Respiratory Flashcards
(44 cards)
1
Q
What is Respiratory Syncytial Virus (RSV)?
A
RSV is a highly contagious virus that causes inflammation and obstruction of the lower respiratory tract.
2
Q
Why is RSV clinically significant in pediatrics?
A
It is the leading cause of hospitalization in infants under 12 months, especially dangerous for preterm infants and those with chronic lung or heart disease.
3
Q
What are hallmark clinical manifestations of RSV in infants and young children?
A
- Nasal congestion, rhinorrhea
- Fever (low-grade)
- Harsh cough, wheezing
- Tachypnea, retractions, nasal flaring
- Apnea (especially in infants <6 weeks)
- Cyanosis, poor feeding
- Irritability, lethargy
4
Q
What is a key respiratory complication associated with RSV in infants?
A
Apnea is often the first sign in young infants and can precede other respiratory symptoms.
5
Q
What diagnostic tests are used to confirm RSV?
A
- RSV antigen testing via nasopharyngeal swab (ELISA or PCR)
- Pulse oximetry for oxygenation
- Chest X-ray (only if needed)
- CBC may show mild leukocytosis
- ABGs in moderate-to-severe cases
6
Q
What is the primary management strategy for RSV?
A
Supportive care including oxygen therapy, suctioning of secretions, hydration, antipyretics, and close respiratory monitoring.
7
Q
Which medications are used or considered in RSV?
A
- Ribavirin (aerosolized): Rarely used
- Palivizumab (Synagis): Preventive IM injection for high-risk infants
- Bronchodilators: Not routinely recommended
8
Q
Who qualifies for Palivizumab prophylaxis?
A
- Preterm infants <29 weeks gestation
- Infants <12 months with chronic lung disease or hemodynamically significant congenital heart disease
9
Q
What are nursing priorities when caring for a hospitalized infant with RSV?
A
- Elevate HOB to promote lung expansion
- Administer humidified oxygen
- Implement contact and droplet precautions
- Educate parents on hand hygiene and RSV transmission
- Monitor for signs of impending respiratory failure
10
Q
What are high-priority nursing diagnoses for RSV?
A
- Ineffective airway clearance related to mucus production
- Impaired gas exchange related to bronchiolar obstruction
- Risk for fluid volume deficit due to fever and decreased oral intake
- Anxiety (parental) related to infant’s respiratory distress
11
Q
What collaborative team members assist in RSV management?
A
- Pediatrician: Medical management
- Respiratory therapist: Oxygen therapy, suctioning support
- Infection control nurse: Prevention of nosocomial spread
- Social worker: Discharge planning, home care needs
12
Q
What is bronchiolitis?
A
Bronchiolitis is an acute viral infection of the lower respiratory tract, affecting the bronchioles, mostly caused by RSV.
13
Q
What are early clinical signs of bronchiolitis?
A
- Mild upper respiratory symptoms: nasal congestion, cough, low-grade fever
- Decreased appetite
- Mild respiratory rate elevation
14
Q
What are severe/progressive clinical manifestations of bronchiolitis?
A
- Tachypnea >60–70/min
- Intercostal/subcostal retractions, nasal flaring, grunting
- Wheezing, crackles on auscultation
- Apnea (especially in preterm or very young infants)
- Poor feeding, dehydration
- Cyanosis and signs of hypoxia
15
Q
What diagnostic tools are used in bronchiolitis assessment?
A
- Clinical presentation is often sufficient
- Pulse oximetry to monitor oxygenation
- RSV swab to confirm viral source
- Chest X-ray if severe
- ABGs in cases of respiratory failure
16
Q
Is bronchiolitis treated with antibiotics or corticosteroids?
A
No, antibiotics are not indicated unless secondary bacterial infection is present, and corticosteroids are not routinely recommended.
17
Q
What are appropriate medications in bronchiolitis?
A
- Antipyretics for fever
- Nebulized 3% hypertonic saline (inpatient setting)
- Trial of bronchodilators may be attempted but are not consistently effective
18
Q
When is hospitalization indicated for bronchiolitis?
A
- Persistent oxygen saturation <90%
- Signs of severe respiratory distress
- Dehydration or inability to feed
- Apnea or cyanosis
- Age <2 months or preterm status with comorbidities
19
Q
What are high-priority nursing interventions for bronchiolitis?
A
- Elevate HOB and provide humidified oxygen
- Frequent nasal suctioning
- Encourage small, frequent feeds or use IV fluids
- Monitor respiratory rate, effort, and oxygen saturation
- Implement contact precautions
20
Q
What are priority nursing diagnoses for bronchiolitis?
A
- Ineffective breathing pattern
- Impaired gas exchange
- Risk for fluid volume deficit
- Fatigue related to increased respiratory effort
- Parental anxiety
21
Q
What collaborative therapies are involved in bronchiolitis management?
A
- Respiratory therapy: Assists with oxygen, suctioning, and aerosol treatments
- Nutrition support: Ensures adequate fluid/caloric intake
- Pediatric provider: Guides diagnostic and treatment decisions
- Case manager/social work: Assists with discharge planning and home resources
22
Q
What are critical teaching points for parents of a child with bronchiolitis?
A
- Monitor breathing rate and effort
- Recognize signs of dehydration
- Use bulb syringe/suction for nasal secretions
- Maintain hydration and feeding
- Prevent spread: strict handwashing, limit contact with sick individuals
23
Q
What is pleural effusion, and what are the main types?
A
Pleural effusion is the accumulation of fluid in the pleural space.
- Transudative: caused by systemic conditions like heart failure or cirrhosis (low protein content)
- Exudative: caused by inflammation or malignancy (high protein content)
24
Q
What are the most common causes of transudative pleural effusion?
A
- Congestive heart failure (left-sided)
- Nephrotic syndrome
- Cirrhosis with ascites
- Hypoalbuminemia
25
What are common causes of exudative pleural effusion?
* Pneumonia (parapneumonic effusion)
* Tuberculosis
* Pulmonary embolism with infarction
* Malignancy (lung, breast, lymphoma)
* Pancreatitis
26
What are key clinical signs and symptoms of pleural effusion?
* Diminished breath sounds
* Dullness to percussion
* Dyspnea, orthopnea
* Pleuritic chest pain (worsens on inspiration)
* Decreased tactile fremitus
* Asymmetrical chest expansion
27
What diagnostic procedures confirm pleural effusion and help identify cause?
* Chest X-ray or CT: shows fluid level
* Ultrasound: guides thoracentesis
* Thoracentesis with pleural fluid analysis (appearance, protein, LDH, pH, cytology, cultures)
* Light’s Criteria: differentiates transudate vs. exudate
28
What are the priority pharmacologic interventions for pleural effusion?
* Diuretics (e.g., furosemide) for transudative effusions (HF-related)
* Antibiotics for infectious causes (e.g., pneumonia, TB)
* Chemotherapy or intracavitary agents (e.g., bleomycin) for malignant effusions
* Anti-inflammatories or corticosteroids in autoimmune-related effusions
29
What are potential complications of untreated or rapidly progressing pleural effusion?
* Empyema (infected pleural fluid)
* Pneumothorax post-thoracentesis
* Respiratory failure
* Pleural fibrosis
30
What are nursing interventions for a patient undergoing thoracentesis?
* Position patient upright, leaning forward
* Monitor for signs of pneumothorax post-procedure (sudden dyspnea, chest pain)
* Apply dressing and monitor for drainage
* Assess breath sounds before and after
31
High-priority nursing diagnoses for pleural effusion?
* Impaired gas exchange related to compression of lung tissue
* Ineffective breathing pattern related to decreased lung expansion
* Acute pain related to pleural inflammation
* Risk for infection (if secondary to pneumonia or TB)
32
What collaborative therapies are used in managing pleural effusion?
* Pulmonologist for thoracentesis/chest tube
* Infectious disease (if infectious cause)
* Oncology (for malignant effusion)
* Respiratory therapy for oxygen and incentive spirometry
33
What is a pulmonary embolism (PE), and how does it impair gas exchange?
A PE is a blockage of pulmonary arterial blood flow, usually from a thrombus. It results in ventilation-perfusion (V/Q) mismatch, decreased oxygenation, and potential right-sided heart strain or failure.
34
What are major risk factors for PE? (Think Virchow’s Triad)
* Venous stasis: immobility, bedrest, long flights
* Endothelial injury: surgery, trauma, central lines
* Hypercoagulability: pregnancy, estrogen therapy, cancer, thrombophilia (e.g., Factor V Leiden), COVID-19, dehydration
35
What are classic and atypical symptoms of pulmonary embolism?
* Sudden onset dyspnea
* Pleuritic chest pain
* Tachypnea, tachycardia
* Cough, hemoptysis
* Hypoxia, cyanosis
* Lightheadedness, syncope (massive PE)
* Fever, diaphoresis
* Feeling of doom/anxiety
36
What diagnostic tests are most specific and sensitive for PE?
* CT pulmonary angiography (CTPA) – gold standard
* V/Q scan – for patients who cannot tolerate contrast
* D-dimer – elevated but nonspecific
* Ultrasound of lower extremities – for DVT source
* ABG – respiratory alkalosis with hypoxemia
37
What ECG findings might be seen in a patient with PE?
* Sinus tachycardia (most common)
* S1Q3T3 pattern (rare but specific)
* Right bundle branch block
* T-wave inversions (V1–V3)
38
What pharmacological agents are used to treat or prevent PE?
* Heparin (IV) – immediate anticoagulation
* Enoxaparin (Lovenox) – subcutaneous LMWH
* Warfarin (Coumadin) – long-term anticoagulation (monitor INR 2–3)
* Direct oral anticoagulants (DOACs) – rivaroxaban, apixaban
* Thrombolytics (alteplase, tPA) – for massive or hemodynamically unstable PE
* Oxygen therapy – for hypoxia
* IV fluids and vasopressors – for hypotension
39
What is the antidote for heparin? For warfarin? For DOACs?
* Heparin: Protamine sulfate
* Warfarin: Vitamin K
* DOACs (e.g., apixaban): Andexanet alfa (if available)
40
What are signs that a PE is becoming life-threatening?
* Sudden drop in blood pressure
* Worsening hypoxia despite oxygen
* Loss of consciousness
* Silent chest (no breath sounds)
* Right-sided heart failure or shock
41
What are nursing interventions in acute PE management?
* Maintain airway and apply oxygen
* Keep HOB elevated
* Administer prescribed anticoagulants or thrombolytics
* Monitor for bleeding (gums, stool, urine, bruising)
* Minimize movement to prevent further embolization
* Reassure the patient and remain calm
* Ensure large-bore IV access for emergency meds
42
What are long-term preventative strategies for PE?
* Lifelong anticoagulation if recurrent
* IVC filter placement (if anticoagulation contraindicated)
* Early ambulation post-op
* Use of compression stockings
* Avoid oral contraceptives in high-risk patients
43
High-priority nursing diagnoses for PE?
* Impaired gas exchange
* Decreased cardiac output
* Anxiety related to hypoxia
* Risk for bleeding related to anticoagulant therapy
44
What are the roles of interprofessional collaborators in PE care?
* Cardiologist or pulmonologist: manage PE severity
* Hematologist: monitor and adjust anticoagulation
* Respiratory therapist: manage oxygen therapy
* Pharmacist: dose anticoagulants and monitor drug interactions
* Physical therapist: promote safe mobilization
