Respiratory Illness Flashcards
causes of COPD
- smoking
- pollution
- genetics
- significant respiratory illness (scar tissue)
COPD
- can’t exhale from loss of elastic recoil
- can’t inhale from mucous hyper-secretion, mucosal edema, and bronchospasm
- hypoxia and hypercapnia
- CO2 retainers
COPD pathophysiology (10)
- mucous hyper-secretion
- cilia dysfuncton
- airflow limitation
- hyperinflation of lungs
- alveolar destruction
- loss of elastic recoil
- gas exchange abnormalities
- pulmonary HTN
- cor pulmonale
- systemic effects
pulmonary HTN
- increased pressure from heart to lungs
- leads to cor pulmonale (hypertrophy or RV)
systemic effects of COPD
- skeletal dysfuntion
- weight loss
- nutritional abnormalities
treatment for COPD (7)
- smoking cessation
- medications
- immunizations (pneumovax)
- pulmonary rehab
- hydration
- nutritional support
- O2 support
nutritional support for COPD
- high cal + high protein foods
- small/more frequent meals
dangers of O2 for COPD
- CO2 retainers
- O2 can decrease respirations
medications for COPD
- bronchodilators
- coticosteroids (rinse mouth)
- anticholinergics (salbutamol, ipotropium)
- prophylactic antibiotics (doxycycline)
salbutamol
increases HR
why to avoid beta blockers for COPD
- puts at risk for bronchospasm (propranolol)
- metoprolol and atenolol are ok because they are cardiac specific
asthma
- hyperresponsivesness of airways
- inflammation, bronchospasm, wheezing
asthma triggers
- allergens
- exercise
- cold weather
- medications (NSAID, acetylsylic acid)
asthmas vs COPD
- onset <40 yrs
- more trigger related
- spirometry will normalize
- stable with some exacerbations
- not caused by smoking
asthma menifestations (8)
- bronchospasm
- vascular congestion
- edema formation
- mucous secretion
- impaired microciliary function
- thickening of airway walls
- bronchial hyper-responsiveness
- airway obstruction/remodelling
medications for asthma
- quick relief SABA
- acute intervention - corticosteroids, anticholinergics
- daily control - LABA, inhaled corticosteroids, mast cell inhibitors, leukotriene receptor antagonists
ER presentation with acute asthma episode
- Ventolin
- best through puffer
- 4-8 puffs q15-20 mins x3
- if severe 1 puff q30-60 secs max 20 puffs
- ipotropium used to open airways, lasts longer than salbutamol
- steroids to decrease inflammation
- O2 support
puffer vs aerosol
- puffer works faster and more cost effective
- puffer increases HR
prednisone in acute ER presentation of asthma
- to decrease inflammation
- tastes really bad
- 1mg/kg for peds
- methoprednisone IV
peak flow expiratory flow meter
- tells strength of exhale
- deep breath and hard/fast exhale for 1-2 secs
- highest of 3 tries
- peak flow may change before symptoms so can catch early
peak flow meter numbers
- 80-100% = good control
- 50-80% = caution asthma is worsening, additional meds
- <50% = danger, rescue medication, potential for ER
types of pneumonia
- community acquired (most common)
- hospital acquired
- aspiration pneumonia
- fungal pneumonia
- opportunistic pneumonia
diagnosis of pneumonia
- Hx and physical
- CXR
- sputum for C&S
- O2 sats
- blood gases
- CBC - leukocytes
presentation of pneumonia
- SOB
- cough w or w/out exudate
- fever
- congestion in lungs
- coarse lung sounds (generally one are)
- dull on percussion
- consolidation on CXR
treatment of pneumonia
- appropriate antibiotics
- increase fluid intake
- antipyretics
- analgesics
- O2 therapy
complications of pneumonia (9)
- pleurisy
- pleural effusion
- atelectasis (collapse)
- lung abscess (in lung)
- empyema
- pericarditis
- bacteremia (in blood)
- endocarditis
- meningitis
pleurisy
- inflammation of lining of lung
pleural effusion
- fluid in pleural space
empyema
- pockets of pus in pleural space
- big consolidation
- treated with chest tube with TPA to break up pus and drain
pediatric differences in upper airway
- <3 months are nose breathers
- large tongue
- trachea narrower
- airway resistance greater
paediatric differences in lower airway
- alveoli fewer in # at birth
- weaker intercostal muscles
retraction
in peds when you can see skin pulling in at ribs
paediatric vs adult airway diameter
- adult = 20mm; 1mm swelling = 18mm
- peds = 4mm; 1mm swelling = 2mm
peds respiratory assessment
- HR, resp rate, O2 sats
- position of comfort
- behaviour (best indicator)
- skin/mucous membrane colour
- Work of breathing (retraction, abd muscles, shoulders rising, head bobbing, grunting)
- chest auscultation
- signs of dehydration
- family/caregiver coping
locations of retraction
- suprasternal
- supraclavicular
- intercostal
- substernal
- subcostal
- tracheal tug
normal respiratory rate per age group
- newborn = 30-55
- 1yr = 25-40
- 3yrs = 20-30
- 6-10 = 16-22
- 17+ = 12-20
normal HR per age group
- newborn = 100-170
- infant-2yrs = 80-130
- 2-6yrs = 70-120
- 6+ = 60-110
bronchiolitis
- inflammation of bronchioles
- <2yrs
- starts upper then moves lower
- wheezing, fever, cough, resp distress, retraction
- preceded by 1-3 days runny nose (causes most problems)
- can decomponsate quickly
treatment for bronchiolitis
- hydration
- ins/out (wet diapers, time breastfeeding)
- saline drops/suction of nose
- sometimes salbutamol or sale aerosol
respiratory syncytial virus (RSV)
- most common cause of bronchiolitis
- breakdown of cell wall in airway causing clumps = blockage
- contagious
- nasopharyngeal aspirate to diagnose
- can get second time
treatment of RSV
- same as bronchiolitis
- hydration, O2, respiratory
Croup
- inflammation of vocal cords
- symptoms, not a virus
- Barky cough
- cold air/humidity can help decrease inflammation
- dexamethasone, aerosolized epinepherine
- not admitted
- up to date croup scores
signs of respiratory failure in children - initial respiratory failure
- restlessness, tachycardia, dyspnea, tachypnea
- monitor frequently, sats
signs of respiratory failure in children - early de compensation
- nasal flaring, retraction, grunting
- respiratory & doc, 100% O2 mask available
signs of respiratory failure in children - severe hypoxia/airway arrest
- cyanotic, SOB, HR slows, cant breath deep enough for audible wheezes, stupor, diaphoretic
- prepare for intubation
