Respiratory Sys Flashcards
Pulse oxy limitations. 9
a. Measures oxygen saturation, not O delivery to tissues
b. Insensitive to hyperoxia.
c. Artificially increased by: Carboxyhemoglobin
d. Artificially decreased by: Intravenous dyes, opaque nail polish, and methemoglobin levels >1%
e. Unreliable when pulse signal is poor: Hypothermia, hypovolemia, shock, edema, movement artifact
Oxyhemoglobin dissociation curve, shifts to right 6
Right shift—ACE BATs right handed:
Decrease affinity of Hb for O 2 (facilitates unloading of O 2 to tissue).
Acid
CO2 (increase in co2)
Exercise
2,3-BPG
Altitude
Temperature (hyperthermia)
Peak Expiratory Flow Rate (PEFR)
Maximal flow rate generated during a forced expiratory maneuver
Forced vital capacity (FVC)
Forced expiratory volume in 1
a. Forced vital capacity (FVC): Maximum volume of air exhaled from the
lungs after a maximum inspiration
b. Forced expiratory volume in 1 second (FEV1): Volume exhaled during
the first second of the FVC maneuver
common symptoms of asthma 5
chronic Cough (>8w) , increased work of breathing, wheezing, breathlessness, chest tightness
when to step up or down in asthma treatment
treatment may be stepped down if asthma is well controlled for at least 3 months and is stepped up 1 or 2 steps if asthma is not well controlled or is very poorly controlled. An alternative to stepping up therapy is to first try one of the alternative options in the same step
BPD definition
- premature birth, characterized by the need for oxygen supplementation >21% for at least 28 days after birth
- Pulmonary barotrauma and oxygen toxicity with subsequent inflammation of lung tissue due to ventilation of the immature lung (ventilation for more than 28 days)
Risk factors for BPD 6
Prematurity, IUGR, maternal smoking, perinatal infection,
mechanical ventilation, supplemental oxygen requirement
Treatment of BPD 8
Bronchodilators, antiinflammatory agents (corticosteroids), oxygen therapy, diuretics, tracheostomy
and prolonged mechanical ventilation for severe cases
increased caloric needs, carefully monitor
fluid status
Complication due to BPD
Pulmonary or systemic hypertension,
electrolyte abnormalities, nephrocalcinosis (from chronic diuretics),
neurodevelopmental or growth delay, sleep-disordered breathing,
aspiration from dysphagia and/or GER, more severe infections with RSV
or influenza
Risk factors for S. bronchiolities 4
age less than 12 weeks, a
history of prematurity, underlying cardiopulmonary disease, or
immunodeficiency
(sweat chloride) test: False-positive results can be seen in. 8
untreated adrenal insufficiency, glycogen storage disease type 1,
hypothyroidism, nephrogenic diabetes insipidus,
malnutrition, mucopolysaccharidosis, and panhypopituitarism.
Test to know if px has CF 3
- newborn screening
- sweat Chloride test
- CFTR genetic analyis
GU complication in CF px. 4
-Nephrolithiasis,
-Men: usually infertile
The vas deferens may be absent.
Undescended testicle
-Women: reduced fertility
Viscous cervical mucus can obstruct fertilization.
Menstrual abnormalities (e.g., amenorrhea)
-Delayed development of secondary sexual characteristics in both men and women
OSA definition
obstruction of the upper airways due to the collapse of the pharyngeal muscles during sleep
OSA Presnetation. 7
snoring
increased respiratory effort during sleep,
sleepwalking,
enuresis,
ADHD
cardiac dysfunction,
systemic & pulmonary hypertension
OSA Risk factors 9
Adenotonsillar hypertrophy, obesity, family history of OSAS,
craniofacial or laryngeal anomalies, prematurity, nasal/pharyngeal
inflammation, cerebral palsy, neuromuscular disease
History in Px with OSA. 11
-Frequent snoring (≥3 nights/week)
-Labored breathing during sleep
-Gasping/snorting noises or observed episodes of apnea
-Mouth breathing
-Sleep enuresis (especially secondary enuresis)
-Sleeping in a seated position or with the neck hyperextended
-Cyanosis
-Headache on awakening
-Daytime sleepiness
-Attention-deficit/hyperactivity disorder
-Learning problems
PE is OSA 7
-Underweight or overweight
-Tonsillar hypertrophy
-Adenoidal facies
-Micrognathia/retrognathia
-High-arched palate
-Failure to thrive
-Hypertension
treatment for OSA
-Adenotonsillectomy
- Watchful waiting for up to 6 months can be considered for otherwise
healthy children with mild/moderate OSAS along with supportive care
(sleep hygiene practices, nasal saline spray, treatment for allergies)
-Intranasal corticosteroids or Oral leukotriene inhibitor
DDX for BRUE
- GER
- Seizure
- abuse/ Trauma
- LRTI
- Arrhythmia
- in born error of metabolism
High Risk BREU 8
- age <2m
- Required CPR
- Event lasted >1min
- more than 1 event of BRUE
- Premature (<32w)
- symptomatic at time of evaluation
- significant physiologic compromise at the time of event
- Dysmorphic features or suspected congenital syndrome
Definition of BRUE
infant younger than 1 year with sudden, brief (<1 minute), and now-resolved episode of at
least one of the following:
1. Cyanosis or pallor
2. Absent, decreased, or irregular breathing
3. Marked change in tone (hyper- or hypotonia)
4. Altered level of responsiveness
most appropriate treatment of first acquisition of Pseudomonas in CF px
inhaled antipseudomonal antibiotic, usually tobramycin + azithromycin
Signs of sever Respiratory Distress 9
*Tachycardia
* Gasping
* Head bobbing
* Inability to speak
* Cyanotic, pale
* Quiet or agitated
* Hypoxic, even with
oxygen
* Chest may be silent
* Consciousness may be
impaired
Signs of moderate Respiratory Distress 4
- Tachypnea
- Recessions are moderate
or severe - Struggles to feed
- Cannot speak in full
sentences
