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Test 1
Respiratory issues
55
Nursing
Undergraduate 3
09/19/2011

Additional Nursing Flashcards

 


 

Cards

Term
Respiratory differences in child
Definition
  • obligatory nose breathers (til ~ 3 months)
  • ribs are horizontal
  • muscles for breathing and holding head underdeveloped
  • lung tissue's ability to inflate and deflate
  • higher RR and demand for O2 make hypoxia easy to occur
Term
Special Considerations  ?
Definition
  • > metabolic rate
  • less muscle glycogen reserve
  • > ECF
  • only have passive immunity first
  • cell-mediated immunity not fully developed so increase chance of infection
  • 1st hepB vaccine in hospital
  • 6wks-2mo 1st resp vaccine
  • resp drive is less
  • blunted ventilatory response to hypoxia
  • immature chemoreceptor mechanisms and brain stem
Term
Age Resp Factors
Definition
  • younger than 3mo: maternal antibodies
  • 3-6mo: infection rate increase (toys in mouth, daycare)
  • toddler/preschool: high viral infections
  • >5mo: increase in mycoplasma pneumonia and b-strep infections
  • increased immunity w/ age
Term
Size Resp Factors:
Definition
  • diameter of airways
  • distance b/n structures is shorter, allowing organisms to rapidly move down
  • short eustachian tubes
Term
Resistance Resp factors:
Definition
  • Immune system
  • allergies, asthma
  • cardiac anomalies
  • cystic fibrosis
  • daycare
Term
seasonal variations resp factors:
Definition
  • most common during winter/spring (allergies)
  • mycoplasmal infections more common in fall/winter
  • asthmatic bronchitis more freq in cold weather
  • RSV season considered winter/spring
Term
Resp Failure Resp Factors:
Definition
  • Predisposing conditions: Obstructive lung disease, restrictive lung disease, primary inefficient gas transfer
Term

Nursing Interventions?

in general

Definition
  1. Ease resp effort
  2. fever management
  3. promote rest & comfort
  4. infection control (handwashing, immunizations)
  5. promote hydration & nutrition
  6. family support & teaching
Term
Nursing Interventions for Children w/ CHRONIC resp conditions:
Definition
  • O2
  • Meds
  • Airway clearance techniques (IS)
  • nutritional support
  • artificial airways
  • mechanical ventilation
  • tracheostomy
Term
Essentials of Ped Resp Care:
Definition
  • Preventive care
  • Monitoring & early detection of symptoms (educate parents)
  • Adequate management (home vs hospital)
  • health education
Term
Diagnostic Procedures:
Definition
  • Measurement of lung volumes & flow rates (pul function tests, peak flow measurement)
  • direct/indirect blood and body fluid analysis (ABG's, fluid cultures, sweat chloride test = CF!!!
  • Imaging tech (radiographs, fluroscopy, bronchography, CT scan, scintigraphy, MRI)
  • Direct visualization of the resp tree (laryngoscopy, bronchoscopy
Term
Therapy:
Definition
  • O2 (mask, nasal cannula, O2 hood, O2 tent, mech ventilation)
  • Meds (oral, inhaled [nebulizer, MDE, space device], IV, SQ/IM0
  • Other: postural drainage, Chest PT, artificial ventilation (bag/mask, oral/nasal airways, endo/orotracheal, +/- pressure, tracheostomy [chronic], ECMO [heart-lung machine is more permanent, last effort, usu waiting for transplant
Term
Possible complications of tracheostomy:
Definition
  • Hemorrhage
  • Edema
  • Subcut emphsema
  • Pneumothroax (too much pressure & blow out lung)
  • Accidental decannulation (careful w/ clearing)
Term

Croup syndromes:

described according to the primary area of inflammation

Definition

Types: acute epiglottis, acute laryngitis, acute larynogotracheobronchitis(LTB), and bacterial tracheitis

  • hoarseness, "barking" cough, inspiratory stridor and varying degrees of resp distress
  • affect larynx, trachea, and bronchi
Term
Acute Epiglottitis
Definition
  • type of croup
  • caused by HIB bacteria (need Hib vaccine!)
  • rare and emergent case
  • sore throat, pain, tripod postioning, retractions, inspir stridor, mild hypoxia, distress
  • Potential for resp obstruction!
  • Nursing Considerations: decrease resp effort so maintain O2, quiet, low stimulation
Term

acute larynigitis

(croup)

Definition
  • more common in older and adolescents
  • usu caused by virus
  • hoarseness (sounds worse than is)
  • loss of voice
  • rest vocal cords, cough drops, fluids!
  • self-limiting and w/o long-term sequelae
Term
Acute Larynogotracheobronchitis (LTB
Definition
  • MOST COMMON type, usu <5yr
  • Organisms responsible: RSV, parainfluenza virus, Mco pn, influenza A&B
  • Inspiratory stridor
  • Suprasternal retractions
  • barking or seal-like cough
  • increasing resp distress & hypoxia
  • can progross to resp acidosis, failure, and death
  • usu in middle of night
Term

Bacterial Tracheitis

(croup syndrome)

Definition
  • can be secondary infection, may be complication of LTB b/c clinical manifestations similar
  • infection of the mucosa of upper trachea
  • thick, purulent secretions result in resp distress

uncommon but life threatening

 

Term

Therapeutic Management

(Croup??)

Definition
  1. Airway management
  2. maintain hydration -po or IV
  3. high humidity w/ cool mist (shower, outside on cool night)
  4. Nebulizer treatments (epi, steroids)
Term
Asthma
Definition
  • chronic inflammatory disorder of airways
  • reactive airway disease can be precuror
  • bronchial hyperresponsiveness (twitchy airways)
  • episodic
  • limited airflow or obstruction that reverses spontaneously or w/ treatment
  • will not outgrow true, but control symptoms
  • mechanical ventilation will not work (outer muscle layer contracts
  • need epi or steriods long term control
  • increased muscus secretions
Term
Drug Therapy for Asthma
Definition
  • long-term control meds
  • quick relief meds (albuterol- opens inner layers0
  • metered-dose inhaler (MDI)
  • Corticosteriods
  • Cromolyn sodium (mast cell stablizer - precursor to histamine - prevent twitchiness)
  • albuterol, metaproterenol, terbutaline (beta antagonists)
Term
Status Asthmaticus:
Definition
  • resp distress continues despite vigorous therapeutic measure
  • emergency treatment - epi subcut
  • concurrent infection in some cases
Term
astham interventions:
Definition
  • Exercise
  • CPT (s/t contra b/c stimulate asthma attack)
  • hyposensitization (controlled fashion, keep introducing allergery)
  • Prognosis: Keep doc appts and checkups
Term
Infections of the lower airways:
Definition
  • considered the "reactive" portion of the lower resp tract
  • includes bronchi and bronchioles
  • cartilaginous support not fully developed until adolescence
  • constriction of airways
Term
Influenza
Definition
  • Sudden onset: fever, dry cough, sore throat, muscle aches, HA, malaise
  • treat the symptoms b/c is viral!
  • VACCINATE for prevention
  • Educate, vaccinate, prevent spread
  • Management: humidifed O2, antipyretics, antibiotics, may require intubation
Term

Bronchitis

(lower airway disorder)

Definition
  • aka tracheobronchitis
  • Viral (primary), bacterial (usu secondary)
  • Fever, loose cough, rhonchi, wheezes
  • larger airways (compared to bronchiolites & RSV)
Term
Bronchiolitis and RSV (respiratory syncytial virus)
Definition
  • smaller airways
  • Diagnostic: lab testing
  • fever, wheezes (more), loose secretions, copious clear drainage (lots of stuff)
  • Management: symptomatic, maintain airway
  • Prevention of RSV - prophylaxis (synagis)
  • Isolation precautions (highly infectious)
Term
Pneumonia
Definition
  • Lobar pneumonia (classic - 1 of lobes)
  • bronchopneumonia
  • interstitial pneumonia
  • pneumonitis

~Etiology: bacterial, viral, aspiration, histomycosis, coccidiomycosis & other fungi (harder to treat), "atypical" = mycoplasma, chlamydial (infants/neonates)

 

~usu put on antibiotic, x-ray to confirm type, decreased O2 sat

 

Term
Aspiration Pneumonia
Definition
  • risk for child w/ feeding difficulties
  • feeding techniques, positioning important
  • Avoid oily nose drips, solvents, talcum powder
  • most common in children
  • GERD - take precautions
  • Can thicken feeds, elevate HOB 30 min after eating
Term
Cystic Fibrosis (CF)
Definition
  • exocrine gland dysfunction that produces multisystem involvement
  • most common lethal genetic illness among white children
  • autosomal recessive trait
  • inherits defective gene from both parents w/ and overall incidence 1:4 (25% chance every child will have it)
Term
Increased Viscosity of Mucous gland secretion in CF:
Definition
  • results in mechanical obstruction
  • thick inspissated mucoprotein accumulates, dilates, precepitates, coagulates to form concretions in glands and ducts
  • resp tract and pancreas are predominantly effected
Term
Increased Sweat Electrolytes in CF:
Definition
  • basis of the most reliable diagnostic procedure = sweat chloride test
  • Na & Cl will be 2-5x's greater than the controls
Term
Resp manifestations in CF:
Definition
  • present in almost all CF pt's, but onset/extent is variable
  • stagnation of mucus and bacterial colonization result in destruction of lung tissue
  • tenacious secretions are difficult to expectorate - obstruct bronchi/bronchioles
  • decreased O2/CO2 exchange
  • results in hypoxia, hypercapnea, acidosis
  • compression of the pul blood vessels and progressive lung dysfunction lead to pul HTN, cor pulmonale, resp failure, and death
Term
Respiratory Progression in CF:
Definition
  • gradual progression follows chronic infection
  • bronchial epithelium is destroyed
  • infection spreads to peribronchial tissues, weakening bronchial walls
  • peribronchial fibrosis
  • decreased O2/CO2 exchange
  • chronic hypoxemai causes contraction/hypertrophy of muscle fibers in pul arteries
  • pul htn, cor pulmonale, pneumothorax, hemoptysis
Term
Clinical manifestations in CF:
Definition
  • pancreatic enzyme deficiency
  • progressive COPD assoc. w/ infection
  • sweat gland dysfunction
  • failure to thrive (thin pt's)
  • increased wt loss despite increased appetite
  • gradual resp deterioration
Term
Presentation of CF:
Definition
  • wheezing respiration, dry nonproductive cough
  • generalized obstructive emphysema
  • patchy atelectasis (blow out in lungs)
  • cyanosis
  • clubbing of fingers and toes (chronic)
  • repeated bronchitis & pneumonia
  • delayed puberty in females
  • sterility in males
  • parents report children taste "salty"
  • dehydration
  • hyponatremic/hypochloremic alkalosis, hypoalbuminemia (r/t dehydration)
Term
Diagnostic Evalv for CF:
Definition

#1 Quantitative sweat Cl test

  • chest x-ray
  • pul function tests
  • stool fat and/or enzyme analysis
  • barium enema
Term
Resp Management in CF:
Definition
  • CPT - daily
  • bronchodilator meds
  • forced expiration (IS, flutter device)
  • aggressive treatment of pul infections (take out the big guns)
  • Home IV antibio theraphy, aerosolized antibiotics
Term
Prognosis of CF:
Definition
  • Estimated life expectancy = 40-50
  • Maximize health potential: nutrition, prevention/early aggresive treatment of infection, pul hygiene
  • New research: gene therapy, bilateral lung transplants, improved pharm agents (hope for the futrure)
Term
Upper Respiratory Tract Infections (URIs)
Definition
  • Nasopharyngitis - "common cold"
  • caused by numerous viruses (RSV, flu, etc)
  • Fever - varies w/ age
  • Home management - varies w/ age
Term

Acute Streptococcal Pharynigitis

(strep throat)

Definition
  • Group A B-hemolytic streptococci
  • Risk for serious sequelae: acute rheumatic fever (should treat before!), acute glomerulonephritis
  • easy to diagnosis and treat
  • Large tonsils, exudate, hard to swallow
Term
Tonsillitis
Definition
  • various bacteria
  • common in children
  • can occlude airway
  • can be secondary for lower resp infection
Term
Pertussis (Whooping Cough)
Definition
  • Caused by Bordetella pertussis
  • In US occurs most often in children not immunized
  • Highly contagious!
  • Vaccines!
  • Booster shot 11-12yo b/c after 5 the immunity wanes
Term
SIDS
Definition
  • peak incidence 3-4mo
  • more common in males
  • nighttime sleep usually
  • winter
  • preemies, LBW, siblings of prior SIDS
  • low economic status, maternal education, sleeping arrangements (cobedding)
  • Back to sleep, clutter free, cool temp, don't overdress
  • maternal smoking
  • learn CPR as a parent
Term
Prematurity stat risk factors:
Definition
  • mom <19 or >34
  • umemployed, medicaid, less than HS education
  • single
  • preconception wt <110
  • substance abuse, smoking
  • any febrile illness
Term

LBW=

VLBW=

ELBW=

SGA:

AGA:

LGA:

Posterm:

Definition
  • <2500g
  • <1500g
  • <1000g
  • <10th percentile
  • 10th-90th percentile
  • >90th percentile
  • >42 completed weeks, regardless of weight
Term

Apnea of Prematurity (AOP)

 

Definition
  • forget to breath
  • lower age = higher incidence of AOP
  • 1/3-1/2 are <30 weeks
  • Orgins: Central, Obstructive, Mixed
  • Pharm: Caffeine (helps HR & resp drive). dosage based on weight. "breakthrough" apneic events - eval
  • Monitoring: hospital, home
  • interventions: stimulate, resuscitate, document
Term
Lung Development in Premature infant
Definition
  • one of the last things to develop
  • alveoli present in some infants as early as 32 wks GA, they are not uniformly present until 36 wks GA
  • alveoli nec for sufficient exchange of O2 & CO2.
  • inadequate numbers of alveoli result in hypoxemia
Term
RDS (resp distress syndrome)
Definition
  • lack of surfactant in lungs contributes to alveolar collapse
  • affected lungs become stiffer and require more pressure to achieve expansion
  • increased transudate of fluid is produced and further impairs gas exchange
Term
Evaluation & Management of RDS
Definition
  • retractions (substernal, subcostal, intercostal)
  • nasal flaring
  • grunting (can sound like fussing, but rhythmic)
  • ventilatory support
  • conventional ventilation (complications - positive pressure ventilation)

 

Term

Respiratory complications of RDS:

Bronchopulmonary dysplasia (BPD) & Chronic Lung Disease (CLD):

Definition
  • secondary issues to RDS
  • O2 requirements or mechanical vent after 36 weeks of age
  • may be marker of long-term pul and neuro outcome
  • Incidence: 15-40% of preemies. is inversely r/t birth wt and GA
Term
Tachypnea (The Downward Spiral):
Definition
  • RR > 60
  • can lead to progressive hypoxemia & dyspnea...irregular respirations & apnea..death
  • assoc w/: expiratory grunting, nasal flaring, cyanosis, inter&subcostal retractions
Term
Asphyxia
Definition

Suffocation

  • lack of O2-rich environment
  • blockage of airways
  • results in O2 failing to reach blood and tissues
  • if not intervention = DEATH!
Term
Tonsilectomy:
Definition

Danger signs after surgery: bleeding, freq swallowing b/c prob blood.

Position: side-lying or semi-prone b/c want secretions to drain out

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