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Week 4 - respiratory
respiratory
27
Nursing
Graduate
11/02/2014

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Term
Obstructive Pulmonary Disease
Definition
- Anything that leads to narrowing of airway (inflammation)

- Asthma, foreign body, bronchiolitis, croup, laryngo/or tracheomalacia
Term
Restrictive Pulmonary Disease
Definition
- Reduction in lung volume or pulmonary compliance due to pathological changes in lung tissue, pleura, deformities, or neuromuscular disease

- pneumonia, or born with pectus excavatum,
Term
Cough: Management
Definition
- Treat underlying cause
- Humidification for only 2-3 nights
- Vaporizer – do not leave it for days and days because it produces mold
- Not given under 4 or 6 years of age
- Expectorants, Mucolytics, Antitussives
Decongestants, Antihistamines
- HONEY
Term
Bronchiolitis
Definition
- common lower respiratory illness of children <2 y/o: leading cause of hospitalization
- WINTER-SPRING
- Etiology: RSV (50%)
- Risk Factors: male, prematurity, age, chronic lung disease, immunodeficiency
- self-limited (1-2 weeks) charact. by airway edema and not bronchospasm
Term
Bronchiolitis: Clinical sx
Definition
TACHYPNEA
Onset: rhinorrhea, nasal congestion, Cough prodrome 3-7 days, (or apnea)
RR 45-80 = tachypnea
Low grade fever
Wheezing, hyperresonance; noisy, raspy breathing
Severe: retractions, accessory muscle use, flaring of nares, grunting, cyanosis
(not definite hoarseness and high wheezing)
Term
Bronchiolitis: Management
Definition
- Saline drops and bulb syringe for nasal congestion – have baby lie down, one drop in each nostril, wait one minute then suction
- Antipyretics – for fever
- *Hydration***********
- Observe Signs of respiratory distress – coughing too much and is nonstop, if around the mouth changes color to blue or black, chest is going in and out
basically, oxygen and hydration
- don't use bronchodilators, but if u do and they work, continue them
Term
Bronchiolitis: discharge criteria
Definition
Respiratory status:
- Respiratory rate usually <80/min.
- Clearing of the infant’s airway can be performed by parent
using bulb suctioning.
- Patient is either: on room air, or on stable oxygen therapy of 1⁄2 L/min by nasal cannulae for 1 day. (really room air)
Term
Foreign Body
Definition
- Nose: unilateral purulent, foul odor
- laryngeal
- Obstructive: cough, localized wheezing, unilat. Absence of breath sounds, stridor
- Management: xray, flexible bronchoscopy, or if definite hx. rigid bronchoscopy for removal.
Term
Croup/Acute Laryngotracheobronchitis
Definition
- Subglottic swelling, respiratory distress and inspiratory stridor; “Cry out in a hoarse voice”
- Epidemiology: 6 months – 3 years, Peak 2nd year of life, Males, Fall & early winter (cold season)
- Etiology: Parainfluenza
Term
Croup/Acute Laryngotracheobronchitis: Clinical features
Definition
- cold, then LOW GRADE FEVER
- URI progressing to spasmodic, deep, brassy or barking tone, seal’s bark, crowing cock
- Inspiratory stridor
- Night—worse at night. +cough, distress, retractions, RR 50, rales, rhonchi, wheezes, cyanosis,
- OUTSIDE COLD AIR HELPS THEM
- Croupy symptoms 3-4 days
Term
Croup/Acute Laryngotracheobronchitis: Management
Definition
- Mild: Night air, cold mist, steam from shower, door open of refrigerator freezer—relieves spasm
- Consider bronchodilators if bronchospasm present (wheezing)
- Corticosteroids diminish swelling of laryngeal mucosa
- Corticosteroids: 0.3-0.6 mg/kg of dexamethasone (decadron), single dose or up to 4 doses at 6 hour intervals (recent studies have shown 0.15 mg/kg as effective)
- Nebulized epinephrine may be used in ER to treat severe croup – do not send them home, observe for at least 24 hours
Term
Epiglottitis
Definition
- Typical 1-5 yr. old
- Sudden onset of stridor, high fever, muffled voice
- Drooling, toxic appearance, anxiety, a sitting posture with the chin pushed forward and refusal to lie down, no barky cough
- Avoid agitating the child – DO NOT MESS WITH THEM
- A medical emergency, kid needs to go to OR
- Xray: only as an adjunct
- Dx.: Cherry-red epiglottis in OR
- If suspected, intubation must be readily available
Term
If kid has asthma, do not give what?
Definition
MOTRIN!!!
MIGHT GIVE BRONCHOSPASM
Term
Asthma: environmental measures
Definition
House Dust Mite Control
Encase mattress/pillows in airtight plastic covers
Wash bedding in hot water weekly
Remove stuffed toys from bedroom
Remove carpets if possible
Reduce indoor humidity to 30-50%
Use chemical agents to kill mites

Keep Pets outdoors or at least out of the pt’s bedroom
Air filters, air conditioning
Mold control
Vacuum cleaners
Avoid indoor irritants
Smoke, odors, pollutants
Term
****Asthma: categories
Definition
- mild intermittent
- mild persistent
- moderate persistent
- severe persistent
Term
intermittent vs. persistent asthma
Definition
RULES OF 2
- symptoms >2x a week OR
- waking at night > 2x a month
= PERSISTENT
Term
Asthma: goals of therapy
Definition
Minimal or no chronic symptoms day or night
Minimal or no exacerbations
No limitations on activities; no school/parent’s work missed
Minimal use of short-acting inhaled beta2-agonist
Minimal or no adverse effects from medications
Term
Asthma: tx
Definition
- SABA: albuterol
- long term therapy: inhaled corticosteroids
- step up step down guidelines
- review tx every 1-6 mos for ability to step down, if not maintained, step up.
Term
Asthma: steroids
Definition
TWICE A YEAR, not 10 times a year
1-2 mg/kg/dose twice a day no more than 3-5 days
Go for the 40 mg
Prednisone
Term
Pneumonia
Definition
Primary and secondary
PERSISTENT TACHYPNEA
Risks: Cigarette smoke, low socioeconomic status, boys, underlying medical ds. (Sickle cell dz., BPD, GER, asthma, CF, CHD, & immunodeficiency sx’s)
Bacterial Etiology: S. pneumoniae (90%)
Term
Pneumonia: S/S
Definition
- The most sensitive & specific sign of pneumonia is persistent tachypnea
- Respiratory rate thresholds:
>60 per minute <2 months
>50 per minute 2-12 months
>40 per minute >12 months to 5 yrs
- Get chest x-ray above RR thresholds
- Hypoxia (decreased oxygen saturation), RR>70, retractions, flaring, grunting, cyanosis, altered mental status
Term
Bacterial pneumonia: clinical presentation
Definition
- Mild URI with abrupt high fever, and toxicity
- Cough (may be productive)
- +/- Chest pain, absence of wheezing
- Nasal flaring, grunting, retractions
- Tachypnea
- Crackles, dullness to percussion, decreased breath sounds
Term
Bacterial Pneumonia: diagnosis
Definition
- Chest x-ray
- Consider CBC with diff
- Consider culture of nasopharyngeal scrapings
- Lobar consolidation
Term
Bacterial Pneumonia: management
Definition
Hospital admission: <3mo-6mo, persistent hypoxemia, dehydration, vomiting, toxic appearance or h/o chronic condition
Outpatient: S. Pneumoniae ,GP B strep: Penicillin G (100,000units/kg/24 hours) OR one 600,000 unit injection followed by oral penicillin
Amox. 80-100 mg/kg/d TID
Term
Viral Pneumonia
Definition
RSV; adenoviruses; parainfluenza; enteroviruses
Slower onset
At risk for secondary bacterial infection
Xray: Diffuse, streaky infiltrate

Management
Hydration, antipyretics
Humidified oxygen, respiratory therapy support
Antibiotics if secondary infection
Term
Mycoplasmal (Atypical Pneumonia)
Definition
Most common older than 5 years
Etiology: m. pneumoniae
Spread by resp. droplet
Incubation: 2-3 weeks
Symptoms: low-grade fever, usually dry cough, scant sputum, headache, sore throat, GI (abdominal pain, vomiting, etc), malaise
Signs: Harsh sounds, widespread rales
Term
Atypical pneumonia: Diagnosis and meds
Definition
Diagnosis: Clinical, xray non-specific (bil. diffuse infiltrate) atelectasis
Erythromycin (<9 years) 20-50 mg/kg/2-4 times a day
Azithromycin 500mg day 1 250 2-5th day
Clarithromycin (tastes like chalk)
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