broncholitis/RSV Flashcards
(38 cards)
what is bronchiolitis?
inflammation of the fine bronchioles and small bronchi
- lower resp tract infection
- usually due to viruses (particularly respiratory syncytial virus (RSV))
- under 2 years old, peak at 6 months
RSV?
most frequent cause of hospitalization in children less than 2 years of age
- higher rates in indigenous populations in Northern Canada
- 1% mortality rate, 3% in underlying conditions
- RSV to asthma link
- can live on surfaces for several hours, hands for 30 minutes
increased risk of RSV
- if born in november, december, january
- siblings in day care
- more than 6 individuals
- low birth weight
- male
- formula fed (immune system isnt as good)
- eczema family history
initial manifestations of RSV
- rhinorrhea
- pharyngitis
- coughing
- wheezing
- ear/eye drainage
- intermittent fever
with progression the symptoms of RSV…
- increased coughing and wheezing
- tachypnea and retractions
- cyanosis
severe RSV?
- tachypnea (over 70 breaths/min)
- listlessness
- apnea
- poor air exchange
- decreased breath sounds
assessment for RSV?
- color
- movements (headbob)
- work of breathing
- auscultation (stridor, wheezing)
- secretions
- circulation and hydration
- caregivers
work of breathing findings?
- resp rate
- nasal flare
- tracheal tug
- in drawing, retractions
- seesaw breathing
- sounds: grunting
- coughing
- crying
circulation and hydration findings?
- mucous membranes (color, moisture)
- peripheral and central color mottling normal
- Ins and outs (IV hydration if nothing by mouth)
- weight: not only for intake and output, medications are weight based!!
- nutritional status: at a nutritional risk, if baby cannot coordinate movement for sucking at risk
- assess sucking reflex!
- RR greater than 55??/
diagnostics for RSV?
o Nasopharyngeal swab- RSV antigen o Chest x-ray: hyperinflation o Arterial blood gases o CBC, electrolytes Any other associated infections?
therapeutic management of RSV?
- treat symptoms
- cool humidified oxygen
- adequate fluids
- airway maintenance
- antipyretics (whether to treat or not??see how child is doing, may be a physiologic response, only treat if over 38.5…)
- home vs hospital (only children with resp distress and who are at risk (have other comorbidities) stay
- tachypnea
- supplemental humidified oxygen
- brochodilator (assess for response, not every child will be ordered them, only stay on if helpful)
- epinephrine nebs (hypertonic nebs, stimulate alpha and beta 2 receptors, relaxes smooth muscles of bronchial tree, relieving bronchial spasm)
- 3% NS nebs (improves mucociliary clearance- like a mucolytic)
nursing diagnosis for RSV (common…)
- ineffective breathing pattern
- potential fluid volume deficit
- potential fluid and electrolyte imbalance
- potential alteration in nutritional status
- potential discomfort
- potential anxiety
- potential knowledge deficit
nursing interventions for RSV?
- VS routine and PRN
- oxygen above 96%
- blow by (nasal prologns too big)
- NS drops prn
- cardiac sling
- sat probe change q4h (burns)
- stirct ins and outs
- daily weight
- NPO if RR over 55 bpm
- hydrate the mother if BF, small frequent feeds
- group care (everyone assessing the child)
- tylenol
- droplet precautions
- grouping with other RSV positive patients
- nursing assignment to limit contact with non-RSV patients
- encourage breastfeeding
- management of secretions
- provide meds (small masks, syringe meds)
- oral and IV hydration
- frequent monitoring
- health promotion opportunities
goal of pharmacology care?
prevent and control symptoms
- reduce freq and severity of exacerbations, improve health status, improve exercise tolerance
- nursing considerations: pre/post resp assess, pt teaching, life span considerations
drugs by inhalation: MDI
metered-dose inhaler
- pressured devices
- 1 minute in between
- teaching is important
- spacers
drugs by inhalation: respimats
- fine mist
- less drug in mouth and oropharynx
dry-powder inhalers (DPI)
micronized powder
breath activated
spacers not used
nebulizers?
mist
for some this may be more effective
with spacer….
57% inhaler device, 22% mouth and throat, 21% lungs
without spacer…
10% inhaler device, 81% mouth and throat, 9% lungs
short-acting beta 2 agonists?
bronchial smooth muscle relaxation causing bronchodilation through activating beta2-adrenergic receptors
- indication: prevention or relief of bronchospasm in asthma or COPD, used PRN inhaled
- side effects: may see nausea in larger doses, anxiety, palpitations, tremors, increased heart rate—> tachydysrhythmias
contraindication: BETA BLOCkers!! or taking MAOIs/other sympathomimetics r/t risk of hypertension - SALBUTAMOL
long-acting beta 2 agonists?
bronchial smooth muscle relaxation causing bronchodilation
-prevention/long term control of bronchospasm in asthma or COPD
-fixed schedule (not PRN, must be given with a glucocorticoid in asthma. inhaled)
may increase risk of death if used MONOTHERAPY
-effect may be diminished if taking beta blockers, avoid taking MAOIs other sympathomimetics r/t hypertension
anticholinergics?
blocks muscarinic receptors in the bronchi—> reduced bronchoconstriction
-indication: slower onset compared to beta agonists. used for prevention of bronchospasm. COPD “off label” for asthma
-inhaled, 1 min gap between inhalers
-SE: dry mouth, throat, nasal congestion, not readily absorbed systemic but if it does can increase intraocular pressure
-contraindications: pt with acute angle glaucoma or prostate enlargement. possible additive toxicity in use with other anticholinergic drugs
EXAMPLE: IPRATOPIUM
methylxanthines?
mech: bronchodilation by relaxing smooth muscle of the bronchi
-not firmly established, likely from blocking adenosine receptors
-indication: chronic, stable, asthma. decrease frequency and severity of attacks. no longer recommended in COPD. oral or IV
side effects: toxicity!! nausea, vomiting, diarrhea, insomnia, restlessness
contraindications: caffeine, tobacco, marijuana, many drug interactions
example: AMINOPHYLLINE, THEOPHYLLINE
