respiratory problems

Question 1

bronchiolitis

Answer 1

• bronchioles

- small bronchi

Question 2

pathogens causing bronchiolitis

Answer 2

• RSV
• adenovirus
• parainfluenza virus

Question 3

incidence of bronchiolitis

Answer 3

<2 years old

• winter & spring
• one of the most frequent cause of hospitalization

Question 4

s/s of bronchiolitis

Answer 4

• fussy, malaise
• URI for 1-2 days
• low grade fever
• elevated ESR/CRP (show infection)
• s/s of lower respiratory obstruction
• nasal flaring/retractions
• prolonged expiration (wheezes, crackles)
• pallor

Question 5

vital signs in bronchiolitis

Answer 5

• increased RR, HR

- low pulse ox

Question 6

diagnosing bronchiolitis

Answer 6

• chest xray: white mass is found (fluid or bones)
• throat culture
• nasopharyngeal swab (for RSV)

Question 7

mgmt of bronchiolitis

Answer 7

• without rx, can cause death
• 95% can be managed at home with high humidity, adequate fluids, rest, manage fever
• hospitalization: if tachypneic/retractions/apnea, and poor fluid intake

Question 8

medical tx for bronchiolitis

Answer 8

• nebulized bronchodilators/steroids
• IV fluids, O2, antipyretics
• antibiotics for secondary bacterial infection
• mechanical ventilation (extreme cases)

Question 9

meds for bronchiolitis

Answer 9

• ribavirin

- caffiene citrate

Question 10

high risk at bronchiolitis

Answer 10

<24 mo (BPD, CF, premature)

Question 11

prevention of RSV

Answer 11

• IGIVV

- synagis: antibodies to prevent serious lower resp tract disease

Question 12

bronchopulmonary dysplasia (BPD)

Answer 12

• usually a secondary dx
• chronic obstructive lung disease
• mortality rate: 10-25%

Question 13

risk factors of BPD

Answer 13

newborns requiring mechanical ventilation

Question 14

what has reduced the incidence of BPD

Answer 14

• antenatal steroids: help lung maturity

- surfactant replacement tx

Question 15

pathophysio of BPD

Answer 15

• caused by tx of respiratory distress syndrome
• bronchial epithelium is dmged over time
• airway edema occurs
• alveolar walls thicken
• fibrotic changes occur in airways & alveoli
• loss of ciliated cells
• continued O2 use decreased developing alveoli

Question 16

s/s of BPD

Answer 16

• s/s of respiratory distress
• adventitious breath sounds
• failure to thrive (not growing normal bc unable to breath, eat)
• episodes of sudden respiratory deterioration (d/t bronchospasms, mucous plugging, air trapping)

Question 17

diagnosing BPD

Answer 17

must have

• • xrays
• • s/s
• required mechanical ventilation @ 1wk old
• O2 dependence befyond 28 days of age

Question 18

mild O2 dependence

Answer 18

room air by 36 wks GA

Question 19

moderate O2 dependence

Answer 19

<30% FiO2 at 36 wks GA

Question 20

severe O2 dependence

Answer 20

> 30% FiO2 at 36 wks GA

Question 21

mgmt of BPD

Answer 21

• O2
• meds
• limiting fluids
• nutrition (similac 27cal/oz - more than normal)
• chest physiotherapy
• immunizations are important
• trach if necessary @ home

Question 22

medications for BPD

Answer 22

• bronchodilators
• corticosteroids
• diuretics
• electrolyte supplements
• antibiotics, ribavirin

Question 23

potential outcomes of BPD

Answer 23

• developmental delays
• growth retardation
• pulmonary dysfunction in adolescents

Question 24

cystic fibrosis incidence

Answer 24

• gender is not a factor

- more common in whites, then blacks, then asians

Question 25

cystic fibrosis

Answer 25

• inherited autosomal recessive disorder (you can be a carrier and not have it)
• mutation of chromosome 7
• severity depends on the form inherited
• *dysfunction of the exocrine glands causing alterations in mucous secretions & sweat electrolytes -> multiple system dmg

Question 26

early s/s of cystic fibrosis

Answer 26

• newborn: meconium ileus (distended abd)
• infants/toddlers: fecal impaction & intussusception
• FTT
• steatorrhea
• rectal prolapse
• insulin insufficiency
• wt loss

Question 27

pulmonary s/s of cystic fibrosis

Answer 27

• coughing, sputum production
• chronic respiratory infections
• hemoptysis
• atelectasis
• pneumothorax
• digital clubbing (d/t chronic hypoxia)

Question 28

metabolic s/s of cystic fibrosis

Answer 28

• “salty taste”

- level of NaCl is 2-5 times above normal perspiration

Question 29

reproductive s/s of cystic fibrosis

Answer 29

males: sterile d/t blockage of vas deferens
females: puberty delayed d/t chronic ventilation and nutritional deficiencies; difficulty conceiving d/t increased mucus secretions in the reproductive tract interfering with passage of sperm

Question 30

tests to diagnose cystic fibrosis

Answer 30

• presence of classic symptoms
• sweat test (easiest)
• family hx
• genetic testing
• pulmonary function test (6+ yrs old)
• chest xray
• stool analysis for fat & enzymes

Question 31

mgmt of cystic fibrosis

Answer 31

• maintain resp function with bronchodilators, mucolytics, chest physiotx, steroids, NSAIDs
• managing infections: antibiotics
• promoting nutrition, hyrdation, & exercise: pancreatic enzyme supplements; diet (200% protein, moderate fat, salt supplements); multivitamins
• prevent GI blockage: laxatives, fluids