Peds Exam 2 - C. Res Flashcards
asthma (reactive airway disease)
a chronic inflammatory airway disorder which consists of airways obstruction, bronchial irritability, edema of mucous membranes, congestion & spasms of smooth muscles of the bronchi and bronchioles
what type of immune response is asthma & how is it mediated
-hypersensitivity type 1
-IgE: mast cells release histamine & leukotrienes
how is asthma classified
1) frequency and severity of symptoms: severe, moderate, mild persistent, mild intermittent
2) levels of control: controlled, partly controlled, uncontrolled
asthma triggers
-stress
-pets if allergic
-exercise
-pollen
-bugs in house
-chemical fumes
-cold air
-fungus spores
-dust
-smoke
-strong odors
-pollution
-anger
eliminate to control, very important
asthma risk factors
age, heredity, gender, obesity, ethnicity
clinical manifestations of asthma
dyspnea, expiratory wheezing, cough
-diaphoresis
- hacking cough -> rattling w/ clear sputum
-anxious & restlessness
-prolonged expiratory phase
-rhonchi
diagnosis of asthma
-med hx
-physical exam
-lab results
-PEFR
PEFR
tells us how much air pt can exhale in 1 second & tells us how well asthma is controlled + care to give (meds or ER)
green zone (80% of personal best), yellow zone (50-79%), red zone (<50%, ER) -> tract multiple times a day and then have action plan for results
goal of asthma mgt
maintain normal activity levels, pulmonary function, prevent chronic symptoms, provide optimal drug therapy and assist child in normal life
do this by controlling the environment & making life be low allergen
drug therapy for asthma
-controllers: start w/ cort steroids then can add long acting beta 2s or leukotriene inhibs (singulair)
-relievers (rescue): short acting beta 2 / bronchodi’s (albuterol, proventil, xopenex) & mag sulfact
give through inhaler
what do you use if a child cannot take all their inhaler meds & hold their breath for 10 seconds
a spacer & a face mask if cannot make good seal around the spacer
can also give rescue meds through a neb
nursing considerations for asthma in outpatient setting
-general, environmental & physical assessment
-review meds
-review action plan every 6mo
-plan regular check up & immunizations up to date
-prevent URI
-regular exercise
discuss how much missed school
asthma exacerbation
episodes of progressively worsening shortness of breath, cough, wheezing, chest tightness or a combo of these changes
red zone
nursing interventions for asthma exacerbation
-high fowlers
-assessment
-O2 & vitals monitoring
-teach
-control panic & stress
-IV access
-administer rescue drugs then transition to regular meds
how do children with asthma prepare for sports
do rescue medicine before
bronchodilators
what type of disorder is CF
autosomal recessive
if both parents carry the gene, child has 25% chance of having CF
pulmonary effects of CF
-bronchitis
-generalized obstructive emphysema
-S/s: wheezy cough, increased dyspnea, thick rattling, cyanosis, pneumonia, polyps in nose, clubbed digits, chronic sinusitis
endocrine effects of CF
islets of langerhans cell may decrease in number -> malabsorption 50% of CF pts develop DM
GI effects of CF
-15 to 20% of newborns w/ CF will develop a meconium ilius (earliest sign)
-appetite changes
-malabsorption, wt loss
-distended abdomen
-sallow skin
-anemia
-oily stools
hepatic effects of CF
bile ducts -> biliary fibrosis -> biliary cirrhosis - portal HTN
-S/s: ascites, GI bleeding, jaundice
reproductive system effects of CF
-delayed puberty
-infertility
95% of males are sterile
salivary & sweat glands effects of CF
-electrolyte loses
-salty sweat
-dehydration
-hyponatremia
-heat stroke
diagnosis of CF
-prenatal diagnosis: DNA analysis of chorionic villi or amniotic fluid samples
-new born screening
-pilocarpine electrophoresis (sweat chloride test) >60mEq
-stool for fecal fat
factors of maximizing health potential of CF pts
-pulmonary hygiene (use meds, vest, & low infections)
-nutrition
-prevention/early aggressive treatment of infection
