Respiratory Disorders Flashcards
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:
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:
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
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
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
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
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
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
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:
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:
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
Pulling at ear
Fussy
Fever
Not want laid flat
Present - Otitis media
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
Comfort measures
Give pain medication - in lot pain
Heat application
N. interventions - Otitis media
Breastfeeding
Immunization - HIB - bacteria - epiglottitis and otitis media decrease
Prevention - Otitis media
Worry about hearing loss leads speech probs
Chronic ear infections: tubes in ear
Myringotomy - cutting eardrum
Tympanostomy - putting in tube
Long-term - Otitis media
Sore throat
See lot in school age
Big tonsils when school age - increased risk for infection
Etiology - Tonsillitis
Sore throat
Bad breath
Redness in throat - Looks inflamed
Temp
Child lethargic
Not eat or drink
Manifestations - Tonsillitis
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
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
AKA common cold
Caused by diff viruses
Etiology - Nasopharyngitis
Runny nose
Sneezing
Fever
Manifestations - Nasopharyngitis
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
Immunization
Out pub
Washing hands
Breastfeeding
Prevention - Nasopharyngitis
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
- The tracheal and bronchial linings overreact to stimuli, causing episodic smooth muscle spasms that severely constrict the airways
- Mucosal edema and thickened secretions also block the airways
- Immunoglobulin E (IgE) antibodies, attached to histamine-containing mast cells and receptors on cell membranes, initiate intrinsic asthma attacks
- When exposed to an antigen such as pollen, the IgE antibody combines with the antigen.
- On subsequent exposures to the antigen, mast cells degranulate and release mediators. These mediators cause the bronchoconstriction and edema of an asthma attack.
- As a results, expiratory airflow decreases, trapping air in the airways and causing aveolar hyperinflation.
- 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
CF
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
