Flashcards in Pediatric COPD Deck (55):
What is asthma characterized by?
Chronic inflammation and exacerbation of irritation from an allergen, bacteria, virus, exercise, or stress.
What is cystic fibrosis?
A genetic disease characterized by an exocrine gland dysfunction causing excessive mucus production.
What happens during an asthma exacerbation?
Irritants cause bronchioles to become hypersensitive, bronchospasms occur and mucus production leads to air trapping, respiratory failure occurs/
What are the four classifications of asthma?
Intermittent, mild persistant, moderate persistent, severe persistent
What are characteristics of an intermittent exacerbation of asthma and what is the treatment?
Symptoms are less than 2 days a week, ADLs not effected, use rescue inhaler.
What are characteristics of a mildly persistent exacerbation of asthma and the treatment?
Symptoms more than 2 days a week, mild effect on ADLs, use rescue inhaler and inhaled corticosteroid.
What are characteristics of moderately persistent asthma and the treatment?
Symptoms are daily with ADL interference, use daily inhaled meds including a long acting bronchodilator and corticosteroid.
What are characteristics of a severely persistent asthma episode and the treatment?
Continual symptoms, limits ADL, use high dose corticosteroid, oral steroid, and long acting bronchodilator.
What are some extrinsic triggers to exacerbations?
allergens, foods, irritants, colds
What are some intrinsic triggers to exacerbations?
Emotions, exercise, GERD, hormones
What are clinical manifestations of asthma?
Inspiratory and expiratory wheeze, cough, SOB, accessory muscle use, hyperresonance, tripoding.
How do you diagnose asthma?
History, manifestations, physical exam, lab tests- PEFR
What is the treatment of asthma?
Allergen control- clean dust, pets, smoking. Drug therapy of rescue inhalers, long term therapy, and acute exacerbation.
What are rescue medications used for and some examples?
Quick relief of symptoms- beta adrenergic agnoists for bronchodilation. Albuterol.
What are corticosteroids used for and examples?
Long term relief and antiinflamatory. Flovent
What are some long term drug therapies for asthma?
Non steroidal antiinflammatory inhalters, leukotriene modifiers, long acting beta agnonists, and combo-drugs.
What is an example of a non-steroidal antiinflammatory inhaler?
Cromolyn sodium (intal)
What are leukotriene modifiers used for and an example?
to block inflammatory and bronchospasm effects- oral. Singular
What are long acting beta agnoists used for an an example?
Anti-inflammatory and are not for acute symptoms. Serevent.
What are combination drugs and an example?
Usually a beta adrenergic agonist and steroid- advair inhaler.
What drugs should be used for acute exacerbations?
What to anticholenergics do?
Bronchodilate and decrease mucous- atropine.
What to methlxanthines do?
Relax muscles- theophylline.
What are some nursing considerations for beta adrenergic agonists?
Assess heart rate before and after the treatment
What are some considerations for corticosteroid inhaler uses?
use a spacer and rinse the mouth
What are some considerations for leukotriene modifiers?
Give 1 hour before meals or 2 hours after, asess for jaundice and use precautions with coumadin
What are some considerations for bronchodilators?
contraindicated with rapid heart rate and know pt's therapeutic range.
How is exercise induced asthma prevented?
Premedicate 20 minutes prior to the exercise
What causes an asthma exacerbation?
When a patient comes in contact with a trigger
What is status asthmaticus?
An emergency- respiratory distress.
What are some nursing responsibilities for a hospitalized child with asthma??
IV therapy- D5 1/2 NSS with K to keep ions balanced. NPO, Bedrest, nebulizer, O2, chest physiotherapy, monitor pulse, HR, Ox, ABGs
What are some things to educate the patient and family on related to asthma?
Recognize symptoms, keep meds on hand, peak flow meter use, treat URIs, predose for exercise induced asthma, determine triggers
What is cystic fibrosis?
An exocrine gland dysfunction that increases mucous production and viscosity that causes multi-system involvement
What kind of gene is cystic fibrosis?
What is the protein that causes cystic fibrosis?
Cystic Fibrosis Transmembrane Regulator (CFTR Protein)
What is the pathophysiology of cystic fibrosis?
the CFTR protein is a transporter for Cl and HCO3 and affects the activiy of the other plasma membrane channels. It causes electrolyte imbalances and mechanical obstruction which causes tubules to become blocked.
What are respiratory clinical manifestations of CF?
Viscous mucus, cough, dyspnea, wheeze, atelectasis, clubbing, barrel chest, cyanosis.
What are GI clinical manifestations of CF?
Steatorhea (fatty stool), prolapsed rectum, weight loss, malabsorption of fat soluable vitamins, abdominal distention, meconium ileus
What is steatorhea?
Fat in the stool
What are integument clinical manifestations in CF?
Increased sodium- salty skin.
What are reproductive clinical manifestations in CF?
Females have mucous plugs in cervix and delayed puberty, males have a 95% sterility rate.
How do you diagnose CF?
History, physical exam, sweat chloride test, chest xray, fecal fat test, lung function test, immunoreactive trypsinogen test.
What is the screening for CF?
Immunoreactive trypsinogen test, newborn screening, CFTR gene mutation
What are the therapeutic goals of CF?
Prevent/minimize pulmonary complications, ensure nutrition for growth, physical activity, reasonable quality of life.
What is the treatment for cystic fibrosis?
Chest PT, forced expirations, bronchodilators, mucolytics, corticosteroids, IV antibiotics, oxygen, lung transplants
What is chest PT?
Chest physiotherapy- manual and mechanical. Cupped hand tapping on back to try to move mucous out of the lungs.
What are contraindications to chest PT?
After eating, pulmonary hemorrhage, PE, increased ICP, osteogenisis imperfecta, cardiac complications, ESRD
What are drug therapies for CF?
Neubulized bronchodilators, mucolytics, antibiotics, kalydeco
What are some nebulized bronchodilators?
with hypertonic saline, before chest PT, Albuterol and Intal
What is a mucolytic used for CF?
Pulmozyme by nebulizer
What is an antibiotic used for CF?
Tobramycin by nebulizer
What are some respiratory complications associated with CF?
Infection- P. aeruginosa and B. cepacia, E. Coli, H. influenza, MRSA, pneumothorax, epistaxis
What is the nutrition for a CF patient?
High protein, high calorie, need pancreatic enzymes, salt, and frequent meals.
What should you teach the patient and family on for CF?
Med management, oxygen, peak flow meter, infection control, skin care, immunizations, high calorie diet, limit fat intake, stool softener, independence, support