respiratory function (1) Flashcards
chronic inflammatory disorder of the airway, airway has increased responsiveness to stimuli
asthma
what do bronchioles do in asthma
constrict
in asthma, exposure to triggers causes cells in the airway to release what?
proinflammatory chemical mediators (histamine, prostaglandins, and leukotrines)
what are symptoms of asthma exacerbation?
- dyspnea/tachypnea
- insp/exp wheezing
- use of accessory muscles
- cough
- discomfort, irritbility, restlessness, anxiety
- chest tightness
which of the following are asthma triggers?
a)exercise
b)food additives
c) emotions
d) temp chamges
e) all
all
what does the diagnosis of asthma include?
- symptoms of wheezing/obstruction
- improvement of wheezing/obstruction with short acting beta adrenergic and oral corticosteroid med
- exclusion of other diagnosis
- pulmonary function testing (spirometry) assess airway function (older than 5-6 years) (need to follow directions)
What meds would be used for status asthmaticus
- albuterol
- methylprednisolone or IV solumedrol
- prednisone or prednisolone orally
which asthma med is a beta adrenergic blocker that causes bronchodilation
albuterol
which asthma meds decrease inflammation?
prednisone/prednisolone/methylprednisolone
what are the 2 ways albuterol can be given?
nebulizer/MDI
steps of using MDI with mask
- shake 30 sec
- put mask on
- push first puff
- take 6 breaths
- wait 30 sec between puffs
steps for using MDI with only spacer and mouthpiece (no mask)
- shake 30 sec
- slow deep breath, let out
- put mouthpiece in, push first puff
- slow breath 3-5 sec
- hold 10 sec
- wait 30 sec between puffs
what are the ages for mouthpieve vs. mask for MDI
mask used up to 5 y.o., then mouthpiece
what is the purpose of albuterol
relax bronchial smooth muscle
side effects of albuterol
- tachycardia
- nervousness
- nausea
- headachesa
how long are oral corticosteroids usually used for?
5 days
what asthma meds decrease inflammation
oral corticosteroids
what asthma meds inhibit bronchoconstriction?
anticholinergics
what meds are used short term MDI with exacerbation of asthma
anticholinergics
what is the onset of anticholinergics?
30-90 min
what is the most effective long-term control therapy for asthma
inhaled corticosteroids
how are inhaled corticisteroids administered
MDI with spacer
what can inhaled corticosteroids cause?
thrush and dyspnea
what is important to do after inhaled steroid use
rinse mouth
what is the purpose of leukotrine receptor antagonist?
prevent asthmatic episodes
what is an objective assessment of signs and symptoms of asthma
pediatric asthma score
what is looked at for a pediatric asthma score?
respiratory rate, oxygen, retractions, dyspnea, auscultation
what is a history of coughing, breathlessness, chest pain, or wheezing during and after exercise
exercise induced bronchospasm
what prevents exercise induced bronchospasm
albuterol immediately prior to exercise prevents and provides relief for 2-4 hours
what is chronic lung disease called
bronchopulmonary dysplasia (BPD)
how long is supplemental oxygen needed after premature birth?
28 days at least
describe alveoli with BPD
- fewer and larger with less functional area
- fibrosis if alveoli
what is the severity of BPD determined by?
respiratory support interventions required at birth and long term
what are characteristics of BPD
persistent signs of increased resp effort (tachypnea/dyspnea, retractions, flaring, grunting, irritability, wheeze/crackle, edema, failure to thrive)
clinical theraoy of BPD
- symptom treatment that supports resp function
- good nutrition which accelerates lung maturity
can BPD be outgrown?
yes, with lung development
what can BPD turn into
asthma (chronic lung disease)
what meds are used for BPD
- bronchodilators
- corticosteroids
- diuretics to remoce excess fluid
what is synagis
injection used for BPD
what problem is a defective CFTR involved in?
cystic fibrosis
what kind if things does a defective CFTR protein cause?
- sodium/chloride problems
- secretions thickened
- airway obstructions
- ciliary action and cough
how is cyctic fibrosis inherited
autosomal recessive, inherits from both oarents
what is the incidence of cystic fibrosis
1:4
is gender a factor in cyctic fibrosis?
No
is cystic fibrosis curable?
no
what high screening is indicative for cystic fibrosis
immunoreactive trypsinogen (IRT)
when is the second IRT for CF done?
2-3 weeks
what is the “gold standard” for CF diagnosis?
sweat chloride test by pilocarpine iontophoresis
when is genetic testing done for CF?
whena adulta have positive family history, to the partner of a CFer, and to identify carriers
which of the following is accurate regarding clinical manifestations of CF?
a) secretions very thick
b) decreased ciliary action in resp tract
c) increased obstruction with mucus
d) effective cough
e) frequent resp infections
a, b, c, e
you might expect which symptoms with CF?
a) chronic harsh cough
b) wheezes, crackles
c) stridor
d) clubbing if fingers
a, b, d
which of the following are manifestations of CF?
1. foul smelling flatulus
2. excess stool fat
3. difficulty maintaining weight
4. meconium ileus
5. constipation
all
what body systems does CF eventually effect?
all
describe pancreas in CF
- thickened mucous damages pancreatic ducts and obstructs enzymes to digest fats, fat soluble vitamins, and proteins
- produces inadequate insulin (diabetes)
which vitamins are deficient in CF
A,D,E,K (fat soluble)
what kind of diet are people with CF on?
high calorie diets
CF effects on reporductive system in females?
- fallopian/ovaries uneffected
- fertility inhibited due to thick secretions and decreased cervical secretions
CF effects on reproductive system in men?
sterile due to blockage or abscence of vas deferens
effects of CF on sweat glands
- skin salty due to high sodium and chloride in sweat
- loss of electrolytes in sweat, saliva, and mucous
- at risk for hyponatremia
what does bronchial hygeine therapy include?
- chest physiotherapy
- therapy vest
chest physiotherapy vs. therapy vest
- physiotherapy= for infants and toddlers, percussion and vibration of multiple areas of lung in different position
- therapy vest= hugh frequency chest wall oscillation (older than 4 y.o.)
what is the order of aerosol meds given for CF?
- bronchodilator
- hypertonic 7% NS (to mobilize mucus/improve airway)
- dornase alfa (pulmozyme): thin secretions
- bronchial hygeine therapy
- inhaled antibiotics
- inhaled steroid
should people with CF eat before or after their aerosol/hygeine routine?
after
what is needed to help nutrition in CF?
enzymes given before all meals and snacks, will not be digested wothout
what kind of isolation is CF patients in?
contact/droplet
an exacerbation of asthma will include which?
a) wheezing on inspiration and expiration
b) inspiratory stridor
c) dyspnea/tachypnea
d) hoarse barky cough
e) moist cough
A, C, E
how is pediatric asthma diagnosed? choose all
1. diagnosis of bronchiolitis with wheezing
2. bronchospasm
3. reversal of bronchospasm with beta adrenergic meds
4. exclusion of airway diagnosis
5. resp swab isolation
6. spirometry after 5-7 y.o.
B, C, D, F
what are corticosteroids used to treat in asthma?
inflammation
treatment of bronchopulmonary dysplasia could include which of the following? choose all
1. beta adrenergic meds
2. corticosteroids
3. high calorie formula
4. low calorie formula
5. alpha adrenergic meds
6. oxygen
1,2,3, 6
how many states is there a screening for cystic fibrosis in newborns?
all 50
what are pancreatic enzymes used to promote?
digestion and absorption of nutrients
which CF intervention are teens more likely to be non-compliant with in order to have more time with friends?
bronchial hygeine therapy
