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Pediatrics > Asthma and Respiratory > Flashcards

Asthma and Respiratory Flashcards

1
Q

Define Asthma

A

a chronic airway inflammatory disease characterized by the infiltration of airway T cells, mast cells, basophils, macrophages, and eosinophils.

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2
Q

The interaction among the cells and chemicals in the inflammatory process associated with asthma cause what 4 things?

A
  1. bronchial muscle constriction
  2. mucous secretion
  3. swelling of the bronchial tube inner lining
  4. and coughing.
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3
Q

What characterizes asthma?

A

Airflow obstruction
1. bronchial hyper-responsiveness
2. airway edema
3. mucous production

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4
Q

What occurs in the early phase response of asthma?

A

“Allergies” for 1-2 hours

Eosino and basophils cause bronchocontriction

Easily reversible and not very long

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5
Q

What occurs in the late phase/delayed reaction of asthma?

A

Secondary infiltration of cells persisting for hours-days that can cause damage to smooth muscles

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6
Q

What characterizes silent asthma?

A

Frequent coughing, especially at night due to pooling of secretions

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7
Q

What characterizes severe persistent asthma?

A
  • Symptoms throughout day
  • Waking up more than once/week
  • Uses SABA/Ventolin several times a day
  • Normal activity severely limited
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8
Q

What is the prevalence of asthma amongst Canadian children?

A

10-20%

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9
Q

What are reasons for the increase in the incidence of asthma?

A
  • increased urbanization and air pollution
  • second/third hand smoke
  • increased technology/lack of physical activity
  • more accurate diagnosis
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10
Q

What are symptom triggers of asthma and give examples?

A

Usually end up as early phase response/easier to control

  • exercise
  • smoking
  • hot/cold air
  • strong fumes
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11
Q

What are examples of inflammatory triggers of asthma?

A
  • Viral resp infections
  • animal
  • moulds
  • pollens
  • air pollutants
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12
Q

What is the most common cause of an asthma exacerbation?

A

Respiratory infections

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13
Q

What are protective factors against asthma?

A

*related to exposure immunity

  • large family
  • later birth order
  • childcare attendance
  • dog in family
  • living on farm
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14
Q

What 4 things does the PRAM (Pediatric Respiratory Assessment Measure) primarily assess?

A
  1. Oxygen Saturation
  2. Use of accessory muscles
  3. Air entry in both lungs
  4. Wheezing
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15
Q

What are the additional indicators used as assessments on the PRAM?

A
  • nasal flaring
  • reduced activity level, inability to feed/speak in full sentences
  • decreased level of alertness, mental agitation, drowsiness or confusion
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16
Q

Define the scores for a mild, moderate, and severe PRAM

A

Mild: 0-3
Moderate: 4-7
Severe: 8-12

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17
Q

Define the following characteristics someone would need to be rated 0-3 PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow

A
  • normal
  • normal activity/exertional dyspnea
  • normal
  • minimal intercostal retractions
  • moderate wheeze
  • > 94%
  • > 80%
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18
Q

Define the following characteristics someone would need to be rated 4-7 PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow

A
  • slightly agitated
  • decreased activity or feeding
  • in phrases
  • intercostal and substernal retractions
  • loud pan- expiratory and inspiratory wheeze
  • 91-94%
  • 60-80%
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19
Q

Define the following characteristics someone would need to be rated 8-12 PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow

A
  • agitated
  • decreased, stops feeding
  • in words
  • all accessory muscles, nasal flaring, paradoxical thoraco-abd
  • 91-94%
  • <60%
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20
Q

What 6 tests are used to diagnose asthma?

A
  1. Pulse Ox
  2. Chest X Ray
  3. Blood Gases
  4. Pulmonary Function Tests
  5. Peak Expiratory Flow Rate
  6. Allergy Testing
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21
Q

Define the following characteristics someone would need to be rated impending respiratory failure on PRAM for:
- mental status:
- activity
- speech
- WOB
- Auscultation
- SpO2 on RA
- Peak Flow

A
  • drowsy/confused
  • unable to eat
  • unable to speak
  • marked distress at rest
  • chest is silent/absent wheeze
  • < 90%
  • unable to perform task
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22
Q

What is the treatment of an asthma patient with a mild PRAM?

A
  1. Keep O2 > 92%
  2. Salbutamol q 30-60min x 1-2 doses
  3. Consider oral steroids
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23
Q

What is the treatment of an asthma patient with a moderate PRAM?

A
  1. Keep O2 > 92%
  2. Salbutamol q30 min x 2-3doses
  3. Oral Steroids
  4. Consider Ipratropium
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24
Q

What is the treatment of an asthma patient with a severe PRAM?

A
  1. Keep O2 > 92%
  2. Salbutamol + Ipratropium q20 min x3doses
  3. Oral steroids
  4. Consider IV methylprednisolone
  5. Consider continuous SABA
  6. Consider IV Magnesium sulphate
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25
Q

What is the use of magnesium sulphate for asthma patients?

A

IV magnesium sulfate may be considered for patients with severe exacerbations not responding to initial treatment. Magnesium sulfate is not recommended for routine use

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26
Q

What is a SABA for asthma?

A

Short acting beta agonist

Salbutamol or Atrovent

Rescue Medication

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27
Q

What is a LABA for asthma?

A

Long acting beta agonist

Salmeterol

Used for long term maintenance alongside inhaled corticosteroids

Pre-exercise

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28
Q

What are anticholinergics used for in asthma therapy? and give example

A

Ipratropium or Atrovent: inhibits bronchoconstriction and decreased mucous production; Inhaled ipratropium bromide can be used as an add-on therapy to ß2-agonists

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29
Q

What is the first line daily maintenance medication therapy for children > 5

A

budesonide or fluticasone

Inhaled corticosteroids are the first-choice long-acting maintenance inhalers for asthma. They are usually the first type of maintenance inhaler taken daily to help control asthma symptoms for mild-to-moderate asthma.

30
Q

When are oral corticosteroids used in asthma therapy?

A

in “bursts” to manage uncontrolled asthma; Children who have a moderate to severe asthma exacerbation should receive systemic steroids as part of their initial treatment. This medication should be administered as early in the ED visit as feasible

31
Q

What is a consideration when using oral vs inhaled steroids?

A

Oral will have more systemic effects

32
Q

What would you assess for the CNS of a patient in an asthma exacerbation?

A

LOC (agitation, drowsiness)
ability to speak/cry
temperature (febrile? With inflammatory process)

33
Q

What would you assess for the CVS of a patient in an asthma exacerbation?

A

HR
colour (central cyanosis with low sats)
capillary refill

34
Q

What would you assess in the respiratory system of a patient in an asthma exacerbation?

A

rate, coughing, air entry, accessory muscle use

35
Q

What would you assess for GI/GU of a patient in an asthma exacerbation?

A

appetite, hydration (in and out), air trapping cause distended abdomen putting increased pressure to breath

36
Q

What type of breathers are infants?

A

Abdominal and nose

37
Q

Describe the structure of the trachea of a child under 8

A

shorter, angle of right bronchus more acute (smallest at cricoid)

38
Q

How does the trachea develop in the first 5 years of life?

A

Increases in length, not diameter

39
Q

When do children reach respiratory maturity

A

12-13

40
Q

What is the most common cause of lower respiratory tract infections?

A

Respiratory Syncytial Virus (RSV)

41
Q

By which age will all children contract RSV?

A

3

42
Q

RSV is the leading cause of what 2 severe conditions in infants?

A

Pneumonia and Bronchiolitis

43
Q

What condition plays a major role in the pathogenesis of asthma?

A

RSV

44
Q

At which ages are pneumonia and bronchiolitis most prevalent in?

A

2-6 months

45
Q

Common symptoms of RSV

A

Rhinorrhea
Coughing
Wheezing
Irritability

46
Q

Which test is done to differentiate between viral infections?

A

Nasopharyngeal swabs

47
Q

What is the management/treatment of viral infections focussed on and how is it accomplished?

A

What is the management/treatment of viral infections focussed on and how is it accomplished?
Symptom management

  • position
  • oxygen
  • suction
48
Q

What medications are used for RSV?

A

Ventolin (albuterol SABA)

Ribovarin: only given if very ill + decreased respiratory function

49
Q

What is Palivizumab (Synagis )Immunoglobulin

A

drug used to prevent severe RSV in high risk children. Found not effective to reduce hospitalizations in low-risk infants.

50
Q

How do infection rates vary between covid and the flu

A

covid: 2-5 people
flu: 1

51
Q

What rare covid complication only effects children?

A

multisystem inflammatory syndrome - inflammation of all organs

52
Q

What is the youngest age the COVID vaccine is available to and how is it dosed?

A

for children 6 mos-18 (2-3 doses recommended at 8-week intervals)

53
Q

What are the most common side effects of the COVID vaccine?

A
  1. local reaction (sore arm)
  2. system effects: fatigue, headache, muscle pain, chills

no cases of myocarditis

54
Q

What does the influenza cause?

A

both upper and lower respiratory infections, including bronchitis, croup, and pneumonia.

55
Q

Clinical Signs of Influenza

A

fever, cough, runny nose, sore throat, shortness of breath, wheezing, fatigue

56
Q

Treatment of Influenza

A
  1. symptom management
  2. prevention through vaccine
57
Q

What is croup?

A

Laryngotracheobronchitis: viral infection causing swelling in the trachea and larynx

58
Q

Who is croup most commonly seen in?

A

3 months - 4 years

59
Q

What are the signs of croup?

A
  1. tachypnea
  2. stridor
  3. seal like barking cough
60
Q

What is pertussis?

A

Whooping cough; highly contagious bacterial disease

61
Q

What is the treatment of croup?

A
  1. oxygen
  2. racemic epinephrine
  3. PO or IV corticosteroids
62
Q

What are the initial symptoms of pertussis?

A

Cold like symptoms: runny nose, fever and mild cough

63
Q

What do pertussis symptoms progress to?

A

Severe coughing followed by a high -pitched whoop/crowing sound, and/or gasp for air

64
Q

Intense coughing caused by pertussis can lead to

A

Young children become apneic, turn dusky, cough so hard they vomit.)

Vomiting after a coughing spell or an inspiratory whooping sound on coughing, almost doubles the likelihood that the illness is pertussis

65
Q

Prevention for pertussis

A

Immunization-Acellular pertussis vaccine is 71-85% effective; given at 2 months and vaccine offered to mother before birth. With one vaccine - not fully protected, boosted at 4, 6, and 18 months

66
Q

When should antibiotics be started for pertussis

A

within 3 weeks of initial symptoms

67
Q

Respiratory Nursing Diagnosis Examples (6)

A
  1. Ineffective breathing patterns
  2. Ineffective airway clearance
  3. Altered blood gases
  4. Maintain patent airway
  5. Promote adequate air exchange
  6. Potential for promoting increased oxygen exchange
68
Q

Respiratory Nursing Intervention Examples (5)

A
  1. Repositioning for maximization of airway
  2. Supply oxygen
  3. Assure functioning suction equipment/suction as needed
  4. Medications (Ventolin, ABX, treat fever)
  5. Adjust feeds based on coughing/IV for hydration
69
Q

When is the MMR vaccine given and why?

A

At 12 months because babies still have placental immunity

70
Q

Why do some vaccines require a booster?

A

Initial exposure to antigen creates a primary immune response, but a secondary exposure to antigen helps great a larger, faster secondary immune response

71
Q

If a child is in hospital with a mild runny nose/sickness, can a vaccine still be given?

A

Yes

Pediatrics (12 decks)

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