respiratory problems Flashcards
bronchiolitis
- bronchioles
- small bronchi
pathogens causing bronchiolitis
- RSV
- adenovirus
- parainfluenza virus
incidence of bronchiolitis
<2 years old
- winter & spring
- one of the most frequent cause of hospitalization
s/s of bronchiolitis
- 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
vital signs in bronchiolitis
- increased RR, HR
- low pulse ox
diagnosing bronchiolitis
- chest xray: white mass is found (fluid or bones)
- throat culture
- nasopharyngeal swab (for RSV)
mgmt of bronchiolitis
- 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
medical tx for bronchiolitis
- nebulized bronchodilators/steroids
- IV fluids, O2, antipyretics
- antibiotics for secondary bacterial infection
- mechanical ventilation (extreme cases)
meds for bronchiolitis
- ribavirin
- caffiene citrate
high risk at bronchiolitis
<24 mo (BPD, CF, premature)
prevention of RSV
- IGIVV
- synagis: antibodies to prevent serious lower resp tract disease
bronchopulmonary dysplasia (BPD)
- usually a secondary dx
- chronic obstructive lung disease
- mortality rate: 10-25%
risk factors of BPD
newborns requiring mechanical ventilation
what has reduced the incidence of BPD
- antenatal steroids: help lung maturity
- surfactant replacement tx
pathophysio of BPD
- 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
s/s of BPD
- 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)
diagnosing BPD
must have
- xrays
- s/s
- required mechanical ventilation @ 1wk old
- O2 dependence befyond 28 days of age
mild O2 dependence
room air by 36 wks GA
moderate O2 dependence
<30% FiO2 at 36 wks GA
severe O2 dependence
> 30% FiO2 at 36 wks GA
mgmt of BPD
- O2
- meds
- limiting fluids
- nutrition (similac 27cal/oz - more than normal)
- chest physiotherapy
- immunizations are important
- trach if necessary @ home
medications for BPD
- bronchodilators
- corticosteroids
- diuretics
- electrolyte supplements
- antibiotics, ribavirin
potential outcomes of BPD
- developmental delays
- growth retardation
- pulmonary dysfunction in adolescents
cystic fibrosis incidence
- gender is not a factor
- more common in whites, then blacks, then asians
cystic fibrosis
- 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
early s/s of cystic fibrosis
- newborn: meconium ileus (distended abd)
- infants/toddlers: fecal impaction & intussusception
- FTT
- steatorrhea
- rectal prolapse
- insulin insufficiency
- wt loss
pulmonary s/s of cystic fibrosis
- coughing, sputum production
- chronic respiratory infections
- hemoptysis
- atelectasis
- pneumothorax
- digital clubbing (d/t chronic hypoxia)
metabolic s/s of cystic fibrosis
- “salty taste”
- level of NaCl is 2-5 times above normal perspiration
reproductive s/s of cystic fibrosis
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
tests to diagnose cystic fibrosis
- presence of classic symptoms
- sweat test (easiest)
- family hx
- genetic testing
- pulmonary function test (6+ yrs old)
- chest xray
- stool analysis for fat & enzymes
mgmt of cystic fibrosis
- 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
