Respiratory Illness

Question 1

causes of COPD

Answer 1

• smoking
• pollution
• genetics
• significant respiratory illness (scar tissue)

Question 2

COPD

Answer 2

• can’t exhale from loss of elastic recoil
• can’t inhale from mucous hyper-secretion, mucosal edema, and bronchospasm
• hypoxia and hypercapnia
• CO2 retainers

Question 3

COPD pathophysiology (10)

Answer 3

• mucous hyper-secretion
• cilia dysfuncton
• airflow limitation
• hyperinflation of lungs
• alveolar destruction
• loss of elastic recoil
• gas exchange abnormalities
• pulmonary HTN
• cor pulmonale
• systemic effects

Question 4

pulmonary HTN

Answer 4

• increased pressure from heart to lungs

- leads to cor pulmonale (hypertrophy or RV)

Question 5

systemic effects of COPD

Answer 5

• skeletal dysfuntion
• weight loss
• nutritional abnormalities

Question 6

treatment for COPD (7)

Answer 6

• smoking cessation
• medications
• immunizations (pneumovax)
• pulmonary rehab
• hydration
• nutritional support
• O2 support

Question 7

nutritional support for COPD

Answer 7

• high cal + high protein foods

- small/more frequent meals

Question 8

dangers of O2 for COPD

Answer 8

• CO2 retainers

- O2 can decrease respirations

Question 9

medications for COPD

Answer 9

• bronchodilators
• coticosteroids (rinse mouth)
• anticholinergics (salbutamol, ipotropium)
• prophylactic antibiotics (doxycycline)

Question 10

salbutamol

Answer 10

increases HR

Question 11

why to avoid beta blockers for COPD

Answer 11

• puts at risk for bronchospasm (propranolol)

- metoprolol and atenolol are ok because they are cardiac specific

Question 12

asthma

Answer 12

• hyperresponsivesness of airways

- inflammation, bronchospasm, wheezing

Question 13

asthma triggers

Answer 13

• allergens
• exercise
• cold weather
• medications (NSAID, acetylsylic acid)

Question 14

asthmas vs COPD

Answer 14

• onset <40 yrs
• more trigger related
• spirometry will normalize
• stable with some exacerbations
• not caused by smoking

Question 15

asthma menifestations (8)

Answer 15

• bronchospasm
• vascular congestion
• edema formation
• mucous secretion
• impaired microciliary function
• thickening of airway walls
• bronchial hyper-responsiveness
• airway obstruction/remodelling

Question 16

medications for asthma

Answer 16

• quick relief SABA
• acute intervention - corticosteroids, anticholinergics
• daily control - LABA, inhaled corticosteroids, mast cell inhibitors, leukotriene receptor antagonists

Question 17

ER presentation with acute asthma episode

Answer 17

• Ventolin
• best through puffer
• 4-8 puffs q15-20 mins x3
• if severe 1 puff q30-60 secs max 20 puffs
• ipotropium used to open airways, lasts longer than salbutamol
• steroids to decrease inflammation
• O2 support

Question 18

puffer vs aerosol

Answer 18

• puffer works faster and more cost effective

- puffer increases HR

Question 19

prednisone in acute ER presentation of asthma

Answer 19

• to decrease inflammation
• tastes really bad
• 1mg/kg for peds
• methoprednisone IV

Question 20

peak flow expiratory flow meter

Answer 20

• tells strength of exhale
• deep breath and hard/fast exhale for 1-2 secs
• highest of 3 tries
• peak flow may change before symptoms so can catch early

Question 21

peak flow meter numbers

Answer 21

• 80-100% = good control
• 50-80% = caution asthma is worsening, additional meds
• <50% = danger, rescue medication, potential for ER

Question 22

types of pneumonia

Answer 22

• community acquired (most common)
• hospital acquired
• aspiration pneumonia
• fungal pneumonia
• opportunistic pneumonia

Question 23

diagnosis of pneumonia

Answer 23

• Hx and physical
• CXR
• sputum for C&S
• O2 sats
• blood gases
• CBC - leukocytes

Question 24

presentation of pneumonia

Answer 24

• SOB
• cough w or w/out exudate
• fever
• congestion in lungs
• coarse lung sounds (generally one are)
• dull on percussion
• consolidation on CXR

Question 25

treatment of pneumonia

Answer 25

- appropriate antibiotics - increase fluid intake - antipyretics - analgesics - O2 therapy

Question 26

complications of pneumonia (9)

Answer 26

- pleurisy - pleural effusion - atelectasis (collapse) - lung abscess (in lung) - empyema - pericarditis - bacteremia (in blood) - endocarditis - meningitis

Question 27

pleurisy

Answer 27

- inflammation of lining of lung

Question 28

pleural effusion

Answer 28

- fluid in pleural space

Question 29

empyema

Answer 29

- pockets of pus in pleural space - big consolidation - treated with chest tube with TPA to break up pus and drain

Question 30

pediatric differences in upper airway

Answer 30

- <3 months are nose breathers - large tongue - trachea narrower - airway resistance greater

Question 31

paediatric differences in lower airway

Answer 31

- alveoli fewer in # at birth | - weaker intercostal muscles

Question 32

retraction

Answer 32

in peds when you can see skin pulling in at ribs

Question 33

paediatric vs adult airway diameter

Answer 33

- adult = 20mm; 1mm swelling = 18mm | - peds = 4mm; 1mm swelling = 2mm

Question 34

peds respiratory assessment

Answer 34

- HR, resp rate, O2 sats - position of comfort - behaviour (best indicator) - skin/mucous membrane colour - Work of breathing (retraction, abd muscles, shoulders rising, head bobbing, grunting) - chest auscultation - signs of dehydration - family/caregiver coping

Question 35

locations of retraction

Answer 35

- suprasternal - supraclavicular - intercostal - substernal - subcostal - tracheal tug

Question 36

normal respiratory rate per age group

Answer 36

- newborn = 30-55 - 1yr = 25-40 - 3yrs = 20-30 - 6-10 = 16-22 - 17+ = 12-20

Question 37

normal HR per age group

Answer 37

- newborn = 100-170 - infant-2yrs = 80-130 - 2-6yrs = 70-120 - 6+ = 60-110

Question 38

bronchiolitis

Answer 38

- inflammation of bronchioles - <2yrs - starts upper then moves lower - wheezing, fever, cough, resp distress, retraction - preceded by 1-3 days runny nose (causes most problems) - can decomponsate quickly

Question 39

treatment for bronchiolitis

Answer 39

- hydration - ins/out (wet diapers, time breastfeeding) - saline drops/suction of nose - sometimes salbutamol or sale aerosol

Question 40

respiratory syncytial virus (RSV)

Answer 40

- most common cause of bronchiolitis - breakdown of cell wall in airway causing clumps = blockage - contagious - nasopharyngeal aspirate to diagnose - can get second time

Question 41

treatment of RSV

Answer 41

- same as bronchiolitis | - hydration, O2, respiratory

Question 42

Croup

Answer 42

- inflammation of vocal cords - symptoms, not a virus - Barky cough - cold air/humidity can help decrease inflammation - dexamethasone, aerosolized epinepherine - not admitted - up to date croup scores

Question 43

signs of respiratory failure in children - initial respiratory failure

Answer 43

- restlessness, tachycardia, dyspnea, tachypnea | - monitor frequently, sats

Question 44

signs of respiratory failure in children - early de compensation

Answer 44

- nasal flaring, retraction, grunting | - respiratory & doc, 100% O2 mask available

Question 45

signs of respiratory failure in children - severe hypoxia/airway arrest

Answer 45

- cyanotic, SOB, HR slows, cant breath deep enough for audible wheezes, stupor, diaphoretic - prepare for intubation