Respiratory System Disorders Flashcards
Viral cause of bronchiolitis
Respiratory syncytial virus (RSV), adenovirus, parainfluenza
Part Affected (Laryngo-tracheo Bronchitis)
Subglottic
Medications for bronchiolitis
a. Nebulizer therapy-bronchodilator, corticosteroids and beta agonists
b. Antipyretics(acetaminophen)
c. Mild sedative
d. Antibiotics only if (+) secondary bacterial infection (otitis media)
e. Antiviral therapy
f. RIBAVIRIN (VIRAZOLE)
Diagnosis of croup
- History (fever, cold symptoms, recent viral infection) and clinical manifestations
- X-ray of the neck
- WBC and differential count
→ may go undiagnosed until the child presents with persistent unilateral nasal drainage (if the
neonate develops respiratory infection) and seem to have more nasal obstruction not
proportional to the degree of infection
→ careful questioning reveals an unusual susceptibility to upper respiratory symptoms
unilateral choanal atresia
Disorders of the respiratory system
- Choanal atresia
- Croup
- Bronchiolitis
- Cystic Fibrosis
diagnostic tests in cystic fibrosis: insertion of a hollow needle through abdominal wall into the uterus to obtain cells
from amniotic fluid around the baby. The fluid is then tested to see if both of the baby’s CFTR genes
are normal.
Amniocentesis
less preferred preventive drugs for bronchiolitis
RSV-IGIV
cystic fibrosis is common to what race
caucasians (northern Europe)
high-pitched or squeaking noise when breathing in created by narrowing of the
airway
inspiratory stridor
complications of cystic fibrosis
o Chronic Respiratory infection – pneumonia
o Pneumotho rax
o Chronic respiratory failure
o Cor Pulmonale
o Liver Disease
o DM
o Osteoporosis and arthritis
– loud, harsh, “brassy” or “barking” cough (similar to a the noise of a seal barking)
o the result of swelling around the vocal cords (larynx) and windpipe (trachea). When the cough
reflex forces air through this narrowed passage, the vocal cords vibrate with a barking noise.
croupy cough
diagnostic tests in bronchiolitis: shows hyperaeration and consolidation (similar to that of pneumonia); shows collapse
of alveoli/atelectasis
a. major risk factor for COPD in later life
Chest X-ray
(a drug that stimulates sweating
pilocarpine
A chronic multisystem disorder characterized by exocrine gland dysfunction, inherited as an autosomal
recessive trait
cystic fobrosis
diagnostic tests in cystic fibrosis:
* This test is used to evaluate fat absorption as an indication of how the liver, gallbladder,
pancreas, and intestines work. Normal fat absorption requires bile from the gallbladder (or liver
if the gallbladder has been removed), enzymes from the pancreas, and normal intestines.
* 24 hour stool collection (or sometimes 72 hours or days)
* Consume a normal diet containing about 100 grams of fat per day for 3 days before starting the test;
no substances that interfere with result such as enemas, laxatives, mineral oil
Fecal fat test
How to maintain patent airway in croup
-Assess respiratory status every 2-4 hours or more often as indicated.
-Keep emergency suction and tracheostomy intubation tray at bedside.
-Care of the child in a croupette
-Administer meds as prescribed.
-No to visual inspection of mouth and throat unless when “E” intubation can be done
- .Position head of bed up, not supine.
-.Suction PRN
Medications for bronchiolitis: for high risk infant/child
antiviral therapy
sex affected in cystic fibrosis
male and females are equal
-decreases viscosity of mucus
dornase alfa
diagnosis of choanal atresia:
to determine the exact location of obstruction
Radiography using contrast material
croup is most common at what age
3mos to 5yrs
clinical manifestations of bronchiolitis
o Preceded by URI, manifested as nasal stuffiness, mild fever progressing to increased respiratory
distress (after 1-2 days)
➢ Tachypnea
➢ Nasal flaring
➢ Intercostal and subcostal retractions in inspiration
➢ Dyspnea
➢ Apnea
➢ Mild fever
➢ Tachycardia results from hypoxia
affected individual married to unaffected individual will have =
all children will be carriers
Manifestation (Laryngo-tracheo Bronchitis)
Low grade fever
Non toxic appearance
diagnostic tests in cystic fibrosis to check absence of pancreatic enzymes
a. FECAL FAT TEST/ QUANTITATIVE STOOL FAT DETERMINATION
b. TRYPSIN AND CHYMOTRYPSIN IN STOOL
c. SECRETIN STIMULATION TEST/ PANCREATIC FUNCTION TEST
Route of RSV-IGIV
IV (infused in 3-4 hours)
40% of patients with cystic fibrosis are diagnosed at what age
18 y/o and above
what results from unabsorbed food fractions excreted in the stool
steatorrhea
Croup management
a. Mild cases are managed at home
✓ Cool air vaporizer in child’s room
✓ Sometimes spasm relieved by sudden exposure to cold air- Breathing in cool night air/air
from open freezer/taking child to a cool basement/garage
✓ Warm mist by steam from hot running water in a closed bathroom could be helpful
✓ Hot steam in a pan because of hazards (burns)
b. When condition does not improve or becomes severe, needs to be hospitalized
surgeries for choanal atresia
-transnasal
-transpalatal
Treatment (Laryngo-tracheo Bronchitis)
Humidity
Racemic epinephrine
Bacterial cause of bronchiolitis
Mycoplasma pneumonia
Onset (Acute Epiglotitis)
rapidly progressive
(hours)
sex at risk in choanal atresia
females
Severity in Acute Laryngitis Spasmodic
least serious
Causative
Agent (Acute Epiglotitis)
Bacterial: usually HIB
Where do you take temperature?
Axillary
cystic fibrosis is inherited as
autosomal recessive trait
Types of choanal atresia
unilateral and bilateral
chest physiotherapy: high frequency chest wall oscillation to loosen secretions
Devices Thairapy rest device
peak year of croup
2nd year
diagnostic tests in cystic fibrosis for Chronic pulmonary involvement
a. CHEST X-RAY
b. PULMONARY FUNCTION TEST
Part Affected in Acute Laryngitis Spasmodic
glottic
anti-inflammatory effects decrease subglottic edema
corticosteroids
nursing care for choanal atresia
- Airway support
- Hydration and nutrition
when to suction in croup
bacterial tracheitis
complication of choanal atresia
restenosis
diagnostic tests in bronchiolitis
- History (exposure to cold the previous week) and physical exam
- Nasal or nasopharyngeal culture
- Chest X-ray
- Pulse oximetry
- ABG
- CBC
what results from absence of enzymes that causes malabsorption of CHO,
fats and CHON
malnutrition
diagnostic tests in cystic fibrosis which are Prenatal genetic tests can find out if baby has CF:
amniocentesis
chorionic villus biopsy
In sweat test, how many hour is it in paraffin before transferring into the weighing jar
1 hour
loosens and liquefies pulmonary secretions
mucolytics
Management of fluid and electrolyte balance in cystic fibrosis
- add salt to all meals, especially in summer
- give salty snacks
NURSING DIAGNOSES for croup
➢ Altered tissue perfusion (cardiopulmonary) r/t partially obstructed airway
➢ High risk for fluid volume deficit r/t inability to meet body requirements and increased
metabolic demands
➢ Fear/anxiety r/t acute illness, hospitalization and uncertain course of illness and treatment
➢ Knowledge deficit r/t diagnosis, treatment, prognosis and home care needs
at what year of age can surgery be done in unilateral choanal atresia
2-3 y/o
Part Affected (Acute Epiglotitis)
Supraglottic
most common age of affected in bronchiolitis
6mos, rare after 2yrs
CLINICAL MANIFESTATIONS of choanal atresia
➢ Difficulty of breathing following birth which may result in cyanosis (unless infant is crying
➢ Inability to nurse and breathe at the same time
➢ Unable to pass a catheter through each side of the nose into the throat
➢ Persistent one-sided nasal blockage/discharge
depth of insertion of catheter in choanal atresia
3-4 cm in nasopharynx
cystic fibrosis is characterized by
exocrine gland dysfunction
cause of cystic fibrosis
defect in the gene cystic fibrosis transmembrane conductance regulator (CFTR)
Lower respiratory illness that occurs when an infecting agent causes inflammation and
obstruction of the bronchioles
BRONCHIOLITIS
Manifestation in Acute Laryngitis Spasmodic
Afebrile Mild distress
respiratory
Disadvantage/advantage of PALIVIZUMAB
▪ Does not interfere with
MMR, and varicella vaccine
▪ Pain and mild transient
erythema at the site
Nursing care for croup
A. Maintain patent airway and provide for adequate respiratory exchange
B. Promote balanced fluid and nutrition
C. Promote rest and comfort
D. Support and educate child and parents
opens large and small airway
bronchodilators
o causes mucosal vasoconstriction and subsequent decrease in edema
o rapid action but sometimes symptoms “relapse” within 2 hours (assessment is
important)
racemic epinephrine (nebulized)
surgeries for choanal atresia: requires less operative time and causes slightly less morbidity
related to the incision, but the risk of the nasal passages closing later may be higher.
transnasal
70% of patients with cystic fibrosis are diagnosed at what age
2 y/o
Manifestation (Bacterial Tracheitis)
High fever
Thick purulent
tracheal secretions URI
appears as viral
croupy cough but no
response to LTB
therapy
In pancreatic function test,
* An NGT is inserted into the duodenum. Secretin is given through this tube, and the contents of
the released material from the duodenum are removed through the tube over a period of
about 2 hours.
* Fast for 12 hours prior to the test
most croup is caused by
virus
In sweat test, The negative
electrode is covered with gauze and saturated with
bicarbonate solution
cause of croup
virus
bacteria/allergic reaction
4F’s of Cystic Fibrosis
❖ Frothy (bulky and large quantity)
❖ Foul-smelling
❖ Fat-containing (greasy)
❖ Float
risk factors for bronchiolitis
o Children in day care
o Kids who are exposed to cigarette smoke
o Formula-fed infants
o Those at high risk for asthma
o exposed to an adult or another child with a cold in the previous
week.
In sweat test, positive electrode is covered by
gauze and saturated with
pilocarpine
A term applied to a broad classification of UPPER AIRWAY illness that result from inflammation and
narrowing of the larynx (voice box), the trachea (windpipe) and the bronchi (larger branching air tubes)
croup
closure of a normal opening
Atresia
diagnosis of choanal atresia: done to evaluate the extent of the choanal atresia once a feeding tube fails to pass through the nasal
passage; it detects the composition (membranous or bony) and thickness of the atresia, the depth of the
nasopharynx and any associated skull base anomalies
CT scan