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NC4-Respiratory Problems


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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
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
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/False epiglottitis is abrupt and can rapidly progress to severe respiratory distress
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
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
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
clinical manifestations of asthma
inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and cough especially at night or in the early morning.
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
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
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/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/False dehydration should be corrected slowly, overhydration can increase the accumulation on interstitial pulmonary fluid to exacerbate small airway obstruction
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
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
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
air flow in and out of the lung
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
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
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
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

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