NC4-Respiratory Problems
Terms
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- Common cold is cause by
- rhinovirus, RSV, adenovirus, influenza virus and the parainfluenza virus
- Strep infections predispose one to
- acute rheumatic fever and inflammatory disease of the heart, joints and central nervous system, acute glomerulonephritis and acute kidney infection
- Nurse alert with toothbrushes of + strep
- toothbrushes should be discarded if positive stretococcal infection
- adenoids
- aka pharyngeal tonsils Adenoids are part of the immune system. Like all lymphoid tissue, they trap infectious agents like viruses and bacteria, and they produce antibodies. Since the adenoids are located at the back of the nasal airway, they provide defense against inhaled substances. This function decreases with age as the adenoids shrink. Because adenoids do ordinarily shrink by late childhood, the problems caused by enlarged adenoids rarely occur in adults.
- influenza is spread by
- large droplets infection
- Influenza and prolonged fever
- prolonged fever or apperance of feer during early convalescence is a ding of sencondary bacterial infection and should be reported to the practitioner for antibiotic therapy
- myringtotomy
- surgical incision of the eardrum- to alleviate pain of AOM
- Bacteria that causes AOM
- streptococus pneumoniae, haemophilus influenzae and moraxella catarrhalis
- Clinical observations of epiglottis
- are absence of spontaneous cough, presence of drooling and agitation
- acute epiglottitis
- a werious obstructive inflammatory process that occurs predominantly in children 2-5 years of age
- True/false nurses who suspect epiglottitis hould not attempt to visualize the epiglottis directly with a tongue depressor or take a throat culture but should refer the child for medical evaluation immediatley
- True
- True/False epiglottitis is abrupt and can rapidly progress to severe respiratory distress
- True
- Clinical manifestations of epiglottis
- child goes to bed asymptomatic and awaken with a soar throat, pain on swallowing, fever, appears sicker, insists on sitting upright, and leaning forward with the chin thrusted out, mouth open and tongue protruding, drooling because of the difficulty swallowing
- Tripod position in epiglottitis
- sitting upright, leaning forward, with the chin thrust out, mouth open and tongue protruding
- How to prevent apiration in children /c resp distress
- children with severe resp distress (> 60 respirations) should not be given anything by mouth to prevent aspiration and decrease the work of breathing
- Signs of impending airway obstruction
- include increased pulse and respiratory rate; substernal, suprasternal and intercostal retractions; flaring nares; and increase restlestness
- spasmodic laryngitis aka
- spasmodic croup, midnight croup or twilight croup
- bronchitis
- inflammation of the large airways (trachea and bronchi)
- Ribivarin and pregnant women
- Pregnant health care workers should not be caring for a child receiving ribivarin because of the potential toxic or teratogenic effects
- Two types of pneumonia
- bacterial or viral
- Severe Acute repiratory distress syndrome SARS
- severe form of atypical pnuemonia
- Clinical manifestations of SARS
- T > 100.4 HA, cough, SOB, difficulty breathing, after 2-7 days dry, nonproductive cough and dyspnea, severe sars require intubation in some patients
- which is the most common bacteria for community acquired pneumonia
- streptococcuss pneumoniae
- bacteria that causes pneumoniae
- staphyloccus aureus, M. catarrhalis, and Haemophilus influenza
- postural drainage
- Drainage used in bronchiectasis and lung abcess. The patient's body is positioned so that the trachea is inclined downward and below the affected chest area [1]. Postural drainage is essential in treating bronchiectasis and patients must receive physiotherapy to learn to tip themselves into a position in which the lobe to be drained is uppermost at least three times daily for 10-20 minutes.
- Chest physiotherapy
- Chest physiotherapy - performed by respiratory therapists whereby breathing is improved by the indirect removal of mucus from the breathing passages of a patient. Techniques include clapping or percussion: the therapist lightly claps the patient's chest, back, and area under the arms.
- Pertussis aka whooping cough
- acutre resp infection caused by Bordetella pertussis- affects children 4yrs old who have not been immunized
- DOT
- Direct observation of therapy
- forein body aspiration is manifested by
- choking, gagging, wheezing or courghing, laryngotracheal obstruction most commnoly causes dyspnea, cough stridor and hoarseness b/c/o decreased air entry, cyanosis occurs if it becomes worse
- clinical manifestation of ARDS associated with
- sepsis, viral pneumonia, smoke inhalation and near drowning. It is a syndrome of respiratory distress and hypoxemia
- True signs of a child choking
- 1. cannot speak; 2. becomes cyanotic; 3. collapses. This is an emergency, can die within 4 minutes
- True/False Carbon monoxide poisoning will show a normal O2 saturaton
- True the device only measure oxygenated and deoxygenated hemoglobin, it dose not measure dysfunctional hemoglobin such as carhoxyhemoglobin (COHb)
- clinical manifetations of carbon monoxide poisoning
-
mild manifestations- headache, visual disturbances, irritability and nausea
severe: confusion , hallucinations, ataxia, and coma.
bright cherry lips are infrequently described, pallor and cyanosis are more frequent - True/False Corticosteroids have not established benefit and may increase the risk of infection, Prophylactic antibiotis offer not benefit and may lead to development of resistant organism in treatment of carbonmonoxide poisoning
- True
- clinical manifestations of asthma
- inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and cough especially at night or in the early morning.
- atopy
- Atopy (Greek ατοπία - placelessness) or atopic syndrome is an allergic hypersensitivity affecting parts of the body not in direct contact with the allergen. It may involve eczema (atopic dermatitis), allergic conjunctivitis, allergic rhinitis and asthma.
- true/false- important component of asthma is bronchospasm and obstruction
- true
- Pulmonary function test
- measures lung function, the amt of air and speed that can be inhaled and exhaled (can be done by spyrometry)
- Peek expiratory flow rate
- measures the patient's maximum ability to expel air from the lungs
- provacative testing
- helps to helps identify inhaled allergens
- Why are spacers added to a metered dose inhaler
- to prevent yeast infections int the mouth
- corticosteroids
- inflammatory drugs used to treat reversible airflow obstruction and to control symptoms and reduce bronchial hyperractivity in chronic asthma.
- Theophylline toxicity
- can occur with serum levels greater than 20ug/dml. Side effects from theophylline include nausea, vomiting, headache, iritability and insomnia, early signs of toxicity are nausea, tachycardia, and irritability; seizures and dysrhythmias occur at blood theophylline levels greater than 30
- True/False hyposensitization injections hould be administered only /c emergency equipment and meds readily available in the event of and anphylactic reaction
- True
- True/False Status asthmaticus is a medical emergency that can result in repiratory failure and death if untreated. The child who sweats profusely, remains sitting upright and refuses to lie dow is in severe respiratory distress, Also the child who sudden
- true
- True/False dehydration should be corrected slowly, overhydration can increase the accumulation on interstitial pulmonary fluid to exacerbate small airway obstruction
- true
- Statis Asthmaticuas
- Status asthmaticus is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators and corticosteroids. Symptoms include chest tightness, rapidly progressive shortness of breath, dry cough and wheezing. The lung failure means that oxygen can no longer be provided, carbon dioxide can no longer be eliminated, which leads to acidosis.
- The earliest manifestation of cystic fibrosis
- meconium ileus in the newborn
- true/false cystic fibrosis also affects the pancreas by blocking essential pancreatic enzymes from reading the duodenum which causes impairment in the digestion
- true
- what kind of stools do pt with cystic fibrosis have
- bulky stools that are frothy from undigested fat (steatorrhea) and foul smelling from putrefied protein (azotorrhea)
- What effect does CF have on the rectum
- can cause prolapse of the rectum
- What finding is Cystic fibrosis diagnosed with?
- 1. Hx of disease in family; 2. absence of pancreatic enzymes; 3. increase in electrolyte concentration of sweat; 4. chronic pulmonary involvement
- signs of pneumothorax in CF
- tachypnea, tachycardia, dyspnea, pallor and cyanosis
- What is the recommended diet of CF patient
- hight protein, high calorie diet, because of impaired intestinal absorption
- What is the recommendation when a child with CF eats a high fat diet
- Add extra enzymes to the diet
- Respiratory failure
- the inability of the respiratory apparatus to maintain adequate oxygenation of the blood /c or /s carbon dioxide retention
- respiratory arrest
- the cessation of respiration
- apnea
- cessation of breathing
- Side effects of beta adrenergics
- tremors, heacaches, nervousness, increased pulse rate and palpitations (high doses)
- Nurse alert on tolerance to beta adrenergics
- It is believed that tolerance to these drugs can develop; if this occurs, the dose may need to be increased,. Failure to respond to a previously effective dose may indicate worsening asthma that requires reevaluation before increasing the dose
- Action of atrovent
- dilates the bronchioles
- Lung compliance
- a measure of the elasticity, expandability, and distensibility of the lungs and thoracic structures is called compliance.
- decreased lung compliance is evidenced by
- when the lungs and thorax are siff
- diffusion in respiration
- the process by which oxygen and carbon dioxide are exchanged a the air-blood interface
- Pulmonary effusion
- actual blood flow through the pulmonary circulation
- ventilation
- air flow in and out of the lung
- perfusion
- filling of the plmonary capillaries with blood
- One thing that causes hypoxia
- ventilation and perfusion imbalance causes shunting of blood resulting in hypoxia (low cellular 02 level)
- note: partial pressure in gas exchange
- when a gas is exposed to a liquid the gas dissolves in the liquid until an equilibrium is reached.
- oxyhemoglobin dissociation curve
- shoes the relationship between the partial pressure of oxygen and the percentalge of saturation of oxygen
- what controls breathing
- the respiratory centers of the brain
- What is one thing that stimulates breathing in an immobile patient
- passive range of motion excercises
- what are the major signs and symptoms of respiratory disease
- dyspnea, cough, sputum production, chest pain, wheezing, clubbing of the fingers, hemoptysis and cyanosis
- pneumothorax
- air in the pleural cavity
- clinical significance in COPD
- is dyspnea with an expiratory wheeze
- pleuritic pain is described
- as sharp stabbing pain and intermittent, or may be dull, aching and persistent
- pleuritic pain is described as
- sharp, like the stabbing of a knife, pts are uncomfortable when they lie on the affected side.
- chest pain associated with pulmonary problems can be described as
- sharp stabbing and intermittent, or it may be dull aching and peristent. May be referred to the neck, back or abdomen
- coffee grounds
- blood that has been in contact with gastric juice
- late indication of hypoxia
- cyanosis
- tubinates
- anatomy shaped like scroll: describes any of the three scroll-shaped bones found on the walls of the nasal passages of mammals
- barrell chest
- overinflation of the lungs seen in COPD patients with emphysema
- funnel chest
- occurs more often in men than women, manifested with depression in the lower sternum, can cause murmers and may depress the heart and great vessels, seen in Rikets and Marfan's syndrome
- pigeon chest
- Pigeon chest is noticeable because of outward projection of the breastbone and/or neighbouring ribs. There is indrawing of the sides of the chest wall and often asymmetry, which can reduce the volume of the chest and place abnormal loads on the thoracic spine.
- Cheyne stokes
- Cheyne-Stokes respiration is an abnormal pattern of breathing characterized by periods of breathing with gradually increasing and decreasing tidal volume interspersed with periods of apnea. In cases of increasing intracranial pressure, it is often the first abnormal breathing pattern to appear.
- Kussmaul breathing
- hyperventilation marked by an increase in rate and depts, associated with severe accidosis of diabetic or renal origin
- tactile fremitus
- sound generated by the larynx travels distally along the bronchial tree to the chest wall in resonant motion. The detection of teh resulting vibration on the chest wall by touch is called textile fremitus.
- True/false fremitus is more pronounced in men
- True because men have a deeper voice
- Which type of pts do not show tactile fremitus
- pts with emphysema
- Why pts have increased tactile fremitus
- pts that have pneumonia
- atelectacis
-
1 collapse of lung: a partial or total collapse of a lung
2. nonexpansion of lungs at birth: a condition in which the lungs fail to expand completely at birth - Pleural effusion
- Pleural effusion is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs.
- Which pts have diminished or absent breath sounds
- pts with emphysema
- Name two diseases would produce abnormal breath sounds
- heart failure and pneumonia
- Name two adventious breath sounds
- crackles and wheezes
- What conditions are crackles heard in?
- They are often present in pneumonia, bronchitis, heart failure, bronchiectasis and pulmonary fibrosis
- Where is a friction rub best heard?
- They are heard over the lower lateral anterior surface of the thorax
- When are wheezies heard?
- They are heard in pts with asthma, chronic bronchitis and bronchiectasis
- Describe crackles in general
- soft, high pitched, discontinuous popping sounds tha occur during inspiration, r/t fluid in the airwas or alveoli or to opening of collpased alveoli
- What are coarse crackles
- disontinuous poppling sounds heard in early inspiration; harsh moist sound originating in the large bronchi (associated with obstructive pulmonary disease)
- What are fine crackles
- discontinuous popping sounds heard in late inspiration, sounds like hair rubbing together, Assoc. with intersitial pneumonia, restrictive pulmonary disease (fibrosis), in early inspiration assoc. with bronchitis or pheumonia
- Sonorous wheezies (ronchi)
- deep, low pitched rumbling sounds heard primarily during expiration, caused by air moving through narrowed tracheobronchial passages, r/t secretions or tumor
- sibilant wheezes
- continuous, musical, high-pitched, whistle-like sound heard during inspiration and expiration caused by air passing through narrowed or partially obstructed airways may clear with coughing, r/t bronchospasm, asthma and buildup of secretions
- friction rubs
- harsh crackling sound, like two piecesof leather being rubbed together, heard during inspiration alone or during both inspiration and expiration, may subside whn pts holds breath, coughing will not clear sound, r/t inflammation or loss of lubricating pleural fluid
- tidal volume
- the volume of each breath
- minute ventilation
- the volume of air expired per minute = to the product of the tidal volume and the respiratory rate or frequency
- vital capacity
- Vital capacity is the maximum volume of air that a person can exhale after maximum inhalation. A person's vital capacity can be measured by a spirometer
- Inspiratory Force
- Inspiratory force measures the effort of the pt during inspiration
- Pulmonary function tests
- used to assess respiratory function and to determine the extent of dysfuntion