Exam 1: Respiratory Alterations Flashcards
(170 cards)
1
Q
What are the differences in the anatomy and physiology of the infants’ respiratory system that increases the risk for respiratory disease?
A
- Neonate’s airway is 50% smaller than adults
- Infants are obligatory nose breathers
- Brief periods of apnea are common
- Irregular respiratory rate
- Increased metabolic rate increases oxygen needs
- Eustachian tubes are relatively horizontal, increases the risk for bacteria entering the middle ear.
2
Q
Otitis Media
A
Fluid and infection or blockage of middle ear
3
Q
What precipitates Otitis Media?
A
Allergies
4
Q
Incidence of Otitis Media
A
- Peak age: 6 months to 6 years (most before the age of 2)**
- Highest in the winter and spring
5
Q
What are risk factors for Otitis Media?
A
- Attending day care centers
- Cigarette smoke exposure
- Allergic rhinitis
- Bottle propping (d/t reflux of formula into eustachian tube from nasopharynx)
6
Q
Clinical Manifestations of Otitis Media
A
- Otalgia (earache
- Tympanic membrane is bulging, opaque, red, diffuse light reflex, decreased mobility and obscured landmarks.
7
Q
How is otitis media diagnosed?
A
- History of signs and symptoms
- Pneumatic otoscopy
8
Q
Treatment/Management of Otitis Media
A
- 80% demonstrate spontaneous resolution
- Relieve pain: Acetaminophen
- ABT: amoxicillin; if allergy or resistance, azithromycin or second or third generation cephalosporin.
- Possible tympanostomy tube placement if recurrent ear infection.
9
Q
Symptomatic Treatment of Otitis Media occurs when?
A
-Done for 48-72 hours for >6 months
10
Q
If Otitis Media is recurrent, what needs to be done?
A
Monitor for hearing, language and learning problems
11
Q
Acute Otitis Media
A
Effusion and inflammation of the middle ear space that occurs suddenly and is associated with other signs of illness.
12
Q
Otitis Media with Effusion
A
Presence of fluid behind tympanic membrane without signs of infection.
13
Q
Causes of Otitis Media include
A
- S. Pneumoniae
- H. Influenzae
- M. Catarrhalis
14
Q
Functions of Eustachian Tube
A
- Ventilates the middle ear by opening and closing regularly which equalizes pressure & permits middle ear drainage
- Protects middle ear from nasopharyngeal secretions & sound pressure
15
Q
Why do episodes of otitis media usually occur at about 6 months?
A
Because this is when maternal antibody levels decline.
16
Q
The younger the child is, the more they are predisposed to OM because of
A
Horizontal Eustachian tubes
17
Q
Early onset of acute otitis media can increase the risk for
A
Recurrent episodes
18
Q
Pathophysiology of Otitis Media
A
- Obstruction of ET -> inadequate drainage and ventilation of the middle ear.
- Effusion accumulates in middle ear creating growth medium for bacteria: after upper respiratory tract infection, pathogens travel from nasopharynx to ET.
- Crying, yawning or sucking can cause negative pressure -> drawing mucus through the ET -> accumulation of purulent fluid in middle ear -> pressure and pain.
19
Q
Otalgia (earache) discomfort is expressed through
A
- Pulling/holding their ears
- Rolling their head from side to side
- Young children usually verbalize pain
20
Q
Tympanic membrane in Otitis Media With Effusion
A
- Retracted
- Dull gray or yellow
- Air fluid level or air bubbles visible
- Decreased mobility and distorted land marks
21
Q
When are antibiotics given to children with otitis media?
A
- After 72 hours if the child is > than 6 months of age and the infection hasn’t resolved on its own.
- If younger than 6 months, treated immediately d/t their immature immune system and risk for ear infection.
22
Q
Tympanostomy Tube Placement
A
Pressure equalizing tubes
23
Q
For patients with otitis media, DO NOT USE
A
Steroids, antihistamines, decongestants and antibiotic ear drops
24
Q
Myringotomy
A
Surgical incision of eardrum to alleviate severe pain of AOM, to drain middle ear in presence of complications, or for purulent fluid to drain for culture specimen.
25
Functional Complications of Otitis Media:
- Hearing loss -> mainly conductive and mild in severity
- Tympanosclerosis (eardrum scarring)
- Adhesive OM (glue ear)
- Cholesteatoma
26
What causes complications from otitis media?
-Negative middle ear pressure
-Effusion in the middle ear
-Structural damage to the tympanic membrane
Fear consequence of development with speech, language and cognition..
27
Continue negative middle ear pressure
Draws the tympanic membrane inward -> resulting in impaired sound transmission, perforation of thinned-out areas, or infection in the pockets and later cholesteatoma.
28
Tympanosclerosis
Eardrum scarring due to inflammation of the middle ear
29
Eardrum perforation is due to
AOC and Chronic disease -> surgery may be required to close
30
Adhesive OM (glue ear)
Thickening of mucous membrane by proliferation of fibrous tissue that can cause fixation of the ossicles with a resultant hearing loss.
31
Cholesteatoma
- Least common, but most dangerous sequela of OME.
- As it enlarges, it erodes all structures it encounters, especially bone, destroying the ossicles and gaining entry into the inner ear and meninges.
32
Cholesteatoma Signs and Symptoms
- Foul smelling, grayish yellow discharge
- Sometimes pain
- Permanent progressive hearing loss.
33
Treatment for Cholesteatoma
Surgical excision of entire cholesteatoma
34
Prevention of Otitis Media
Reduce Risk Factors:
- Breast feed infant for the first 6 months of life
- Avoid propping bottle
- Decrease or discontinue pacifier use after 6 months
- Prevent exposure to tobacco smoke
Vaccination: pneumococcal conjugate vaccine
35
Prognosis for Otitis Media
- Most cases of OM resolve eventually; conductive hearing loss is common
- Sensorineural may be present with severe/chronic recurrent OM
- The longer the fluid is present, the greater the sensorineural hearing loss is.
36
What facilitates drainage of ear in patients with otitis media?
Local heat over the ear while the child lies on the affected side
37
Nursing Care for Ear Drainage
- External canal may be cleansed with sterile cotton swabs or pledgers coupled with topical ABT
- Ear wicks/gauze placed in ear after surgical procedure: loose enough to allow accumulated drainage to flow out of the ear, if not, infection can transfer to mastoid process.
38
Anticipatory guidance about hearing loss
- Speak louder at a closer proximity while facing the child
| - Seat child closer to the front of the class
39
Anticipate behavioral changes in children with otitis media
- Inattentiveness or lack of awareness to environmental sounds
- Requests for repetition in conversation, mishearing of content
- Softer/louder voice than usual
- Poor attention span and fidgety behavior when a group listening situation
- Aggressiveness and low frustration tolerance because of frequent communication breakdowns
- Impaired speech and language skills
40
Tympanostomy teaching
- Keep bathwater and shampoo out of ear
- Make parents aware of appearance of grommet (tiny, white, plastic spool-shaped tube) so they recognize if it falls out → they are usually colored as well, know color
41
Forceful blowing of nose during upper respiratory tract infection is discourage to avoid what?
Organisms ascending through Eustachian tube.
42
Pharyngitis
- Inflammation of pharynx and surround lymphoid tissue.
- Can be viral or bacterial.
- Self-limiting and relatively minor
43
Pharyngitis: Streptococcal Infections can have serious complications including
- Rheumatic Fever
| - Acute Glomerulonephritis
44
What are viral causes of pharyngitis?
RACE
- RSV
- Adenovirus
- Coronavirus
- Enterovirus
45
What are bacterial causes of pharyngitis?
Group A beta-hemolytic streptococcal (GABHS)
46
Tonsillitis
- Inflammation and infection of two palatine tonsils.
| - Can be viral or bacterial; (GABHS) most common
47
Pathophysiology of Pharyngitis
- Often accompanies a cold and tonsillitis is usually present with pharyngitis.
- Infection and inflammation -> enlarged tonsils -> difficulty swallowing and breathing.
- Enlarged adenoids -> obstruction of ET -> otitis media and hearing impairment
- Hypertrophy of adenoids -> blocked passageway between nose & throat -> mouth breathing or obstructive sleep apnea.
48
Incidence for Pharyngitis and Tonsilitis
- Incidence peaks between 4-7 y/o
| - GABHS occurs more in the winter
49
Clinical Manifestations of Pharyngitis and Tonsilitis
- Fever
- Sore throat
- Enlarged tonsils: bright red, may be covered with exudate or cryptic plugs; Adenoids (pharyngeal tonsils)
- Difficulty swallowing
- Mouth breathing
- Unpleasant mouth odor
50
Evaluation for Pharyngitis and Tonsilitis includes
1. Rapid Strep Test -> swab tonsils
| 2. Throat Culture
51
Rapid Strep Test
Rapid streptococcal antigen tests -> 20% false negatives
52
Throat Culture
- Done at the same time
| - If the strep test comes back negative, make sure to send a culture to confirm the negative test.
53
If there is a history of multiple strep throat,
- Make sure chart as history of strep and how many times
| - If multiple strep throats -> could lead to mitral stenosis -> heart issues can occur later on in life.
54
Symptomatic Treatment of Pharyngitis and Tonsilitis
- Pain relief (acetaminophen or ibuprofen if older than 6 months)
- Provide clear, cool liquids
- Rest
- Warm salt water gargles
- Warm or cool compresses to neck
- DO NOT force to eat
- Tonsillectomy in severe cases
55
If positive strep test:
- Give ABT; amoxicillin (1st choice)
- 2nd choice: erythromycin or cephalosporin
- 3rd choice: PCN G IM
56
Tonsillectomy
- In severe cases, if kissing tonsils and they won’t go down then you will remove tonsils.
- Not performed in children under 3 yo
57
Contraindications for Tonsillectomy
- Active infection
| - Cleft palate
58
Preoperative Interventions for Tonsillectomy: Assessment
- Signs of active infection, bleeding & clotting studies (throat is vascular)
- Loose teeth (decrease risk of aspiration during surgery)
59
Nursing Interventions for Patients with Pharyngitis and Tonsillitis
- Prone or side-lying position → side laying is always better to facilitate drainage
- If child vomiting → NPO for 30 minutes and then resume clear liquids
- Ice for comfort
- Provide clear liquids
60
What should be avoided in patients that have undergone a tonsillectomy?
- Avoid red foods/drinks, milk products
| - No straws, forks or hard pointy foods (ex. Chips) to prevent trauma
61
Tonsillectomy: Monitor for
- Excessive swallowing
- Increased pulse
- Signs of bleeding
62
Manifestations of bleeding include
- Frequent swallowing,
- Upset stomach
- Clearing of the throat
- Elevated pulse
- Decrease BP
- Vomit bright red blood, restlessness not associated with pain
63
Epiglotitis
- Acute inflammation and swelling of epiglottis and surrounding tissue -> pretty far back in the throat.
- Life threatening -> rapidly progressive condition.
64
Incidence of Epiglotitis
- Occurs most often 3-7 years old
| - Decreased incidence -> Hib vaccine
65
What causes epiglottitis?
H. Influenza
66
Clinical Manifestations of Epiglottitis
- Abrupt onset of symptoms: child will go to bed asymptomatic and awaken with sore throat/pain on swallowing.
- Drooling
- Upright, tripod position
- Sore throat
- High fever (102-104)
- Difficulty swallowing/talking
- Chin thrust out and mouth open
- Epiglottis is edematous and cherry-red
- Can rapidly progress to severe respiratory distress
67
What are 3 observations that are predictive of epiglottis?
- Absence of spontaneous cough
- Presence of drooling
- Agitation
- Voice is thick and muffled with a frog like croaking sound on inspiration.
68
How is epiglottitis diagnosed?
- Most reliable is the visualization of the epiglottis
- Edematous, cherry-red
- WBC usually elevated
- Signs and symptoms
69
Management of Epiglottitis
- DO NOT VIEW EPIGLOTTIS until you have intubation equipment and personnel ready
- NO INVASIVE PROCEDURES AND DON’T FORCE CHILD TO LIE DOWN until ready to intubate
- Do not do anything with the child that could cause them stress because that will trigger the epiglottis to completely close which is BAD (won’t be able to get tube down there).
70
Once intubation is complete in a child, the nurse should
- Do a throat and blood culture
- Start ABT
- Give antipyretics
- NPO, Fluids given IV
71
When does epiglottis swelling decrease?
Decreases after 24 hours of ABT, epiglottis almost normal by 3rd day.
72
Epiglottitis: Use of Corticosteroids
- Beneficial to reduce edema during the first few hours of treatment
- Children who are incubated also get a course of 24 hours before extubation.
73
Prevention of Epiglottitis
All children, starting 2 months of age, receive the H.influenzae type b conjugate vaccine (Hib vaccine)
74
Nursing Care for Patients with Epiglottitis
- Child is allowed to remain in the position that provides the most comfort and security.
- Parents are reassured that everything possible is being done to obtain relief for their child
- Nurses who suspect epiglottitis should not attempt to visualize the epiglottis directly with a tongue depressor or take a throat culture but should have the child seen by the primary care provider immediately.
- Resuscitation equipment and suction should be immediately available and ready at the child’s bedside
75
Bronchiolitis
- Inflammation of the bronchioles d/t acute viral infection.
| - Causes production of thick mucus that concludes bronchiole tubes and bronchi.
76
What are causes of bronchiolitis?
RSV causative in more than 1/2 the cases.
77
RSV stands for
Respiratory sinvistual virus
78
RSV
- Annual epidemics in winter/spring
- Easily communicable: contact isolation (get it by touching everything; NOT airborne)
- Can live on skin and paper for up to 1 hour and nonporous surfaces for up to 6 hours.
- Most frequent cause of hospitalizations in children <1 y/o.
79
Severe RSV infections in the first year of life are a significant risk factor for
Developing asthma up to the age of 13.
80
Broncholitis: By the age of 3, most children
Have been infected at least once.
81
Incidence of Bronchiolitis
- By age 3 most children have been infected at least once.
| - Higher incidence in males, bottle fed and children living in crowded living conditions.
82
Clinical Manifestations of Bronchiolitis
- Preceded by mild upper respiratory infection
- Serious nasal drainage
- Sneezing
- Low grade fever
- Difficulty feeding
- Then -> acute onset of respiratory distress
- Apnea
83
Respiratory Distress includes symptoms such as
- Tachypnea
- Tachycardia
- Wheezing, crackles, rhonchi
- Cyanosis
84
Serious nasal drainage
- Super thick drainage
- When you get this mucus, they can’t breathe so you are constantly sucking it out.
- May provide oxygen to help breath. Worried about risk for aspiration.
85
Complication of Bronchiolitis: Apnea is more common in
- Term infants <1 month old
- In preterm infants with post conceptual age less than 48 weeks
- Infants with a previous history of apnea
86
How is bronchiolitis diagnosed?
- Chest XR
| - Nasal or nasopharyngeal washings -> rapid identification on respiratory secretions.
87
What findings from a chest x-ray can indicate bronchiolitis?
- Hyperinflation
- Increased A-P diameter
- Scatter areas of consolidation
88
With nasal or nasopharyngeal washings, use either
- Direct fluorescent antibody staining (DFA)
| - Enzyme-linked immunosorbent assay (ELISA) techniques for antigen RSV detection
89
Bronchiolitis: Monitor/Assess
- Apnea and cardiorespiratory monitor
- Assess for dehydration
- Monitor temperature
90
Treatment for Bronchiolitis
- Maintain oxygen saturation’s >90%
- Cool, humidified oxygen
- Inhaled hypertonic (3%) normal saline solution
- No antibiotics unless secondary infection present
91
How is bronchiolitis prevented?
- IM Palivizumab (Synagis) during RSV season
- Encourage breast feeding
- Avoid passive tobacco smoke exposure
- Promote preventive measures such as hand washing and administration of Palivizumab (Synagis) to high-risk infants.
92
Who is qualified for IM Palivizumab (Synagis)?
- Premature infants during the first year of life.
| - Children <24 months with chronic lung disease or congenital heart disease.
93
Nursing Care: Bronchiolitis
- Quality patient outcomes: room air O2 sat >90%, RR <60 breaths per minute, adequate PO intake.
- Use contact and standard precautions
94
How is bronchiolitis transmitted?
- Direct contact with respiratory secretions (not airborne) inoculation from hand to eye, nose or other mucous membranes
- RSV in secretions can survive for hours on countertops, gloves, paper tissues, and cloth, and for half an hour on skin; it remains infectious when transferred from hands to objects
95
Standard precautions
Hand washing
| Not touching nasal mucosa or conjunctiva.
96
Contact precautions
Donning gloves and gowns when entering patient’s room
97
What should the nurse teach parents in relation to bronchiolitis?
1. Parents should learn how to instill NS drops into the nares and suction the mucus with a bulb syringe before feedings and before bedtime so the child may eat and rest better.
2. Parents may offer small amounts of clear fluids, 5-10 mL at a time, with a medication syringe every 10 minutes or so to keep infant hydrated.
3. Inform parents that infant cough may persist for weeks.
98
Nurses assigned to children with RSV should NOT
Be caring for other patients who are considered high risk.
99
What is croup?
A group of conditions characterized by:
- Inspiratory strider
- Harsh (brassy, coupry) cough
- Hoarseness, varying degrees of respiratory distress resulting from swelling or obstruction in the larynx.
100
What causes Croup?
Viruses -> Parainfluenza virus
101
Croup: Incidence
- Number of cases increase in late autumn through early winter months and occurs primarily in children 6 months to 3 years
- Some children with croup may be hospitalized and some of them may require intubation
102
Croup affects what structures?
- Larynx
- Trachea
- Bronchi
103
Clinical Manifestations of Croup
- Usually precedes upper respiratory infection → then fever and harsh cough begin
- Begins at night
- Sudden onset of harsh, metallic barky cough → can sound like a seal
- Sore throat
- Inspiratory stridor
- Hoarseness
- Accessory muscle use (substernal, intercoastal, suprasternal retractions)
- Frightened appearance
- Agitation
- Cyanosis
104
How is croup diagnosed?
Observation of clinical symptoms
105
Nursing Management of Croup
- Maintain patent airway
- Cool, humidified night air
- Keep calm
- Increase oral intake or if hospitalized, IV fluids
106
Treatment for Coup
- Nebulized racemic epinephrine
- Oral Dexamethasone
- Acetaminophen (if fever)
- NO ABT (will not help unless an infection is present)
- NO COUGH SYRUPS (>6 is the recommended age for cough syrup)
107
Oral Dexamthasone
Decreases airway inflammation and reduces necessity for hospitalization for many children.
108
Foreign Body Aspiration: Incidence
Frequently in children 6 months - 5 y/o (Explore by putting things in the mouth)
109
Where can most foreign objects be found with foreign body aspiration?
Most objects lodged in right main bronchus (once it goes into the mouth it can go either to the stomach or can aspirate into the right main bronchi)
110
What are the clinical manifestations of foreign body aspiration?
- Sudden, violent coughing
- Gagging
- Wheezing
- Vomiting
- Brief episode of apnea
- Possibly cyanotic
- May be asymptomatic → may show signs of infection
111
What are complications of foreign body aspiration?
- Mediastinitis
- Pleural effusion
- Pneumothorax
- Lung abscess
- Aspiration with food
112
Common Aspiration Items
- Nuts, seeds, earrings, popcorn, carrots, toy parts
| - Coins, grapes, small toys, hot dogs, hard candy, latex balloons
113
Assessment for Foreign Body Aspiration
- Assess breathing and airway first
- Perform complete hx and physical evaluation
- XR (only thing that will pop up will be metallic)
- MRI or CT (used if still concerned but can’t see through XR)
114
What confirms diagnosis of foreign body aspiration?
Rigid Bronchoscopy
115
How is foreign body aspiration treated?
- Removal of object
- Monitor respiratory status
- NPO until gag reflex returns
- Treatment of cause if known
116
Asthma
- Reversible obstructive airway disease
| - Lifelong disease
117
Asthma is characterized by:
- Increased airway responsiveness
- Bronchospasm
- Inflammation and edema of mucous membranes
118
Asthma Etiology
- Interaction between environmental factors and genetics
| - Physiologic alteration is inflammatory
119
What can trigger asthma?**
- Cold air
- Smoke
- Allergens
- Viral Infections
- Stress
- Exercise
- Odors and Medications (aspirin or NSAIDs)
120
Children are more prone to airway obstruction d/t
- Having smaller, narrower airways (severity of asthma decreases as child grows d/t increased airway size and improved diaphragmatic support)
- Decreased elastic recoil
121
What are clinical manifestations of asthma?**
- Vary but classic symptoms: Wheezing, SOB, Cough, Dyspnea on exertion
- Chest tightness
- Tachypnea
- Non-productive cough
- Worsening Symptoms at night
122
Why are asthma symptoms worse at night?
Because increased narrowing of the airways and pooling of secretions
123
Clinical Manifestations of Asthma in Children that are in severe respiratory distress
- Do NOT demonstrate wheezing because of decreased air movement
- AKA “silent chest” ominous sign; w/ treatment increased wheezing may signal that the child’s condition is improving.
124
How is asthma diagnosed?
- Spirometry
- Chest XR usually normal
- Pulmonary function test reveal: Decreased forced expiratory volume in one second
- Chronic cough without infection or diffuse wheezing during the expiratory phase of respiration is sufficient to establish diagnosis.
125
Classification of Asthma
-Always classify based on the most severe symptom.
126
Asthma Classificaton
1. Mild Intermittent
2. Mild Persistent
3. Moderate Persistent
4. Severe Persistent
*Always based on the most severe symptom
127
Mild Intermittent Asthma
Symptoms:
-Daytime: < or = 2 per week
-Nighttime: < or = 2 per month
Exercise tolerance in those < or = 5 years of age: Excellent tolerance
128
Mild Persistent Asthma
Symptoms:
-Daytime: > 2 per week but < 1 per day
-Nighttime: > 2 per month
Exercise tolerance in those < or = 5 years of age: Exercise symptoms
129
Moderate Persistent Asthma
Symptoms:
-Daytime: Daily symptoms
-Nighttime: > 1 per week
Exercise tolerance in those < or = 5 years of age: Frequent exercise symptoms
130
Severe Persistent Asthma
Symptoms:
-Daytime: Continual day symptoms
-Nighttime: Frequent night symptoms
Exercise tolerance in those < or = 5 years of age: Exercise is severely limited
131
Management of Asthma
- Based off of classification
- Control triggers → exercise, infection, emotions, allergies → infection is the #1 cause
- Assess lung sounds
- Watch for breathing, ask them how they feel, make sure oxygen is hooked up and effective → check effectiveness through pulse ox.
132
Asthma Treatment
- Long-term control medications used daily
- Quick relief (rescue) medications used when needed
- Have PRN medication breathing treatment → oxygen, medical air and connect vial of treatment to oxygen mask
133
Therapy and management of asthma should be reviewed
- q1-6 months and should be individualized
| - Pharmacological management and environmental control and education interventions are essential at each step.
134
Asthma is treated with a combination of medications from 2 categories
1. Bronchodilators
| 2. Anti-inflammatory agents
135
What is the first line treatment to children for long-term control of persistent asthma?
-Inhaled corticosteroid: dose reflects the severity of the asthma
136
Rescue Medications for Asthma include:
- SABA: albuterol, levalbuterol and terbutaline
- Anticholinergic-Ipratropium bromide (atrovent)
- Mast Cell Inhibitors: Cromolyn sodium (intake), nedrocromil sodium (tilade)
- Systemic corticosteroids: prednisone, prednisone
137
Asthma Rescue Medication: SABA (albuterol, levalbuterol and terbutaline)
Delivered by MDI’s or by nebulizer 3-4x/daily is symptomatic or before exercise
138
Asthma Rescue Medication: Anticholinergic-Ipratropium Bromide
Combo with beta2-adrenergic agonist in child >12 years with severe asthma
139
Asthma Rescue Medication: Mast Cell Inhibitors
- Inhaled NSAID that prevents asthma symptoms by blocking mast cell mediators.
- Give 30 min before exposure/trigger
140
Asthma Rescue Medication: Systemic Corticosteroids
- Decreases airway inflammation
- Preferable given in short-burst course 5-7 days
- Inhaled should be taken every single day. 1 puff 2x/day.
- Educate family that albuterol is needed with exercise or exacerbation.
141
Routine Asthma Medications include
1. Inhaled corticosteroids-beclomethasone, budesonide (topical)
2. LABAs- sametrerol
3. Combination medication-Advair (inhaled)
4. Leukotriene blockers- montelukast (Chewable tablets, 1+)
5. Ani-IgE- Omalizumab (SQ, >12 years)
142
Education for Asthma: Asthma Action Plan
- Green Zone (good zone)
- Yellow Zone: starts to have issues (i.e coughing, wheezing, difficulty breathing)
- Red Zone: feel awful, can’t breath
- If the airway closes off, there is nothing you can do (you stop breathing)
143
What is used to monitor children with chronic asthma?
-Peak Flow
| PEFR <50% baseline must be hospitalized
144
Asthma Action Plan: Yellow Zone Teaching
- Let physician know
| - Important to educate family to avoid progressing to red zone
145
Asthma Action Plan: Red Zone Teaching
- Take albuterol and call 911
- DO NOT take child to ER by yourself, always better to call 911 because they have skills to help if things get worse while you may not.
146
What are complications of Asthma?
Status Asthmaticus
147
Status Asthmaticus
Severe asthma that is unresponsive to vigorous treatment
| Medical emergency!
148
Apnea
Cessation of breathing for a period of 20 seconds or longer or for shorter period but accompanied by bradycardia or cyanosis.
149
Periodic breathing is
Normal
150
Acute Life Threatening Events
Sudden episodes characterized by apnea, a color change (blue and grey), a change in muscle tone (limp/floppy), choking, or gagging in a healthy infant.
151
Diagnostic Evaluation of Apnea
- Cardiorespiratory and neurophysiologic studies are ordered.
- Sleep studies
152
Management of Apnea
- Gentle stimulation during event
- Avoid suctioning if possible
- Monitor during feedings
- Possible home apnea monitor (want to avoid, keeps going off and desensitizes parent)
- Treatment of cause if known
153
Cystic Fibrosis
- Chronic multisystem disorder affecting exocrine glands.
- Mucus produced by the exocrine glands are abnormally thick.
- Mucus causes obstruction of passageways in the bronchioles, small intestine and pancreatic/bile ducts.
154
CF: Mucus produced by the exocrine glands, particularly those of the bronchioles, small intestine, pancreas and bile duct
- Abnormally thick mucus
| - Causes obstruction of small passageways in organs
155
The biggest issue with cystic fibrosis is
Respiratory issues
156
Cystic Fibrosis Incidence
- The most common lethal genetic illness among white children, adolescents and young adults.
- Median survival age is 40 y/o
157
Cystic Fibrosis Etiology
- CF is an inherited autosomal recessive trait (defective gene from both parents); mutated gene located on the long arm of chromosome 7 this gene codes a protein of 1480 amino acids called the cystic fibrosis transmembrane regulator (CFTR)
- CF defect reduces the ability of the epithelial cells in the airways and pancreas to transport chloride
- Abnormal transport of sodium and chloride across the epithelium leads to increased viscosity of airway mucus, abnormal mucociliary clearance, and lung disease
- Severity of lung disease and presence of hepatic disease cannot be predicted by genotype
158
Clinical Manifestations of Cystic Fibrosis
- Symptoms worsen as disease progresses
| - Outcome is eventually fatal
159
Respiratory Manifestations of Cystic Fibrosis
- Wheezing/crackles
- Diminished breath sounds
- Retractions
- Dry, nonproductive cough
- Recurrent: Pneumonia & bronchitis
- Nasal polyps
- Sinusitis
- Digital clubbing
160
Exocrine Manifestations of Cystic Fibrosis
- Abnormally high concentration of sodium and chloride in sweat
- Risk for electrolyte imbalances in hot weather is high
161
Digestive Manifestations of Cystic Fibrosis
- Steatorrhea
- Flatus
- Malnutrition & growth failure
- Thin & underweight
- Meconium ileus – neonate
- Possible rectal prolapse
- Liver disease
162
Reproductive Manifestations of Cystic Fibrosis
- Average of 2 years delay in development of secondary sex characteristics
- Thick cervical mucus acts as barrier to sperm (Do not use as birth control; Can carry a pregnancy)
- Sterility (caused by lack of sperm)
163
Diagnosis of Cystic Fibrosis
- Meconium ileus at birth - primary
- Routine newborn screening - heel stick
- Requirement: positive sweat chloride test (Not reliable in infants younger then 2 weeks)
164
Treatment for Cystic Fibrosis
- Antibiotics, prophylactically** (broad spectrum everyday)
- Oxygen: humidified, low-flow (2L/min or less) to facilitate gas exchange
- Chest physiotherapy: 2-3x/day for at least 1 hour before or 2 hours after meals
- Supplements**
165
Management of Cystic Fibrosis
- Exercise (mobilizes secretions; improves/maintains lung function)
- Increased caloric requirement: breathing faster and a lot of work to breath which makes them use more calories; calories are also needed for growth and development.
- Huffing (forced expiration to mobilize secretions)
166
What type of supplements are given to patients with cystic fibrosis?
- Digestive enzymes (pancreatic): taken when eating anything to help break down the food and help absorb more.
- Supplemental vitamins
167
What is the number one thing that can kill those with CF?
Pneumonia if the mucous just sits there.
168
What are the goals for management of cystic fibrosis?
- Preventing and treating pulmonary infections
- Maintaining optimal nutritional status
- Promoting psychological adjustment
169
Management of respiratory symptoms caused by cystic fibrosis
- Relieve airway obstruction by mobilizing secretions, decrease number of bacteria by removing secretions and to treat infections with ABT
- Segmental percussion and postural drainage w. inhalation therapy performed several times a day
- Mucolytic agents, inhaled bronchodilators, anti-inflammatory agents
- Exercise → aerobic → jogging, swimming, weight training → improve/maintains lung fx
- ABT to increase life expectancy → usually on higher than usual doses d/t rapid metabolism of drug
- Oxygen therapy → used with caution → children may have chronic carbon dioxide retention and are at risk for oxygen-induced carbon dioxide narcosis
170
Management of digestive symptoms caused by cystic fibrosis
- Exhibit huge appetite but not gain weight
- Chronic pulmonary infections, increase work of breathing, malabsorption → increase caloric and protein demand
- High-calorie, high-protein, pancreatic enzyme replacement therapy, fat-soluble vitamins
- If severe → G tube feeding or TPN
- Pancreatic enzymes administered with meal/snacks and dosage is adjusted according to stool formation
