Respiratory Illness of Lower Airway - Bronchiolitis, Pneumonia, Asthma, Cystic Fibrosis

Question 1

where does lower airway infections happen and what is the general thing that they do to the body

Answer 1

-Considered the “reactive” portion of the lower respiratory tract
-Includes bronchi and bronchioles
-Cartilaginous support is not fully developed until adolescence
-Constriction of airways
-Trapped air

Question 2

what is bronchiolitis

Answer 2

-Acute inflammatory disease
-Small airway obstruction.
-RSV (Respiratory Syncytial virus): 50 to 90% of cases, 5 to 40 % of pneumonia cases, contact precautions
-Peak incidence is 2 to 5 months of age.

Question 3

what is pneumonia

Answer 3

-Causative organism varies greatly by age
-The most useful classification is etiologic agent: Viral, Bacterial, Mycoplasmal, Aspiration of foreign substances

Question 4

what is the RSV pneumonia presentation & diagnosis

Answer 4

-Seasonal Presentation
-Under two years
-Clinical Presentation, Significant respiratory distress: tachypnea, retractions, wheezing, rales, prolonged expiration
-Hyperinflated chest x-ray
-Rapid testing: swab
-hear rales (crackles is different in pneumonia)

Question 5

how do you manage RSV pneumonia

Answer 5

-Apnea (especially <6months)
-Oxygen
-May be NPO
-Maintenance fluids
-Albuterol nebulized
-Antibiotics if uncertain dx

Question 6

what are the RSV medications

Answer 6

-Ribavirin (anti-viral) for high-risk patients (i.e.. congenital heart disease, cystic fibrosis, immunocompromised)
-Steroids only with asthma-like presentation
-Prophylaxis (Monthly): Respigam (IV Immunoglobulin) & Synagis (IM)

Question 7

explain aspiration pneumonia

Answer 7

-Risk for a child with feeding difficulties
-Prevention of aspiration
-Feeding techniques and positioning
-Avoid aspiration risks: Oily nose drops, Solvents, Talcum powder

Question 8

what is the most common lethal genetic illness among white children

Answer 8

cystic fibrosis

Question 9

what is cystic fibrosis

Answer 9

-Exocrine gland dysfunction that produces multisystem involvement
-Autosomal recessive trait

Question 10

what is the prognosis of cystic fibrosis

Answer 10

-CF continues to be a progressive, incurable disease
-Organ transplantation has increased the survival rate

Question 11

what are the respiratory cystic fibrosis symptoms

Answer 11

Cough, wheezing, increased work of breathing, frequent bouts of respiratory illness, thick secretions

Question 12

what are the GI manifestations of cystic fibrosis

Answer 12

-Excretion of undigested food in stool
-Stool is bulky, frothy and foul smelling
-Wasting

Question 13

what are the endocrine manifestations of cystic fibrosis

Answer 13

-Insulin resistance, insulin deficiency, unstable glucose homeostasis = microvascular complications.
-Bone health

Question 14

what type of chest do cystic fibrosis patients have

Answer 14

barrel chest due to hyperinflammation and clubbing

Question 15

what are the treatment goals for cystic fibrosis

Answer 15

-Prevent or minimize pulmonary complications: CPT, bronchodilators, antibiotics, steroids, Dornase alpha (decreases viscosity of mucous – aerosolized medication)
-Adequate nutrition for growth: Pancreatic enzymes, high protein and high calorie diet
-Assist the child and family in adapting to a chronic illness

Question 16

A nurse is planning care for a child who has cystic fibrosis. Which of the following interventions should she include in the plan of care?

a. Provide a low calorie, low protein diet
b. Administer pancreatic enzymes with meals and snacks
c. Promote an increase in fluids after 1800
d. Restrict physical activity

Answer 16

b. Administer pancreatic enzymes with meals and snacks