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Paeds > Cardiorespiratory illnesses > Flashcards

Cardiorespiratory illnesses Flashcards

2
Q

Bronchiolitis (definition, pathophysiology - 3)

A

Viral infection of respiratory tract by Respiratory Syncytial Virus (RSV)

Pathophysiology

  • Acute inflammation, oedema and necrosis of epithelial cells in the bronchioles
  • Immune response
  • Bronchospasm
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3
Q

Bronchiolitis (clinical presentation - 5)

A

Symptoms
- initially cold-like, progresses to:

  • Cough
  • Wheeze +/- crackles (ausc)
  • CXR - clear or patchy
  • Increased work of breathing (respiratory distress symptoms)
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4
Q

Bronchiolitis (PT)

A

Perotta et al (2006) Cochrane review

- vibration + percussion didn’t reduce hospital stay, O2 needed or improve severity?

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5
Q

Pertussis (definition, symptoms - 3)

A

Bordatella pertussis organism

Symptoms

  • cold-like for 7-10 days (most infectious)
  • cough becomes paroxysmal (provoked by crying, feeding etc)
  • spasms of coughing causing hypoxia/apnoea (can lead to seizures and intracranial bleeding)
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6
Q

Pertussis management (medical - 3, PT)

A

Medical

  • Immunisation (2, 4, 6 months)
  • most managed at home
  • erythromycin may reduce infectiousness

PT - NONE in acute

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7
Q

Croup (definition, symptoms - 3)

A

Inflammation of upper airway triggered by recent infection (parainfluenza = common)

Symptoms

  • harsh barking cough, hoarse voice
  • Stridor (begins insp then both) - may continue 7-10 days
  • May develop respiratory failure
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8
Q

Croup (medical - 3, PT)

A

Medical

  • O2 and minimal handling
  • Nebulised adrenaline (short term relief)
  • Antibiotics if another infection suspected
  • Glucocorticoids (rapid effects)

PT - contraindicated in non-intubate child

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9
Q

Asthma (definition/pathophysiology - 3, symptoms - 2)

A

Chronic inflammatory process within the airway.

  • increased smooth mm responsiveness
  • mucus gland hypertrophy

Symptoms

  • recurrent wheezing, breathlessness and cough
  • triggers (allergens, exercise, emotion)
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10
Q

Asthma management (general - 3, PT - 2)

A

General

  • Education
  • Asthma action plans
  • Drug therapy (relievers, spacers etc)

PT

  • not routinely indicated
  • may need to assume other roles
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11
Q

Pneumonia (definition - 2)

A

Acute infection causing lung parenchyma inflammation (gas exchange areas)

  • infection can be bacterial, viral, fungal etc
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12
Q

Evidence for PT in pneumonia (2)

A

None for chest PT in children

Early mobilisation in adults reduces length of stay

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13
Q

Aspiration pneumonia (who, PT - 5)

A

Usually in neurologically impaired children

PT

  • lack of sensitive cough reflex
  • sputum retention
  • can’t mobilise
  • limited positioning
  • – estabilish normal and only aim to restore that
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14
Q

Post-op PT (why - 2, So? - 2)

A

Paeds

  • NOT routinely referred
  • children are often resistant

So

  • asssess respiratory issues/risk for complications
  • educate staff and parents
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15
Q

Post-op PT (intervention strategy - 2, eg.s)

A

Rx

  • Problem list
  • Age appropriate options
  • – e.g. party blowers, bubbles, sitting for play
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16
Q

Chest PT in neuromuscular disease (who, problems - 2, Rx)

A

e. g. DMD and spinal muscular atrophy (SMA)
- main cause of mortility = resp failure

Problems

  • Reduced lung fn
  • Reduced secretion clearance

Rx

  • Assisted breathing, breath stacking
  • Cough assist, suction, percs and vibes
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17
Q

Spinal muscular atrophy (features - 3)

A

Features

  • Usually defective SMN gene
  • Bulbar mm weakness
  • Intercostals severely weak (diaphragm ok until late)
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18
Q

Assisted cough techniques (4)

A

Techs

  • manually assisted
  • cough assist machine
  • deep breathing bag
  • spinal cord or abdominal stimulation???
19
Q

Manually assisted cough (technique, use - 3, consider - 3, research - 2)

A

Push on upper abdomen/chest wall in synchrony with cough

Used

  • often 1st line
  • taught to parents

Consider

  • tolerance
  • positioning
  • meals

Research

  • improved cough peak flow
  • cases studies showing less complications
20
Q

Cough-assist machine (technique - 2, research - 2)

A 
Positive pressure (insufflation) then rapid shift to negative pressure (exsufflation)
- via nose, mouth or trache

Research

  • some suggest increased peak cough flow and insp volumes
  • guidelines recommending use in long-term resp management
21
Q

Assisted deep breathing and breath stacking (technique, research)

A

Positive inspiratory pressure generated by the bag as it is squeezed (MHI type bag)

Recommended in guidelines by no RCT

22
Q

Assessment (Hx, Info from nurse - 4, signs - 7)

A

Hx

Nurse info

  • pt stability/handling
  • episodes
  • pain control
  • previous Rx

Signs

  • Vitals
  • Obs (colour, WOB, chest shape, drains etc)
  • Ventilation
  • ABGs
  • CXR
  • Ausc
  • Medications
23
Q

CF description (3)

A

CF description

  • Autosomal recessive genetic defect on chromosome 7
  • Dysfunctional CFTR (CF transmembrane conductance regulator) protein in epithelial walls
  • Abnormality leads to ion transport changes
24
Q

Effects of CFTR dysfunction (2)

A

Chloride secretion fails, leading to increased reabsorption of sodium ions and water

Creates thick and dehydrated mucous inside the airway lumen

25
Q

CF pathophysiology - progression of airway damage (7)

A

Progression of airway damage

  1. Abnormal CFTR
  2. Abdnormal chloride and water transport
  3. Abnormally thick + dry mucous (bacteria can inflitrate)
  4. Bronchial obstruction
  5. Infection then inflammation
  6. Release of proteases + DNA
  7. Mucous thickens further (Repeats from step 3?)
26
Q

How is CF diagnosed?

A

New born screening program (5-10% missed on screening: need clinical diagnosis later)

27
Q

CF - Respiratory features (4)

A
  1. Cilia damaged, fused and flattened
  2. Mucus plugging (recurrent infection)
  3. Airway collapse, air trapping and hyperinflation
  4. Progressive bronchiectasis
28
Q

How would you see hyperinflation on an CXR?

A

CXR

  • Flattened diaphragm
  • Elongated heart
  • Increased no ribs visible
29
Q

CF - respiratory lung Vs (3), compensation (1)

A

Lung Vs

  • FRC increase (gas trapping)
  • higher closing V
  • inspiratory mm work harder

Compensation
- increased RR (decreased TV) to maintain minute ventilation

30
Q

CF - GI system (description - 2, Rx - 1)

A

90% are pancreatic exo/endocrine insufficient from mucus accumulation in pancreatic ducts
- reduced enzymes = malabsorption of fat from small intestine

Rx
- pancreatic enzyme replacement therapy (<10% energy loss)

31
Q

Growth and development (what, why - 3)

A

Delayed growth from imbalance between nutrient intake and energy requirements

From

  • decreased nutrient intake and malabsorption
  • increased energy expenditure (WOB, lung inflammation)
  • endocrine effects (i.e. glucose intolerance)
32
Q

CF - BMI research (2)

A 
Lower = poor clinical outcome
Improved = less hospitalisations and antibiotics needed
33
Q

CF - Reproductive system (male, female - 2)

A

Male
- 95-99% infertile due to blocked/absent vas deferens

Female

  • Viscous cervical secretions may block sperm entry
  • Success with IVF
34
Q

CF - PT airway clearance (how, techniques)

A

Starts at diagnosis

Techniques

  • normal CI2 techs
  • blowing games
  • Autogenic drainage
  • Exercise
35
Q

Australian consensus on CF PT (1., 2.+3, 3.+2)

A
  1. Education
  2. Newly diagnosed infants Rx
    - before feeds/>1hr after
    - child is awake
    - within family routine
  3. Infants Rx
    - modified postural drainage (4-5 positions) with 3-5mins percussion
    - later introduce vibrations
36
Q

CF potential exercise benefits (3) and testing (what, why - 3)

A

Improved

  • CV, muscle, core stability
  • QoL
  • maybe bone mineral density, lung fn, airway clearance
Testing annually (cardiopulmonary, field tests)
Purpose
- measure disease progress
- exercise prescription
- level of exercise limits
37
Q

General Inhalation Therapy points (3)

A
  1. Optimise timing with airway clearance (e.g. pre-physio bronchodilators; post-physio antibiotics)
  2. Slow inspirations
  3. Mouthpiece better than face mask
38
Q

Pulmozyme (describe, Note - 2)

A

Enzyme cuts up RNA strands released with cell death to thin secretions

Note

  • Timing doesn’t seem to be important pre/post PT
  • Beneficial to adolescents (unsure about under 5)
  • very expensive
39
Q

Hypertonic saline (results - 3)

A

Results

  • mild FVC and FEV1 improvement
  • decreased infective exacerbation rate
  • decreased hospitalisation
40
Q

Mannitol/Bronchitol (description - 2)

A

Sugar alcohol acting as an osmotic agent (dry powder for inhalation)

Expensive and needs more research for funding

41
Q

Musculoskeletal issues with CF (5)

A
  1. Spinal pain (64-94% of CF)
  2. Low BMD (malnutrition, vit D malabsorption, steroids, reduced activity)
  3. Fractures (vertebral, rib)
  4. Thoracic kyphosis (abnormal kyphosis angles)
  5. CF arthropathy
42
Q

Continence (general, Rx)

A

22-64% urinary incontinence in females
- determine cause (stress, urge etc)

Rx
- Qualified continence PT (exercise, electrical stimulation, biofeedback etc)

Paeds (5 decks)

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