Respiratory Disorders Flashcards by Kelsey Klipfel

Kids have:
Highest rate of respiratory infections is 3 months to 5 years.
Mom’s antibodies present first 3 months - breastfed - extends it
Winter and Spring is when most respiratory infections happen
Alveoli continue to change in shape/size and number during the first 12 years
Kids (mostly infants and toddlers) lack common sense and put anything and everything in their mouth.
Toddlers - put everything in mouth
When a child has trouble breathing, it is extremely stressful to caregivers. Especially first time parents.
Parents get anxious and kids feed off that - Kids get anxious - cycle - take fast deep breaths; child have resp illness - parents lot anxiety - working through it imp

Things to note:

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Small oral cavities and large tongues - any kind edema can swell airway - restrict airway easily
Greater airway resistance - harder to breath
Short distance from nose to lungs
Lower amount and less effective cilia - Not working cilia - working less - not have body protection to get viruses and bacteria cilia

Kids have:

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Nebulizor
Bronchodilator/steroid
Get creative - in parents lap - put mask on face - distraction during treatments
Can do at home - teach parents - how long takes, how set up

Nebulized aerosol therapy - Oxygen and respiratory therapies

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Emergencies and maintenance
Kids with asthma
Shake sev times before given
Lot times use spacer - to properly do it
Daily use steroids - fungal infections: rinse mouth after use; immune sys; growth - stunted - ensure not falling off charts

Metered-dose/dry powder inhaler - Oxygen and respiratory therapies

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Cystic fibrosis
RSV
Effective: auscultate - appears breathing better
Point: loosen up the mucous
Do before: given bronchodilator - help start break those up then chest physiotherapy - percuss lungs to get it out in all fields to loosen up secretions
CF - do multiple times a day
Before eat; wait 1-2 times after eat otherwise puke and aspiration
Vests: shakes them

Chest physiotherapy

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Tracheostomy and et tube - best way to O2 tube
No cuff in ET tubes in kids - trachea too soft and will break it; Do tend to pull out
Older kids are do sedate them
Suction them like adults - may do couple passes; wait in between
Nasal cannula - great for kids - eat and talk - irritating; will try pull off face; thicker prongs - CPAP - then can do higher flow
CPAP - mouth open - lost out mouth or into stomach - distended stomach; higher amounts oxygen
Oxygen hood - higher amounts O2 - nothing on face; open up to look at kid O2 comes out; first few months life when not moving
O2 tent - move around and play - nothing on face - lower amts O2 can give - open up decrease amount O2
All humidified O2 - wetter environment
O2 is a drug - need prescription - can cause if too much too long - retinopathy to neonates

Oxygen therapy

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Small airways - suction a lot
Every baby has blue bulb - squeeze then put in - clear nose and mouth - send home and show how use it
Normal saline - help break it up and more out
Nose frida - way more suction - filter - more parent thing - educate parents on this - electric ones - parent have one end in mouth and other end on patient
Suction hooked up to wall - saline in nose to get deeper secretions out

Suctioning

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Not like grunting - compensating to try keep alveoli opening - pressure keeps alveoli open even as they expire
Respiratory Distress:
Respiratory Failure:

Respiratory distress vs failure

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Breathing harder
Retractions - visible
Moving shoulders up and down when breathing
Not lay flat
Increased rate and work of breathing
Retractions
Nasal flaring
Head bobbing
Use of accessory muscles
Grunting
Anxiety (Increase heart rate)
Child wants to sit upright

Respiratory Distress:

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When compensatory mechanism fails leads to this
Leads to change in mental status as compared to Respiratory stress
Desaturation
Cyanosis
Little air entry (gasping)
Head bobbing
Seesaw respirations
Stridor
Distress fails go here
Worn out
Cannot keep up with measures

Respiratory Failure:

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Most common in first 24 months, rare after 7 years
upper respiratory infection Precedes this
Straight tube, Bottle feeding, Second hand smoke, URI, Day care
Rare after first couple years
Present:
Treat
N. interventions
Prevention
Long-term
Can have lot fluid in ear - worry about hearing

Otitis media

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Pulling at ear
Fussy
Fever
Not want laid flat

Present - Otitis media

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Antibiotics - yes and no - can be viral - not treat all - if six months or younger treat as if bacterial = if older than 6 months wait 48-72 hours - get worse treat with abx - not always followed

Treat - Otitis media

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Comfort measures
Give pain medication - in lot pain
Heat application

N. interventions - Otitis media

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Breastfeeding
Immunization - HIB - bacteria - epiglottitis and otitis media decrease

Prevention - Otitis media

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Worry about hearing loss leads speech probs
Chronic ear infections: tubes in ear
Myringotomy - cutting eardrum
Tympanostomy - putting in tube

Long-term - Otitis media

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Sore throat
See lot in school age
Big tonsils when school age - increased risk for infection

Etiology - Tonsillitis

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Sore throat
Bad breath
Redness in throat - Looks inflamed
Temp
Child lethargic
Not eat or drink

Manifestations - Tonsillitis

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Abx - depends - viral/bacterial - strep test - neg not get abx
Tonsils issue: big and obstructing airway - chronic infections or snoring at night - should not be snoring: airway thing

Therapeutic management - Tonsillitis

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No straws
No blowing nose
No coughing
No throwing up
Red flags
Stitches - worry about breaking lose and bleeding - bleeding - continually swallowing: concerning
Throw up and red - concerned
Edu: not give anything with red food coloring
Diet
Not red jello
Popsicles
Nothing too hot
No dairy - coats it
Applesauce
Juice is acidic so careful
No carbonation
Water good

Post-op care - Tonsillectomy

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AKA common cold
Caused by diff viruses

Etiology - Nasopharyngitis

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Runny nose
Sneezing
Fever

Manifestations - Nasopharyngitis

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Treated at home
Hydration - big; give break from eating; pedialyte - Oral Refreeding Solution (ORS) - give kids when not eating food or drink
Rest - want to rest
Cool mist humidifier - bring inflammation down
Medications
Antipyretics - tylenol and motrin/ibuprofen - 6 mo for ibuprofen
Decongestants - after 6 yrs unless special order
Cough suppressants - avoid - coughing something up - not suppress - impact ability to sleep - do give - regularly in these: tylenol ensure not over max dose

Therapeutic management/ Nursing Interventions - Nasopharyngitis

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Immunization
Out pub
Washing hands
Breastfeeding

Prevention - Nasopharyngitis

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High fever not brought down by antipyretic and had for awhile Breathing issues - retractions - blue - most common reason brought in is breathing Long time not eaten or drinken Listless in babies - no muscle tone Sat probs on babies at night - low - can take them in

Sign that child needs to be seen by a provider - Nasopharyngitis

Group A streptococcus Strep throat

Etiology - Acute streptococcal pharyngitis

Sore throat Bad breath Redness in throat - Looks inflamed Temp Child lethargic Not eat or drink

Manifestations - Acute streptococcal pharyngitis

Pharmacologic Abx - penicillin - if + strep test

Therapeutic management - Acute streptococcal pharyngitis

Abx - strep test - + get abx

Nursing Interventions - Acute streptococcal pharyngitis

Worried about rheumatic fever - worried about cardiac issues - fever - untreated/partially treated strep infection - test kids for tonsillitis for strep

What is a risk if this infection is not fully treated? - Acute streptococcal pharyngitis

More commonly called: respiratory syncytial virus (RSV)

Bronchiolitis

Infants most impacted - up to toddlers Peaks 6 mo - more rare after 24 mo Small airways - lot mucus and edema - occludes bronchioles - lot trouble breathing; very sick

Etiology - Bronchiolitis

Presents common cold then worsens; struggle breathing, wheezing turning blue, coughing lot, not eat, lot secretions

Manifestations - Bronchiolitis

Suctioning a lot Droplet precautions - highly contagious - put in private room and gown up Abx - none its a virus; steroids - bronchodilators; pain medications

Therapeutic management/ Nursing Interventions - Bronchiolitis

Vaccine: no - shot can give babies monthly to prevent this - not super effecive - extremely expensive

Prevention - Bronchiolitis

Medical emergency Where virus is - On epiglottis More common hemophilous influenza - can be diff viruses and bacteria that cause it Form croup - can easily occlude airway - med emergency

Etiology - Epiglottitis

Bed at night - cold and wake up and not breathe Throat - look at it - red and bright Not look in mouth or anything in mouth unless ready to intubate Absence of cough Tripod positioning Drooling Words muffled Stridor Nothing in mouth - enough irritation to where occlude airway - wait for intubation just in case

Manifestations - Epiglottitis

Medications: abx - yes; corticosteroids; bronchodilators contagious - droplet precautions Avoid: nothing in mouth

Therapeutic management - Epiglottitis

Vaccination: HIB

Prevention - Epiglottitis

Aka croup - barky cough - go to ER in middle night - bed to URI - not med emergency - breathing issues because edema

Etiology - Acute laryngotracheobronchitis

Barky cough

Manifestations - Acute laryngotracheobronchitis

Keep at home: coolness - not want hotness - inflammation - edema occluding airway - heat not decrease edema - cold will Treat with fluids, pain, rest - like nasopharyngitis Hospital - get steroids - bronchodilators No abx - swab for potentially bacterial - is bacterial present as epiglottitis Some type of virus

Therapeutic management/ Nursing Interventions - Acute laryngotracheobronchitis

Croup - winter and spring months - cold air breathing in helps

More commonly referred to as? - Acute laryngotracheobronchitis

HIB, pneumonia vaccines: PCV

Prevention - Acute laryngotracheobronchitis

Aka whooping cough

Pertussis

Bordetella pertussis

Etiology - Pertussis

Coughing fits so bad - vomiting; break ribs because severe cough

Manifestations - Pertussis

Do give abx

Therapeutic management/N. Interventions - Pertussis

Vaccination DTAP TDAP - q10 yrs Common in kids not vaccinated or those unvaccinated caring for children Imp be Up to date

Prevention - Pertussis

Aka kissing disease

Mononucleosis

Epstein-Barr Teenagers - sports - via water bottles; teens Passed through saliva

Etiology - Mononucleosis

Sore throat Very tired Out for awhile

Manifestations - Mononucleosis

No abx - virus Long incubation period

Therapeutic management/N. Interventions - Mononucleosis

Spleen - enlarged spleen as a result - no longer protected by ribs - have contact can rupture it - not participate in contact sports for 2-3 months after having mono

Long-term concerns - Mononucleosis

Chronic inflammatory disorder of airways Limited airflow or obstruction that reverses spontaneously or with treatment Causes and pathophysiology

Asthma

Recurring symptoms Bronchial hyperesponsiveness Airway obstruction Occlude - edema - then mucous - junk in small airways - trouble breathing See wheezing - in lower airway vs would see Stridor in upper airways

Chronic inflammatory disorder of airways - Asthma

Recurring typ - triggered by something - intrinsic (laughing, coughing, emotions) or extrinsic factor (try avoid those) Precipitants triggering an asthma attack Allergens Irritants Exercise Cold air Colds/infections Food additives Animals Medications Strong emotions

Causes and pathophysiology- Asthma

1. The tracheal and bronchial linings overreact to stimuli, causing episodic smooth muscle spasms that severely constrict the airways 2. Mucosal edema and thickened secretions also block the airways 3. Immunoglobulin E (IgE) antibodies, attached to histamine-containing mast cells and receptors on cell membranes, initiate intrinsic asthma attacks 4. When exposed to an antigen such as pollen, the IgE antibody combines with the antigen. 5. On subsequent exposures to the antigen, mast cells degranulate and release mediators. These mediators cause the bronchoconstriction and edema of an asthma attack. 6. As a results, expiratory airflow decreases, trapping air in the airways and causing aveolar hyperinflation. 7. Atelectasis may develop in some lung regions. The increased airway resistance initiates labored breathing.

How does asthma develop?

Spirometry testing assesses the presence and degree of disease and can determine the response to treatment. most common - tell how healthy lungs are and how well functioning once/yr Testing see how well breathe - how air flow is

Pulmonary Function Tests: - Laboratory Tests

Measures maximum flow of air that can be forcefully exhaled in 1 second; child uses a peak expiratory flowmeter to determine a “personal best” value that can be used for comparison at other times, such as during and after an asthma attack. most common - tell how healthy lungs are daily - say what zone in - take highest one Green zone = good Yellow = worried - not as much air out - air trapping; struggling - predict if having asthma attack; do rescue inhaler Red = bad - use rescue inhaler if in this area Do multiple times How do it - Take highest ones after do multiple times

Peak Expiratory Flow Rate Measurement: - Laboratory Tests

Done to identify specific allergens.

Skin Testing: - Laboratory Tests

Exercise is used to identify the occurrence of exercise-induced bronchospasm.

Exercise Challenges: - Laboratory Tests

May show hyperexpansion of the airways.

Chest Radiograph: - Laboratory Tests

Guage of how severe and how often impacting their day Diff levels and depending on level falls under tell how many meds on

Diff types of asthma

SABA: Short-acting beta2-agonist (ex. albuterol) ICS: Inhaled corticosteroid (ex. Solumedrol, Flovent) LABA: Long-acting beta2-agonist (ex. formoterol) Quick-relief (rescue medications) Long-term control (medications to prevent attacks)

Medications

Oral systemic corticosteroid (ex. Dexamethasone, prednisone) Leukotriene modifier can be used instead of LABA (ex. Montelukast/Singulair)

LABA: Long-acting beta2-agonist (ex. formoterol)

Short Acting B2 agonists For bronchodilation Anticholinergics For relief of acute bronchospasm Systemic corticosteroids For anti-inflammatory action to treat reversible airflow obstruction Asthma attack - home Status asthmaticus - hospital; rescue inhaler not working Going through 1 or 2/yr albuterol not good - - not refilled more than 2 a yr No daily asthma attacks - edu not stop because doing well because of the meds which want - if they go long time without, can work on slowly decreasing

Quick-relief (rescue medications)

Inhaled corticosteroids For anti-inflammatory action Long-acting B2 agonists For long-acting bronchodilation Leukotriene modifiers To prevent bronchospasm and inflammatory cell infiltration Monoclonal antibody Blocks binding of IgE to mast cells to inhibit inflammation Antiallergy medication Nonsteroidal anti-inflammatory drugs

Long-term control (medications to prevent attacks)

Prevent exacerbation Avoid allergens Provide acute asthma care Relieve bronchospasm Monitor function with peak flowmeter Master self-management of inhalers, devices, and activity regulation Avoid long-term damage - more attacks - more damage to lungs Number one reason why brought to ER Want try prevent them from coming in Come in with status asthmaticus - on O2; loading dose corticosteroids; breathing treatments; intubate if not controlled; anxiety - struggling to breath - fight takes off - more anxiety - harder breathe

Goals of asthma management

Autosomal recessive trait Passed on Can test on eggs Main issue: thick mucous - biggest issue Systems impact: GI, respiratory, reproductive - eggs cannot descend - sperm very thick Chronic multisystem disorder Pathophysiology Dx and manifestations Impact on sys - general Impact on sys - nose and sinuses Impact on sys - liver Impact on sys - gallbladder Impact on sys - bone Impact on sys - intestines Impact on sys - lungs Impact on sys - heart Impact on sys - spleen Impact on sys - stomach Impact on sys - pancreas Impact on sys - reproductive Respiratory sys GI sys Integ sys Reprodu sys

Exocrine gland dysfunction leading to increased viscosity of mucus Secretion results in mechanical obstruction Thick mucus accumulates, dilates, precipitates, and coagulates to form oncretions in glands and ducts Respiratory tract and pancreas are predominantly affected Also impacts the gastrointestinal and reproductive systems Progressive and incurable

Pathophysiology

Diagnostic evaluation Cirrhosis Common for diabetes In and out hospital out Mucus sits in lungs - part issue - so much infection - struggle coughing out - causes scarring - more infections have - sig damages lungs - chest physiotherapy helps breathe - get out infection as well - no cough suppressants as well because of this - always before bed

Dx and manifestations

Sweat chloride test Chloride concentration greater than 60 mEq/L (60 mmol/L) is a positive test result (higher than 40 mEq/L (40 mmol/L) is diagnostic in infants younger than 3 months of age. Sweat chloride test - draw blood Universal newborn screening - on there - sent home without dx DNA identification of mutant genes Universal screening Delayed passage of meconium - not have then sent home Come back - resp issues - recurrent resp issues - testing for it - state screening but sometimes missed on state screen - not past 1-2 yrs without dx

Diagnostic evaluation

Growth failure (malabsorption) Vitamin deficiency states (vitamins A, D, E, K)

Impact on sys - general

Nasal polyps Sinusitis

Impact on sys - nose and sinuses

Hepatic steatosis Portal HTN

Impact on sys - liver

Biliary cirrhosis Neonatal obstructive jaundice Cholelithiasis

Impact on sys - gallbladder

Hypertrophic osteoarthropathy - clubbing Arthritis Osteoporosis

Impact on sys - bone

Meconium ileus Meconium peritonitis Rectal prolapse Intussusception Volvulus Fibrosing colonopathy (strictures) Appendicitis Intestinal atresia Distal intestinal obstruction syndrome Inguinal hernia

Impact on sys - intestines

Bronchiectasis Bronchitis Bronchiolitis Pneumonia Atelectasis Hemoptysis Pneumothorax Reactive airway disease Cor pulmonale Respiratory failure Mucoid impaction of the bronchi Allergic bronchopulmonary aspergillosis

Impact on sys - lungs

RV hypertrophy Pulmonary artery dilation

Impact on sys - heart

Hypersplenism

Impact on sys - spleen

GERD

Impact on sys - stomach

Pancreatitis Insulin deficiency Symptomatic hyperglycemia Diabetes

Impact on sys - pancreas

Infertility (aspermia, absence of vas deferens) Amenorrhea Delayed puberty

Impact on sys - reproductive

Stagnation of mucus and bacterial colonization result in destruction of lung tissue Tenacious secretions are difficult to expectorate: They obstruct bronchi/bronchioles Emphysema and atelectasis occur as the airways become increasingly obstructed Chronically in a hypoxic state which contraction and thickening of the muscle fibers in pulmonary arteries/arterioles. This leads to pulmonary hypertension and eventual cor pulmonale. Ruptured bullae leads to pneumothorax. Erosion of the bronchial wall leads to hemoptysis. Respiratory management

Respiratory sys

Airway clearance therapies Bronchodilator medication Physical exercise Aggressive treatment of pulmonary infections Aerosolized antibiotics Home intravenous antibiotic therapy

Respiratory management

One of the first manifestations is a meconium ileus in the newborn Intestinal obstruction caused by thick intestinal secretions Frothy and foul-smelling stools Deficiency in fat-soluble vitamins Malnutrition and failure to thrive Pancreatic fibrosis which may increase the child's risk for diabetes mellitus Not passing meconium Obstructions in intestines Not move as easy Trouble absorbing fat - body not absorbing fat Typ underweight - short and staturte - moon face because steroids whole life Fat soluble vits - A, D, E, K Give pancreatic enzymes - everytime eat - helps absorb food better

GI sys

Very high concentrations of sodium and chloride in sweat Skin tastes salty Dehydration and electrolyte imbalances can occur. Dehydrated lot quicker

Integ sys

Delayed Can delay puberty in girls Inhibits fertility due to thick mucus Males are typically sterile due to blockage of the vas deferens

Reprodu sys

Median survival is 42 years Progressive and incurable disease - Progressive - older get - worse gets Transplantation Interprofessional care management

Prognosis of CF

Increases life expectancy - Things we implement help them survive longer Availability of organs Surgical complications Do lung transplants - sig increase life span

Transplantation

Hospital care Home care Family support Transition to adulthood Lot edu to parents Parent stays home with child or nurse around clock Chest physiotherapy and meds and sick a lot - stressful for parents Kids have body image issues - esp MS and HS issues

Interprofessional care management

Coping with emotional needs of child and family Need for treatments multiple times a day Frequent hospitalization Home care Implications of genetic transmission of disease

CF: fam support