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
