dust
- mold
- emotional upset
- smoke (1st, 2nd & 3rd hand)
- cold
- pets
what are some additional triggers for asthma?
- exercise
- medical conditions that aggrivate it (GERD, rhinitis)
- menstrual cycle
what is an asthma trigger?
- something that can lead to irritation of the airways that results in bronchoconstriction
- these symptoms tend to be immediate, short-lived, and rapidly reversible
what is an asthma inducer?
- something that can cause airway inflammation and hyper-responsiveness in the airway
- inducers can cause long lasting symptoms and their effect may be delayed
- may be difficult to reverse effects
what are common inducers?
- RSV
- Influenza
- pneumonia
- allergens
what are some allergens that can induce asthma?
- pollen from grasses, trees and/or weeds
- animal secretions (cat and horse most common)
- mold
- house dust mites
can respiratory viral infections cause asthma exacerbation?
yes, one of the more common causes of exacerbation in children
what is intermittent asthma?
asthma where symptoms occur with a cold from time to time
what is persistent asthma?
asthma where symptoms are present at least twice a week during the day and 2 times a month at night
what is a stridor?
an upper airway sound, usually NOT heard with asthma
typically caused by croup, epiglotitis, inflammation
is a sign airway may be closing or blocked
loud, high-pitched sound most often heard during inspiration
what is a crackle?
a sound in the airway caused by secretions in bronchioles and alveoli
discontinuous, brief popping sounds
what is a wheeze?
- a sound in airway caused by constrict bronchioles that may be heard on inspiration and/or expiration
- continuous, musical sounds that can be high or low pitched
what is a grunt?
-a sound caused by resistance to expiraton
what is a rub?
- an airways ound caused by inflamed pleural membrane
- sounds similar to walking on hard packed snow
what are some things a nurse should assess about a child arriving to the hospital who has an asthma exacerbation?
- body position taken to breath
- any chest/abdomen movement or indrawing
- respiration rate
- respiratory effort
- tracheal tug?
- adventitious airway sounds
- mental status
- spo2
what are some mental status changes that may be noted in a child experiencing an asthma exacerbation?
- lethargy
- fatigue
- delirium
- anxiety
- unresponsiveness (especially if CO2 is high)
what is spirometry and how is it used?
spirometry is used to measure forced vital capacity (the maximal amount of air expired from the point of maximal inhalation)
is a test of pulmonary functioning
with asthma, test is given, then a short-acting bronchodilator is given, then the test is taken again - if greater than 12% improvement it indicates asthma
what is a normal respiratory rate for an infant from 0-6 months?
30-60
for children with intermittent asthma or a mild exacerbation, what is usually a first choice for medication?
a short acting beta-agonist
why may there be a failure to demonstrate a clinical response to inhaled corticosteroid therapy?
- erroneous diagnosis of asthma
- poor inhaler device technique
- poor adherence with treatment of ICS
- ongoing exposure to environmental triggers
- comorbidities
how are medications usually added to a treatment regimen for asthma?
- short acting beta-agonist is first
- then a low dose inhaled corticosteroid
- a longer acting beta-agonist
- upping to a medium dose corticosteroid
- a leukotrine receptor may be added
- stepping up to a long acting beta-agonist, and taking an inhaled corticosteroid as well as an oral systemic corticosteroid
what are the goals of asthma management?
- no sleep disruption
- no missed school
- no need to go to ER
- maintain normal activity including exercise
- have near normal lung function
- avoid side effects of drugs
what is the danger of missing diagnosis until patient is older?
that lung function has permanent decrease because of lack of treatment when symptoms onset
1/5 of people in Saskatchewan have poor asthma control, why?
- patients are not on preventor meds or are taking inadequate dosages
- patients have poor knowledge related to good asthma control
- health professionals have a lack of knowledge
what is ventolin?
a bronchodilator (also called Salbutamol)
-used for prevention and relief of bronchospasm in clients with reversible airway obstruction due to asthma
why may a nebulizer be a more appropriate during an exacerbation?
-continuous administration with a nebulizer may be more effective for severely obstructed patients
why is inhalation therapy the prefered route for asthma medications/
-inhaled has a more rapid onset of action, requires less drug to be used, better tolerated, ideal to treat acute symptoms
what are some nursing diagnoses related to asthma?
- ineffective airway clearance
- risk for aspiration
- altered gas exchange
- knowledge deficit
- ineffective breathing pattern
- ineffective management of therapeutic regimen
- inadequate fluid intake
what is flovent?
- a corticosteroid
- used for long-term control of persistent asthma (not for acute relief)
- reduces inflammation and swelling
what are some side effects of flovent?
-sore throat, hoarseness, thrush
what are appropriate doses for flovent for children under 12?
low dose: 50mcg 2-4 puffs/day
medium: 50mcg 4-10 puffs/day
high: 125mcg >4 puffs/day
what are appropriate doses for flovent for children greater than 12?
low dose: 50 mcg 2-6 puffs/day
medium: 125mcg 2-6 puffs/day
high: 125mcg >6 puffs/day
what precaution should athletes with asthma take?
warm up for 20-30 minutes before exercise
what is methylprednisone?
- an anti-inflammatory and immunosuppressant agent used in treatment of allergic, inflammatory and autoimmune disorders
- used IV route instead of oral in acute cases
- given as 1mg/kg every 6 hours for 48 hours then 1-2mg/kg/day divided in 2 doses
what age group is most affected by RSV infections?
-2-6 month olds
what are two infections that RSV can lead to?
pneumonia and bronchiolitis
what children are at highest risk of serious complications due to RSV?
- the very young (less than 6 months)
- those with underlying cardiac or pulmonary disease
- those who are immunocompromised
how is RSV transmitted?
through respiratory secretions
what are some symptoms of RSV?
- runny nose (rhinnorrhea)
- wheezing and coughing
- irritability
- low grade fever, though temperature can become quite high
- nasal flaring, retractions
- liver and spleen enlargement
what strategies are used to manage RSV?
- hydration
- relief of symptoms with bronchodilators and possibly cough/cold medicines
- antiviral med (ribavirin)
- oxygen therapy
- treatment of other infections
- humidity
what illness is the major cause of croup?
-para influenze
- colonizes nose and nasopharynx then invades epithelium causing cell damage and edema as well as a loss of cilia
- leads to airway obstruction and laryngeal muscle spasm which account for typical croup symptoms
what serious infections can hemophilus influenza b cause?
- meningitis
- severe throat and lung infections
what is the mortality related to hemophilus influenza b?
1 in 20 children who get it will die
20-50 percent will suffer deafness and/or permanent brain damage
when is the vaccination for hemophilus influenza b given?
2,4,6, and 18 months of age
what is influenza?
- commonly known as the flu
- a contagious disease caused by the influenza virus
- attacks respiratory tract
what are symptoms of influenza?
- fever
- headache
- tiredness
- dry cough
- sore throat
- nasal congestion
- body aches
what is the common name for a pertussis infection?
whooping cough