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Asthma and Respiratory Flashcards

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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
What is the use of magnesium sulphate for asthma patients?
IV magnesium sulfate may be considered for patients with severe exacerbations not responding to initial treatment. Magnesium sulfate is not recommended for routine use
26
What is a SABA for asthma?
Short acting beta agonist Salbutamol or Atrovent Rescue Medication
27
What is a LABA for asthma?
Long acting beta agonist Salmeterol Used for long term maintenance alongside inhaled corticosteroids Pre-exercise
28
What are anticholinergics used for in asthma therapy? and give example
Ipratropium or Atrovent: inhibits bronchoconstriction and decreased mucous production; Inhaled ipratropium bromide can be used as an add-on therapy to ß2-agonists
29
What is the first line daily maintenance medication therapy for children > 5
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
When are oral corticosteroids used in asthma therapy?
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
What is a consideration when using oral vs inhaled steroids?
Oral will have more systemic effects
32
What would you assess for the CNS of a patient in an asthma exacerbation?
LOC (agitation, drowsiness) ability to speak/cry temperature (febrile? With inflammatory process)
33
What would you assess for the CVS of a patient in an asthma exacerbation?
HR colour (central cyanosis with low sats) capillary refill
34
What would you assess in the respiratory system of a patient in an asthma exacerbation?
rate, coughing, air entry, accessory muscle use
35
What would you assess for GI/GU of a patient in an asthma exacerbation?
appetite, hydration (in and out), air trapping cause distended abdomen putting increased pressure to breath
36
What type of breathers are infants?
Abdominal and nose
37
Describe the structure of the trachea of a child under 8
shorter, angle of right bronchus more acute (smallest at cricoid)
38
How does the trachea develop in the first 5 years of life?
Increases in length, not diameter
39
When do children reach respiratory maturity
12-13
40
What is the most common cause of lower respiratory tract infections?
Respiratory Syncytial Virus (RSV)
41
By which age will all children contract RSV?
3
42
RSV is the leading cause of what 2 severe conditions in infants?
Pneumonia and Bronchiolitis
43
What condition plays a major role in the pathogenesis of asthma?
RSV
44
At which ages are pneumonia and bronchiolitis most prevalent in?
2-6 months
45
Common symptoms of RSV
Rhinorrhea Coughing Wheezing Irritability
46
Which test is done to differentiate between viral infections?
Nasopharyngeal swabs
47
What is the management/treatment of viral infections focussed on and how is it accomplished?
What is the management/treatment of viral infections focussed on and how is it accomplished? Symptom management - position - oxygen - suction
48
What medications are used for RSV?
Ventolin (albuterol SABA) Ribovarin: only given if very ill + decreased respiratory function
49
What is Palivizumab (Synagis )Immunoglobulin
drug used to prevent severe RSV in high risk children. Found not effective to reduce hospitalizations in low-risk infants.
50
How do infection rates vary between covid and the flu
covid: 2-5 people flu: 1
51
What rare covid complication only effects children?
multisystem inflammatory syndrome - inflammation of all organs
52
What is the youngest age the COVID vaccine is available to and how is it dosed?
for children 6 mos-18 (2-3 doses recommended at 8-week intervals)
53
What are the most common side effects of the COVID vaccine?
1. local reaction (sore arm) 2. system effects: fatigue, headache, muscle pain, chills no cases of myocarditis
54
What does the influenza cause?
both upper and lower respiratory infections, including bronchitis, croup, and pneumonia.
55
Clinical Signs of Influenza
fever, cough, runny nose, sore throat, shortness of breath, wheezing, fatigue
56
Treatment of Influenza
1. symptom management 2. prevention through vaccine
57
What is croup?
Laryngotracheobronchitis: viral infection causing swelling in the trachea and larynx
58
Who is croup most commonly seen in?
3 months - 4 years
59
What are the signs of croup?
1. tachypnea 2. stridor 3. seal like barking cough
60
What is pertussis?
Whooping cough; highly contagious bacterial disease
61
What is the treatment of croup?
1. oxygen 2. racemic epinephrine 3. PO or IV corticosteroids
62
What are the initial symptoms of pertussis?
Cold like symptoms: runny nose, fever and mild cough
63
What do pertussis symptoms progress to?
Severe coughing followed by a high -pitched whoop/crowing sound, and/or gasp for air
64
Intense coughing caused by pertussis can lead to
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
Prevention for pertussis
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
When should antibiotics be started for pertussis
within 3 weeks of initial symptoms
67
Respiratory Nursing Diagnosis Examples (6)
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
Respiratory Nursing Intervention Examples (5)
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
When is the MMR vaccine given and why?
At 12 months because babies still have placental immunity
70
Why do some vaccines require a booster?
Initial exposure to antigen creates a primary immune response, but a secondary exposure to antigen helps great a larger, faster secondary immune response
71
If a child is in hospital with a mild runny nose/sickness, can a vaccine still be given?
Yes

Pediatrics (12 decks)

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