Respiratory Problems Flashcards
6 viruses known to cause the common cold:
Rhinovirus Parainfluenza Adenovirus Coronavirus Respiratory syncytial virus (RSV) Influenza
What is Epiglottitis?
- Serious inflammation of the epiglottis that results in supraglottic obstruction; bacterial in origin
- Occurs primarily in children between 2 and 7 years, but it can occur from infancy to adulthood.
- The onset is abrupt and usually preceded by a sore throat, but not by cold clinical manifestations.
- Considered an emergency situation
- Epiglottic swelling is diminished after 24 hours of antibiotic therapy and intubated children can usually be extubated by day 3.
- Bacterial causative agent is usually Haemophilus influenzae.
Symptoms of epiglottitis:
a. High fever
b. Irritability and restlessness
c. Red and inflamed throat with cherry edematous epiglottis (Note: Attempt throat inspection ONLY when immediate intubation can be performed if needed.)
d. Difficulty swallowing and drooling
e. Muffled voice
f. Inspiratory and sometimes expiratory stridor
g. Suprasternal and substernal retractions may be visible.
h. Tripod positioning: while supporting the body with the hands, the child thrusts the chin forward and opens the mouth in an attempt to widen the airway.
i. Sallow color of mild hypoxia, possibly progressing to cyanosis
Thumb sign
In radiology, the thumbprint sign, or thumbprinting, is a radiologic sign found on a lateral C-spine radiograph that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb.
Nursing interventions for epiglottitis
a. Arrange for transport of the child to an emergency facility.
b. Monitor airway status and breath sounds. Assess for signs of respiratory distress: nasal flaring, the use of accessory muscles, stridor, and retractions.
c. Monitor vital signs; take axillary temperature, not oral temperature.
d. Maintain the child in a position that provides the most comfort and security.
e. Do not leave the child unattended and do not allow the child to lie down.
f. Do not restrain the child.
g. Do not attempt to visualize the posterior pharynx using a tongue depressor because this could result in spasm of the epiglottis and airway occlusion.
h. Prepare the child for lateral neck films to confirm the diagnosis.
i. Prepare the child with severe respiratory distress for possible endotracheal intubation or tracheostomy.
j. Establish IV access (any invasive procedure should be done in a setting in which intubation is available if needed).
k. Maintain NPO status.
l. Administer IV fluids and antibiotics as prescribed.,
m. Monitor hydration status and record intake and output.
n. Administer corticosteroids, as prescribed, to reduce edema during the early hours of treatment and for 24 hours after extubation.
What can be done for prevention of epiglottitis?
Prevention - Haemophilus influenzae type B conjugate vaccine beginning at age 2 months
What is LARYNGOTRACHEOBRONCHITIS (INFECTIOUS CROUP)?
- Caused by inflammation of the mucosa lining the larynx and trachea, which results in airway narrowing
- Narrowed airways impede inspiration, resulting in stridor.
- Viral etiology is most common but may have viral or bacterial etiology.
- Most common type of croup
- Primarily affects children less than age 5 years
- Gradual onset, often preceded by an upper respiratory infection
4 stages of LARYNGOTRACHEOBRONCHITIS
Stage I
Anxiousness or fear, Hoarseness (primary complaint),
Croupy cough (like a seal barking),
May demonstrate inspiratory stridor when disturbed
Stage II
Respiratory stridor becomes continuous.
Soft tissue of the neck may retract.
Intercostal retractions of the lower ribs. Accessory muscles.
Stage III
Signs of anoxia and carbon dioxide retention develop such as tachypnea, restlessness, anxiety.
Sweating, Pallor
Labored respiration, mild wheezing may be present.
Stage IV
Intermittent cyanosis progressing to permanent cyanosis
Respiratory failure (cessation of breathing)
ACUTE SPASMODIC LARYNGITIS
Brief attacks of laryngeal obstruction that occur suddenly, chiefly at night.
Absent to mild signs of inflammation.
Usually affects children ages 1 to 3 years and may be recurrent.
There is no associated fever.
Duration of the attack is a few hours and the child feels well the next morning
Treatment for ACUTE SPASMODIC LARYNGITIS
Administer steam from a hot bath or shower or cold steam from a humidifier in the bedroom to relieve mild clinical manifestations.
Attempt exposure to night air to terminate laryngeal spasm.
Administer cough and cold medicines as prescribed if the child has accompanying upper respiratory infection manifestations.
Administer a bronchodilator such as albuterol, as prescribed, if bronchospasm is suspected.
If moderately severe clinical manifestations, child may need to be hospitalized for observation and administration of cool mist and racemic epinephrine therapy.
BACTERIAL TRACHEITIS
What is it and what are symptoms
• Bacterial infection involving the mucosa of the upper trachea
• Common pathogens include Staphylococcus aureus, group A betahemolytic streptococcus, and Haemophilus influenzae
• Exhibits features of both croup and epiglottitis
Affects children ages 1 month to 6 years
• Usually preceded by upper respiratory infection with croupy cough
• May be a complication of laryngotracheobronchitis
• Early identification is essential to prevent airway obstruction.
• Usually follows a slower course than epiglottitis.
Symptoms:
Fever, Brassy cough, Inspiratory stridor
Hallmark: production of thick purulent tracheal secretions which can result in airway obstruction and even respiratory arrest
Sleep apnea risk factors
Risk factors include a family history of sleep apnea, hypothyroidism, recessed chin, large neck, cigarette smoking, and alcohol or sedative use.
Name and describe three types of sleep apnea:
- -Obstructive sleep apnea (OSA) is the most common type and involves the upper respiratory tract. With obstructive sleep apnea, obstruction of the airway occurs at either the soft palate (nasopharynx) or at the level of the tongue (oropharynx).
- -central sleep apnea, the brain fails to trigger the muscles of respiration.
- -Mixed sleep apnea is a combination of these two types.
Blood oxygen levels drop with each apneic episode in all types of sleep apnea.
Without treatment, individuals with OSA are at risk for severe and life-threatening complications of the heart and lungs.
What are some complications of sleep apnea?
Secondary health problems include hypertension, at dysrhythmias, myocardial infarction, stroke, hypoxia (reduced oxygen content or tension), hypercapnia (abnormally increased arterial carbon dioxide tension), pulmonary hypertension, or cor pulmonale (hypertrophy or failure of the right ventricle resulting from disorders of the lungs, pulmonary vessels, or chest wall).
It has been estimated that up to 50% of people with sleep apnea have hypertension.
Symptoms of OSA
presence of a narrowed oropharynx, enlarged tonsils or uvula, or prominent tongue.
Nasal obstruction by a deviated septum may be present.
loud snoring or snorting. Bed partners report this sign because the patient may be unaware.
morning headaches, daytime somnolence (prolonged drowsiness or sleepiness), memory problems, personality changes, gastric reflux, sore throat, impotence, fatigue.
Other than foreign body obstruction, name 3 causes of swelling of the mucous membranes within the larynx that can close off the opening and lead to suffocation.
Swelling of the larynx rarely occurs with acute laryngitis but is more often seen with:
1-epiglottitis,
2-inflammation of the throat, such as in scarlet fever.
3-In cases of a severe allergic reaction (anaphylaxis), the edema can close off the airway, leading to death if not reversed.
Ineffective Ciliary Clearance - Normal cilia beat in a coordinated unidirectional fashion to mobilize mucus and clear particulate matter from the airways. cilia perform this function inadequately or not at all. Ciliary impairment is associated with conditions including:
- Cystic fibrosis
- Primary ciliary dyskinesia
- Kartagener syndrome
- Status post heart-lung or lung transplantation
- Smoking or exposure to second hand smoke
Abnormal amounts of mucus with altered physical properties, inhibiting normal airway clearance, may be present in:
- Cystic fibrosis
- Chronic obstructive pulmonary disease
- Bronchiectasis (COPD), emphysema, chronic bronchitis
- Asthma
- Mechanical ventilation
What is atelectasis?
Atelectasis means “incomplete expansion” and is defined as collapse of lung tissue because of airway obstruction, an abnormal breathing pattern, or compression of the lung tissue. Obstructive atelectasis is the most common type.
What is obstructive atelectasis ?
When the airway becomes completely obstructed, the gas distal to the obstruction becomes absorbed into the pulmonary circulation and the lung collapses.
can be caused by a foreign body, tumor, or mucous plugging.
What is Nonobstructive atelectasis?
caused by loss of contact between parietal and visceral pleurae, as well as compression, loss of surfactant replacement of parenchymal tissue by scarring or infiltrative disease.
Abnormal breathing patterns, such as hypoventilation and a slow respiratory rate, can also lead to atelectasis. In such cases, the lung does not fully expand, which causes the lower airways to collapse.
It is common after surgery, or in patients who were in the hospital. Risk factors for developing atelectasis include:
• Anesthesia
• Mucus that plugs the airway
• Foreign object in the airway (most common in children)
• Prolonged bed rest with few changes in position
• Shallow breathing (may be caused by painful breathing)
• Tumors that block an airway
• Lung diseases
–Pleural effusion
