respiratory system Flashcards
acute otitus media
infection that lasts for up to 6 weeks
chronic otitus media
chronic tissue damage that has an irreversible pathology
peak age of otitis media
6-18 months
otitis media is the most common disease in children in under the age
of 5
OM becomes bilateral how often?
50% of the time
OM and effusion
OM can occur with or with out effusion
OM can be infectious or it can be
non infectious
common in children under 3 years old because
they have a wider straighter shorter eustatian tube
OM can cause inflammation where?
surrounding lymphoid tissue (AKA adenoid lymphoid hypertrophy)
there is obstruction the pharynx due to
enlargement and secretions
risks of OM
infection
perforated tympanic membrane
hearing loss
disequilibrium
common surgical interventions for OM
tympanoplasty (or reconstruction of the tympanic membrane)
predisposing factors for OM
cleft pallate immune defficency allergic rhinitis sinititus down syndrome upper respiratory infections
other risk factors for OM
passive smoking
poor feeding habits
day care
20-40% of pediatric office visits have to do with what?
OM
in acute otitis media a bacterial infection accompanies a
viral URI infection
eustachian tube dysfunctions
secretions access middle ear via eustacian tube
otorrhea
discharge from the ear = perforated tympanic membrane
clinical manifestaions of OM
unilateral, bilateral in children otalgia (pain in ear) fever (often afebrile) nasal discharge cough irritable pulling at ear URI (upper respiratory infection) diahhrea, vomiting, anoxeria falls conductive hearing loss strep throat
antibiotic treatments of OM
antibiotics amoxicilin cefaclor co-trimoxazole ciftriaoxone
analgesics and antipyretics used for OM
acetaminophen
ibuprofen
other treatments for OM
hydration
position on uneffected side
surgical interventions for OM
Myringomectomy
incision in the tympanic membrane
what is asthma?
chronic inflammation of the airways that causes airway hyper responsiveness mucosal edema and mucus production
inflammation leads to reccurent episodes of
cough
chest tightness
wheezing and dyspnea
unlike other COPD
asthma is reversible with or with out treatment (spontaneously sometimes)
does asthma lead to long term airway narrowing?
yes, due to changes causes by the chronic inflammation
Narrowing airway includes
bronchoconstriction, airway edema, airway remodling (causes by chronic inflammation, the airway changes its shape)
hypoxemia can occur
in asthma
three common symptoms of asthma
dysnpea
cough
wheezing
common triggers (allergins)
grass
trees
weeds and pollen
common triggers (pereninnal)
mold
dust
roaches
animal dander
common triggers for asthma
air pollutants cold heat weather changes strong odors/ perfumes smoke exercise viral infections stress medications occupational exposure (nuts and shellfish)
treatment of asthma
antiinflammatory medications
short acting treatments of asthma
relax smooth muscles
relieve acute symptoms onset by stress and exercise
Long acting treatments of asthma
corticosteroids
most potent and effective treatment of asthma
use with a spacer and patient should rinse their mouths to prevent thrush
commonly used long acting treatments
corticosteroids
theophylline- mild bronchodiolator
Salmeterol and Formoterol
commonly used short acting treatments
beta-andergenic agonists Albuterol Proventil Ventolin Levalbuterol Pirbuterol
thrush
fungal infection on skin or mucus membranes
what is croup?
an acute infection of the upper and lower respiratory tract that occurs in children 3mo-3yrs after an URI
croup is characterized by
hoarseness
irriability
fever
brassy cough, dysnpea, and tachynpea, resulting from the obstruction of the larynx
cyanosis and pallor occurs in severe cases
interventions for croup
bed rest
fluid intake
allevation of airway obstruction to ensure adequate respiratory exchange
provide humidity and monitor for signs of distress
what is tonsillitis?
inflammation of the tonsils usually due to an URI
Acute tonsillitis can be confused with
pharyngitis
chronic tonsillitis can be mistake for other disorders such as
allergy
asthma
rhinosinitus
tonsillitis can occur where?
adenoid or pharyngeal tonsils
why does tonsillitis occur after a Uri
because the bacteria is inhaled and can get into the tonsils
symptoms of acute tonsilitis
sore throat
fever
snoring
difficulty swallowing
enlarged adenoids causes
mouth breathing ear ache draining in ear frequent head colds bronchitis foul smelling breath voice impairment noisy respiration
why does tonsilitus present this way?
enlargement of the tonsils causes filling behind the nares, making it difficult for air to travel from the nose to the throat resulting in nasal obstruction. the infection can also travel through the eustain tubes causing acute otitis media which can lead to tympanic rupture
medical treatment of tonsilitis
increase fluid intake salt water gargles rest anaglesics bacterial infections are treated with penicillin (or cephalosporins)
post op position for tonsilectomy
prone to allow draniage from the phayrnx and mouth (with head turned to the side)
pt may not return to a normal position and oral airway must not be removed until
gag reflex has returned
risk of hemorrhage mean that
there is risk for damage to the patients airway
bleeding is common however
excess bleeding needs to be reported
teach patient that
bleeding may occur up till 8 days after surgery
sore throat
stiff neck
minor ear pain
vomiting
all may occur in the first 24hrs after surgery
encourage what? after tonsillectomy
ice chips, soft foods and liquids
apply what? after tonsillectomy
ice collar
pulmonary perfusion
blood flow through the respiratory system
goal of oxygen therapy
provide adequate transportation of oxygen in the blood while decreasing the work of breathing and reducing the stress on the myocarduim
oxygen transport is dependent on
cardiac output
hemoglobin
arterial oxygen content
metabolic requirements
hypoxemia
decrease in the arterial oxygen saturation (low o2 in blood)
manifestation of hypoxemia
changes in mental status
impaired judgement
agitation, confusion, disorientation, confusion, lethargy, increased BP, changes in HR, dysrythmias, central cyanosis, disphoresis, cool extremities
hypoxemia leads to
hypoxia
what is hypoxia?
decrease in oxygen saturation of tissues severe hypoxia is life threatening
rapidly occuring hypoxia leads to changes in what?
central nervous system
lack of coordination or impaired judgement
fatigue, drowsiness, apathy, inattentiveness, delayed reaction
hypoxia can occur in patients with
COPD, CHF
hypoxia is assessed by
ABGS, pulse ox, clinical evaluation
hypoxia is the leading cause of
post op mortality and morbidity
indicators of poor respiratory status
confusion restlessness diaphoresis pallor tachycardia tachypnea hypertension
preoperative risk factors
preexisiting medications life style weight age
intraoperative risk factors
location of incision
horizontal vs vertical
anesthia
duration of anesthia
when pt coughs
have them hold a pillow over their chest
post op risk factors
having an NG tube in longer that 24hrs
immobilization
pain
hypoventalion causes
decreased o2 transfer
mild hypoxemia
moderate hypoxemia
respiratory acidosis
causes of post op hypoventilation
residual paralysis airway resistance increased tissue resistance lung and chest compliance obesity abdominal distension dressings and casts
what is atelectasis?
incomplete expansion of the lung or part of the lung
Microatelectasis
involves the collapse of aveoli
macroatelectasis
collapse of a lobe or lung, normally not bilateral
atelectisis can is caused by
intrinsic obstruction
extrinsic airway obstruction
lung tissue may be compressed
aveoli may be incompletely and eventually collapse
acute atelectisis
closure or collapse or airless condition of the aveoli caused by hypoventilation or obstruction of the airway
chronic atelectisis
with out enough surfactant lungs may collapse
acute atelectasis is usually a
post operative complication
clinical manifestations of atelectasis
insidious cough sputum acute marked distress chronic, similar to acute pt may be anxious
universal sign of atelectasis
low grade fever
nursing diagnosis for atelectasis
ineffective airway ineffective gas exchange infection activity intolerance altered mobilization
nursing interventions for atelectasis
education auscultation pulse ox t and p cough/deep breathe incentive spirometry suctioning ambulation chest physiology thoracentesis mechanical ventilation bronchodialators
thoracentesis
procedure that removes the fluid from the pleural space
what is pneumonia?
lower respiratory infection
most common cause of death from infectious disease, at all ages
8th leading cause of death
treated inpatient and outpatient
caused by bacteria, myobacteria, fungi, parasites, viruses
community acquired pneumonia
common cause strep pneunomia all ages in children- URI acute symptoms Gold standard CXR treatment 10-14 days of antibiotics fluids and rest occurs in community or 48hrs after hospitalization
hospital acquired pneumonia
nosocomial common causes- staph, strep, psuedomonas, MRSA CBC, CXR, blood culture, sputum culture colonized by multiple organisms occurs 48 hours after admission
immunocompromised pneumonia
caused when a pt is immunocompromised and cannot fight of the infection
aspiration pneumonia
inhalation of gastric content
regurgitation is silent
chemical irritation and pneumonia
signs and symptoms depends on severity
prevention and reduction of complications
can cause tachycardia, dysnpea, cyanoisis, hyper or hypotension, death
clinical manifestations of pneumonia
depends on extent and location depends on cause depends on patients condition predominant symptoms low grade fever, cough, myaglia plueratic pain, mucoid sputum
inoculum
introduction of microorganisms or pathogens into the body
gold standard cxr
review of cxr by 3 radiologists
ventilation associated pneumonia
type of pneumonia that occurs >48hrs after ventilation
causes of aspiration pneumonia
brain injury, decreased LOC, drug or alchohol, intoxication, seiziure activity, flat body positioning, stroke, swallowing disorders,v
