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Unit 5 Peds- Respiratory
Terms in this set (189)
What is bronchiolitis?
The airway becomes obstructed from swelling of the bronchial walls and mucus caused by an infection of the respiratory tract
Greater increased resistance to air flow in the small passages during expiration
This causes a greater increased resistance to air flow in the small passages of the lungs during expiration...this prevents air from leaving the lungs. When air is trapped and causes progressive overinflation it is known as emphysema.
80% of bronchiolitis cases are caused by-
What are Adenoviruses?
a group of viruses that can cause infections of the upper respiratory tract
What are Parainfluenza viruses?
A group of viruses that causes acute respiratory infections in human, esp. children. Virtually all children in U.S. have been infected by age 6
Bronchiolitis occurs at what age most often?
during the 1st year
Diagnosis of bronchiolitis?
nasal swab for RSV & clinical manifestations
What is RSV?
Respiratory syncytial virus (RSV), which causes infection of the lungs and breathing passages, is a major cause of respiratory illness in young children.
Vital signs associated with bronchiolitis?
High respirations, heart rate increases (because it's trying to pump more blood and oxygen)
droplet and contact
When air is trapped and causes progressive overinflation it is known as
The increase in mucus and edema associated with bronchiolitis causes inflammation of the bronchioles and can lead to.....
bronchiolar obstruction, air trapping.
Respiratory assessment for bronchiolitis & RSV--
RR>60-80/minute, labored and shallow
Wheezes, crackles, or diminished breath sounds
Slight Temperature elevation
Oxygen (most people on nasal cannula turned up to 2)
Equipment-- suction, AMBU bag
Ribiviran, Respigam & Synagis
Cool mist tent
O2 in moderate to severe cases (SaO2 93-98%)
I & O
Steroids, antibiotics, antihistamines, and bronchodilators have not been shown to be effective and are not recommended for use
Won't feed them if their respirations are so high
Have them close to the nurse's station and close to emergency equipment
What is the most common med given for respiratory infections?
Synagis (preventative drug)
Do not PO feed if infant RR is >__. Why?
Ribavirn is -
an aerosolized antiviral agent that is the only specific therapy approved for children hospitalized with RSV (toxic to healthcare providers)
Respigam is -
IV preparation of immunoglobulin G that is used prophylactically to prevent RSV in high-risk infants...monthly like synagis (defer chickenpox, MMR for 9mths following infusion since antiboidies may interfere w/the immune response.
What is the peak age for respiratory problems?
(The younger the infant the greater chance they will have of needing to be hospitalized)
Prophylactic treatment of RSV -use before they get sick
How is synagis administered?
How much does it cost?
IM monthly (Nov. thru April)
1200-1300 per injection
Who qualifies for Synagis treatment?
1. Less than 2 years with chronic lung disease (CLD)(permanent lung damage) who have received medical therapy for CLD within 6 months before RSV season
2. 32 weeks or earlier w/o CLD
3. Severe immunodeficiencies
In hospitalized infants the major means to prevent RSV disease is --
strict observance of infection control practice and segregation of RSV-infected infants (DROPLET PRECAUTIONS)
What is croup?
an VIRAL infection of the upper airway, generally in children, which obstructs breathing and causes a characteristic barking cough.
May also involve: larynx, trachea, bronchi
What causes croup?
inflammation in the airway, esp. in the bronchioles, trachea
Most common hospitalized form of croup
Parainfluenza Virus Types 1, 2, 3
agglutinins Influenza Types A & B
H. influenzae type B (Hib) ***Gram negative bacteria
Mycoplasma pneumoniae (use cold test)
What is stridor?
Stridor is the audible symptom produced by the rapid, turbulent flow of air through a narrowed segment of the respiratory tract, more specifically, the large airways.
Stridor is a symptom and not a diagnosis.
Stridor is most often inspiratory.
Typically originates from the larynx, upper trachea, or hypopharynx.
There are different stages of croup...
starts with intermittent stridor maybe only when disturbed then progresses to continuous stridor.
Why do children with croup display stridor?
Children have smaller diameter of the airway - any inflammation will cause significant breathing problems due to extreme narrowing of the airway. Child tries to struggle to inhale air past the obstruction into the lungs. This causes the stridorous sound.
In croup, edema in the airway produces--
air trapping and poor gas exchange leading to acidosis and cyanosis; can progress to respiratory failure.
Resp failure due to complete obstruction due to swelling
Shock due to acidosis/cyanosis
Signs and symptoms of croup--
Barky seal like cough
Increase respiratory effort
Types of croup
What is Acute Spasmodic croup?
AKA midnight croup
resolves with exposure to cool night air or humidifier
Snotty nose for a few days and at night the kid wakes up with a croupy cough (barky cough)
Area involved in croup
usually limited to larynx
A croupy cough may progress to
How to treat stridor in croup patients-
warm mist in shower or exposure to cold air
Cool night air decreases swelling just enough with what kind of croup?
Does LTB (Laryngotracheobronchitis) respond to night air?
What can you do for LTB (Laryngotracheobronchitis) patients?
Humidified air may work better than nebulized
They may be admitted because they are afraid the subglottic area may close together
All you can do is monitor VS, RR, and O2 sat
Treatment of croup--
Cool mist vaporizer controversial
Racemic epinephrine treatment
Corticosteriods (IV or PO)
Antibiotics if bacterial
Intubation to maintain airway
Hands off. Allow parents to assist child when able. Extreme anxiety can increase WOB and cause them to work to breathe.
What does cool air do for croup kids?
constricts edematous blood vessels
What should parents do why a croup kid starts crying?
encourage parents to hold child and comfort. Not to antagonize, try to keep from crying. This is the one time parents need to give in to the child when it doesn't harm them.
What is Raceic epinephrine treatment used for?
Croup; adrenergic effects cause mucosal vasoconstriction & decreases edema. Onset is rapid (in 10 minutes) peak effect in 2 hrs.
What should you monitor if the patient is on Raceic epinephrine treatment?
Monitor Heart rate (can cause extreme tachycardia and lead to ventricular fibrillation)
After giving this they have to stay in the hospital for at least 23 hours to monitor VS
Nursing interventions for children with croup
Keep the kid from screaming and crying
Sometimes skip vitals like BP if that bothers them
Still take respirations
Sometimes you can let parent do the BP if they are more comfortable
6 months-3 years old
Give them what they want with this
Nursing Prescriptions for croup
Assess for WOB (work of breathing)
Keep SaO2 >92%
Semi-Fowler's position (elevate HOB)
Maintain cool mist air (may help decrease swelling & is easier to breathe cool air)
adequate hydration & nourishment
DO NOT p.o. feed infant RR>60
Endotracheal and tracheostomy equipment
Support parents/keep informed
What will you do if a croup child has a SaO2 <92%?
Oxygen- by nasal cannula? - think about how a child 6mo-5yrs will react to this ?
Oxygen by face mask or "blow by" oxygen.
What is Epiglottitis?
potentially life-threatening condition that occurs when the epiglottis — a small cartilage "lid" that covers your windpipe — swells, blocking the flow of air into your lungs.
Bacterial Infection of epiglottis
What bacteria causes epiglottitis?
Haemophilus influenzae- or Streptococcal (HIB immunizations have decreased its occurrence)
Why is epiglottitis almost non-existant now?
the HIB (H.influenzae) type B conjugate vaccine.
Clinical Symptoms of epiglottitis?
Abrupt onset, Sore throat, Dysphagia, Tripod position, Drooling(can't swallow bc throat is swollen), Anxious / Frightened, Muffled, Absence of spontaneous cough
They are worse than they actually sound.
Key words for epiglotitis?
Calm, respiratory assessment, intubation, noninvasive
Is epiglotitis a medical emergency?
No invasive procedure on a patient with epiglottitis until--
airway is secure
What are signs of deterioration with epiglottitis?
Hypoxia, hypercapnia, respiratory acidosis-- decreased muscle tone, decreased LOC, full obstruction
What to avoid with a child with epiglottitis?
no tongue blades, swabs or anything invasive until airway is secure.
Avoid anything that may irritate child
This may cause the epiglottis to swell more and close the throat
Treatment of epiglottitis--
3 days or/until epiglottis returns to normal size.
Epiglottal swelling ↓24hrs after abx
Ampicillin,Chloramphenicol, or Cephalosporins
3 days IV then p.o.
prior to extubation
About 24 hours after antibiotics in bacterial infections you get much better.
What is the Single largest health burden in pediatrics?
Respiratory Infections influenced by:
Infectious agent: bacterial, viral, fungal
Age: < 3mths lower infection rate D/T mom's antibiodies
3 - 6 months: infections increase D/T disappearance of maternal antibodies and child's own development of antibodies
Size: airways smaller in young children
Short eustachian tubes allow easy access to middle ear
Resistance: any history to underlying disease (cardiac, prematurity, CF)
What is included in the upper airway?
Larynx----upper end of trachea
rigid circular framework of cartiledge
contains epiglottis and glottis (vocal cords) Prevent foods from entering trachea
What is included in the lower airway?
Right & left main bronchi
Functions of the respiratory system?
What is Ventilation?
Mechanical movement of air in & out of lungs
What is the primary gas exchange unit?
25 million at birth
300 million by adulthood (cover a football field)
True or false? -Children usually outgrow asthma.
False---if you truly have asthma, it is life long. They may have episodes that they don't have incidents. Most of the time pulmonologists will not diagnosed until they are 3 years old. S/S of asthma kind of look like that of a cold & kids get recurrent colds when they are little.
True or false? -Reactive Airway Disease is the same as asthma.
If a virus gets in the bronchioles, it's reactive, so RAD is an umbrella term that asthma falls under.
True or false? --Ceiling fans help asthma.
False---it stirs up dust, but it's not the air circulation that harms them
True or false? --Children with asthma should limit running and strenuous physical activity.
False---The goal is to let them do what everyone else is doing, they may need albuterol and take allergy medicine. We don't want to limit them.
True or false? --Wheezing is often the first symptom of an asthma attack.
False---The first symptoms is coughing. This cough is more of a deeper cough like they have bronchitis & they will tell you their chest feels tight.
True or false? --Asthma can be controlled.
True---There are a few patients that they try many meds that don't work but it is a very small percentage.
True or false? --Humidifiers should be used at night for children diagnosed with asthma.
False---You don't want the air too moist. Moisture harbors mold and bacteria and can worsen. Actually should purchace a dehumidifier. LOW HUMIDITY
What is asthma?
Chronic disorder of the airways
A disease that causes wheezing,
breathlessness, chest tightness,
& nighttime or early morning
coughing (tends to be consistant)
Can asthma be cured?
no; only controlled
Pathophysiology of asthma
Reversible airway obstruction
Edema & narrowing of airways
Smooth muscle thickening
Classifications of asthma depend on
frequency of symptoms
Classification of asthma-- Step 1
Mild intermittent Asthma <2wks symptoms
Classification of asthma-- Step 2
Mild Persistent Asthma >2wks symptoms
Classification of asthma-- Step 3
Moderate Persistent Asthma - Daily symptoms
Classification of asthma-- Step 4
Severe Persistent Asthma- Continuous
Drug therapy for asthma patients is based on
What are some ASTHMA TRIGGERS?
Pollens & Mold
House Dust Mites
Odors & Sprays
How can someone exercise with asthma?
Medical plan with MD to allow exercise
Beta 2 agonist (albuterol) 20 minutes prior to exercise
Warm up & cool down
Take Albuterol 30 mins before exercise
Exercise is good (works the lungs and makes them stronger)
How to avoid cockroach triggers?
Food in containers
Eat in kitchen
Spray, put out Bates, Clean (don't leave food laying around)
Commonly if you are allergic to outdoor things or have eczema, they will likely have asthma
How to avoid pollen and mold triggers?
Stay indoors during midday & afternoon when pollen count is high
Keep windows and doors closed
Shower, wash hair, change clothes after playing outside; AT LEAST wash hands
Keep bathrooms clean
Avoid basements, wet leaves
How to avoid dist mites triggers?
Encase mattress, and pillow in airtight cover
Wash bed lines weekly in hot water
Avoid lying on upholstered furniture, carpet (place quilt/blanket on top)
Limit stuffed animals
Use dehumidifiers ***no humidifiers
No ceiling fans
Clean and vacuum (twice a week) (the one with asthma should not do the cleaning)
How to avoid weather triggers?
Triggered by rain/ change in barometric pressure
Cold air: use scarf over mouth
Breathe through nose
Is asthma genetic?
No single gene identified
***Atopy and a family history of allergies is the strongest predisposing factor
What are some predisposing factors for asthma?
Perinatal exposure to tobacco smoke ,Decreased birth weight, Males, African-Americans
Lower socio-economic, Viral respiratory infections (RSV)
overuse of antibiotics
early exposure to allergens (animal dander etc)
Diagnosis of asthma- history of recurrent symptoms:
Persistent cough at night or early morning
Recurrent episodes of wheezing
Cough or wheeze after exposure to exercise or triggers
Frequent "chest" colds or > 10 days duration
Allergies / eczema
Responds to bronchodilators / steroids
Diagnosis of asthma- Physical examination findings:
HEENT: Allergic appearance
Dark circles under eyes or Nasal crease
Nasal secretions, polyps, sinusitis
Skin: dermatitis / eczema
Lungs: Prolonged expiratory phase
(*exam may be normal)
Diagnosis of asthma- monitoring:
Reversible airflow obstruction: FEV1 > 12 %
Common Symptoms of Asthma
Tightness in chest
Decrease in peak flow
Anxious / Irritable
Prolonged expiratory phase
Crackles, wheezing, rhonchi, Tachypnea, Tachycardia
Decrease of peak flow-
Nursing Care for Acute Asthma
Response to medications
Strict I & O
Avoid ICE/Cold beverages with those having a flare up
High Fowler's position
Assess response to medications: VS, breath sounds, pre & post peak flow
Why should an asthmatic avoid ice when having a flare up?
Avoid ice if vagal stimulation increases bronchospasm
Ice and cold beverages will make them wheeze and their hospital stay will be longer
If not in a flare up, they can have
Medications for Asthma: prevention
Corticosteriods (Flovent, Advair, Pulmicort)
Leukotriene Modifiers (Singulair)
Medications for Asthma: Rescue Drugs
Beta 2 Adernergics agonists (Albuterol)
Systemic Corticosteriods (Prednisone, Methylprednisolone)
What are corticosteroids for with asthma patients?
**Do not relieve immediate symptoms (Oral) Onset 3 hours Peak 6-12 hours)
(IV) Onset 1-2 hours
Inhaled: yeast in mouth-- Drink water, brush teeth, use of spacer
Bottle of water for infants
Long term use: osteoporosis, stunted growth, Cushing Syndrome (moon face) hypertension, cataracts (inhaled less effects than parental)
Short term: elevated glucose
What are Leukotriene Modifiers used for in asthmatic patients?
Leukotriene Receptor antagonist
Leukotriene: "slow histamine" Inflammatory agents that cause bronchoconstriction and mucus
Peak: 3-4 hours
What are Non-inflammatory medications used for in asthmatic patients?
mast cell stabilizer
inhibits release of histamine and bronchoconstrictors
"mild to moderate asthma & seasonal
Onset: one week
What are Beta 2 medications used for in asthmatic patients?
Relax smooth muscle
Inhibits histamine release by mast cells
Stop attack once started or prevent attack in exercise induced
***Albuterol: effect on potassium
Liquid / tablets: 30 minutes
Side effects: increased heart rate, tremors, nervousness, nausea
**** If inhaled: Give bronchodilator first
What are Anticholinergics used for in asthmatic patients?
Parasympatholytic Local specific site on the larger central airways
Peak effect: 1.5 to 2 hours
__ is given if asthma is triggered by allergies.
How is Cromolyn administered?
What is the #1 asthma rescue drug?
What are some important things to educate parents about when talking about albuterol?
patient should have it with them at all times
They need to access it very quickly
They will be really hyper
What are important things to educate parents about when talking about corticosteroids?
patient will be very hyper (may have rage)
Warn the parents
They may have emesis
Rinse out mouth after giving corticosteroids or give a drink of water
With a spacer, this can also get on the nose and mouth so clean face
It will cause yeast on face and in mouth (very common)
These will cause glucose to be elevated
What is a Peak Expiratory Flow Meter?
Measures the maximum amt. of air that can be forcefully exhaled in 1 second
Peak flow use technique
Same time each day: morning and evening
Before & 15 minutes after taking medications
Slide marker to bottom
Remove gum / candy
Close lips & keep tongue away from mouthpiece
Blow hard and quick "fast hard puff"
Repeat 3 times
Record highest of three readings
Wait 30 second between attempts
They need to be old enough to seal mouth around it and blow from the lungs (about 4 or 5 years old)
Have them stand
Blow 3 times and take the best of the 3
technique for an inhaler
Tilt head slightly and breathe out
Open mouth with inhaler 1-2 inches away or into aerochamber or spacer into mouth forming airtight seal
Breathe in slowly (3-5 seconds)
Hold breath 5-10 seconds
Wait one minute between puffs
New is full
Dose counting device
Count each puff
Do not place in water
Peak flow: In the red-
You have your ideal peak flow number and the number you blow this time is < 50% of personal best
Seek Medical Attention
If less than 50% they should take albuterol and go to the ER immediately.
Peak flow: In the yellow-
You have your ideal peak flow number and the number you blow this time is 50%-80% of personal best
Change medication plan
Coughing?-probably in the yellow and need albuterol
Peak flow: In the green-
You have your ideal peak flow number and the number you blow this time is 80%-100% of personal best
Take medications as usual
What is STATUS ASTHMATICUS?
Severe prolonged attack
What to know about status asthmaticus?
Medical emegency ** No response or continue to deteriorate
Needs aggressive treatment (ventilator, probable high settings, paralytics etc or continuous nebulizers for prolonged period)
Brief Hx & Exam
Short acting inhaled beta2-agonist
Replacement IV fluids (may cause pulmonary edema)
Hypoventilation leads to respiratory __
In respiratory acidosis:
How is epinephrine used in STATUS ASTHMATICUS?
not recommended but may be given if inhaled medication is not available
used more for anaphylaxis
Anticholinergics for STATUS ASTHMATICUS
(Atrovent) ***Parasympatholytic Local specific site on the larger central airways
Peak effect: 1.5 to 2 hours
Not the initial emergency drug but may be used in combination (kicking in at end of treatments)
Systemic corticosteroids for STATUS ASTHMATICUS
Peak 1-2 hours
Theophylline / Aminophylline are not recommended: provides no additional benefits to beta agonist
May cause adverse reactions (tachycardia)
Antibiotics in STATUS ASTHMATICUS
Only if underlying infection (sinusitis, otitis, pneumonia)
May sound like congested & need antibiotics, when there is no underlying infection
Rely on CBC, CXR, physical exam
Albuterol in STATUS ASTHMATICUS
They don't respond well to albuterol
Need a LONG albuterol dose
Will need some support
Discharge education for asthma
verbal and return demonstration by family & child when age appropriate
Basic asthma facts
S & S of respiratory distress
indications that asthma is under control & adjustment is not needed
Minimal or no chronic symptoms
Minimal or no exacerbations
No activity limitations
No alterations in sleep
Minimal albuterol use (< 1 x per day)
No medication side effects
No symptoms day or night
Should be able to do anything they want
What is Sinusitis/Rhinitis?
Inflammation of paranasal sinuses.
Viral & Bacteria
Viral VS bacterial Sinusitis/Rhinitis
Bacteria has symptoms persist >10days w/purulent drainage & fever above 102
Chronic sinusitis can ooccur in
children w/uncontrolled allergies or ashtma
Most common lethal genetic illness of Caucasian children?
What is Cystic Fibrosis
Exocrine or mucus producing gland dysfunction
Cystic Fibrosis is a Genetic disease of Chromosome #?
The mutated gene responsible for CF codes amino acids - regulates choloride and sodium channels at the surfaces of the epithelial cells. Reduces the ability of the epithelial cells in the airways and pancreas to transport chloride. Abnormal transport of NA & Chloride across the epithelium increases the viscosity of airway mucus causing abnormal mucocilary clearance & lung disease.
What is a sweat test and what is it used for?
sweat electrolyte abnormality is present from birth (place drug on a special device that collects the sweat. 2 separate samples are collected usually one on each forearm, Usually hard to obtain sweat on nb's due to nonactive sweat glands, usually 6months & older.
Sweat test: great than 60 is diagnostic for CF
Normal below 40
Values between 50-60 are repeated
Sweat Test - inotophoresis uses the drug Pilocarpine to stimulate skin
To diagnose Cystic Fibrosis
Cystic Fibrosis symptoms
Have organic failure to thrive
When you lose your salt like that, it makes the mucus in the body really sticky. Most all organs have mucus & it stays dry and sticky.
If it's <40 it's fine, if it's >60 it is a positive test.
How quickly do we want to see the first meconium stool?
the 1st 24 hours
Why do infants with cystic fibrosis have trouble passing the meconium stool?
the mucus blocks them from passing that first stool. (meconium illius)
If a child with cystic fibrosis has a clogged pancreas, they will have--
low blood sugar
Bile duct problems in cystic fibrosis may lead to __.
Clinical Presentation of cystic fibrosis
Meconium ileus (obstruction)
Failure to Thrive (FTT)
Tastes "Salty" to Kiss (sweat all their salt out)
Pathophysiology of CF
Interferes with ion transport
Increased viscosity of mucous
Mucus plugging of air passages, glands & ducts
Increased sodium & chloride in the sweat
Primarily mucous gland dysfunction
Clinical Manifestations of cystic fibrosis: Pulmonary
Thick, sticky mucus plugs damage cilia & bronchial walls.
Obstruction producing emphysema (overinflation) & atelectasis.
Lungs become fibrotic. Hypertrophy leads to pulmonary HTN.
Quickly develop resistant strains, especially pseudomonas,
Repeated/continual infections lead to fibrosis in bronchial walls leading to decreased oxygen/carbon dioxide exchange.
Lungs are dark, moist, with sticky mucus
Cilia is damaged
The more infections they get, the quicker their respiratory status falls
Most have MRSA in the sputum
barrel chest (they have this)
Chromic deoxygenation- clubbing on the fingers (clubbing is a chronic problem)
Eventually the lungs become fibrotic- they take a breath and it is not enough
End of life----CO2 is high, CNS problems because of lack of oxygen
Wheezing and crackles
Coughing-nonproductive to productive
Barrel chest (chronically over-inflated lungs)
Very thick secretions
Pulmonary exacerbations-infectious flare-ups
Sinusitis, nasal congestion & nasal polyps
Forceful cough that may contain blood
Sputum is green and just looks like bacteria
Sometimes they will have coughing episodes that will take their breath
There is a bacteria in what food that can kill CF patients?
What type isolation should CF patients be on?
contact at minimum
What kind of chest will CF patients have?
Pseudomonas aeruginosa, Burkholderia cepacia, Staph aureus (methicillin resistant), Haemophilus influenza, Escherichia coli, Klebsiella pneumoniae
What is Hemoptysis?
spitting up blood
due to pulmonary hypertension & forceful coughing - if it's greater than 5-10ml per hemoptysis, administer dose of Vit K, They will d/c cpt when this occurs, usually resolves on its on occasionally patients have to have the area cauterized due to excessive bleeding.
How much blood can someone cough up for us to worry?
What will be the first order for hemoptysis?
vitamin k; this helps with coagulation and clotting
s/s of spontaneous pneumothorax-
Absent breath sounds on one side
Deviation of the trachea
One side does not expand with inspiration
Increase need of O2
They will take albuterol & chest PT (3-4 times a day) (vibrates the lungs- can do it with hands, a vest, or a machine) on daily basis
What is Pneumothorax
caused by rupture of subpleural blebs through the visceral pleura & usually occurs in advanced CF disease. (usually resolve w/o intervention).
Clinical Manifestations for CF: GI
Constipation throughout life
Deficient in Vitamins-ADEK. (anemia)
Bulky/Large frothy, foul-smelling, floating stools (steatorrhea & azotorrhea)
Why do CF patients have poor digestion and absorption of nutrients (fats and proteins)
Deficient pancreatic enzymes
What labs & nursing actions would be appropriate for GI problems for CF patients?
Electrolytes (be specific)
Vitamin levels: ADEK
I & O: Characteristics of stools
What do stools in CF look like?
Stools will look fatty and have a lot of protein in them
What problems might occur in CF patients due to inability to absorb vitamins?
A=eyes (vision checks)
D=calcium (check bones yearly)
Not absorbing fat soluble vitamins
Prone to anemia
Why do CF patients have a ravenous appetite?
lack of absorption of nutrients remain hungry
Why do CF patients have rectal prolapse?
due to large, bulky stools, malnutrition & increased intraabdominal pressure secondary to coughing.
Where would you assess for pain in a CF patient involving GI symptoms?
also look for jaundice
How many calories does a CF patient need?
Calories for a normal person= 1800-2000
These people need 150% more of what's recommended
Clinical Manifestations for CF Reproductive:
98% males sterile
Fertility- inhibited by highly viscous cervical secretions which block sperm entry.
Males- infertile due to blockage of the vas deferens w/abnormal secretions or by failure of normal development) resulting in decreased or absent sperm production.
Clinical Manifestations for CF: Integument
Salt depletion with sweat, dehydration
High salt & chloride content on skin. The chloride channel defect in sweat glands prevents reabsorption of na & chloride which leaves the person at risk for dehydration.
Hypoalbuminemia- decreased protein intake which leads to decreased albumin (or protein).
Clinical Manifestations for CF: Cardiac
Pulmonary hypertension- The blood vessels that supply the lungs constrict and their walls thicken, so they can't carry as much blood. As in a kinked garden hose, pressure builds up and backs up. The heart works harder, trying to force the blood through. If the pressure is high enough, eventually the heart can't keep up, and less blood can circulate through the lungs to pick up oxygen. Patients then become tired, dizzy and short of breath.
Congestive heart failure
Cariac- Chronic hypoxemia causes hypertrophy of medial muscle fibers in pulmonary arteries & arterioles, leading to pulmonary hypertension & congestive heart failure
What are some S & S of CHF?
Increase 02 requirement
Decreased output with increased weight gain
Treatment for cystic fibrosis-
HCHP diet (150% of RDA)--"Happy to Consume My Calories Sanely"
C: Cottage Cheese
S: Soy Beans
Depo placed due to repeated need for IV access
Vitamin replacement (given with meals)
Replace pancreatic enzymes
Pancrease, Creon, Ultrase
(Give With Meals)
Salt supplementation-- usually NS for medications. Liberal fluids for dilution
Chest PT / Aerosols / Breathing exercises
(CPT: all lobes
Perform after aerosols)
Antibiotics-- multiple, high doses
Expectorants / mucolytics
May need "No added sugar" diet depending on glucose levels
We will give them salt pills
We want them to eat high sodium foods
We want them to cough!
May be on 3 antibiotics at the same time to treat the bacteria they have
What research is available for CF?
Genetic testing in newborns
Nutrition (Research associating poor nutrition with stunted growth/death
What is Pulmozyme or DNase?
- used to decrease viscosity of the mucus
genetic engineered enzyme given by aerosol that alters the mucus in the airways
Estimated life expectancy born with CF in 2003 is __-__ years
40 - 50
Cystic Fibrosis: SICKER KID
S Steatorrhea (fat in stool) Sweat test (high salt content)
I Ileus-meconium (mucus blocks small intestine)
C Constant hunger (poor food absorption)
K Vitamins (fat soluble ADEK)
E Enzyme replacement (prior to meals and snacks)
R Reduce fat (low fat milk or fats as tolerated)
K Keep calories up (simple sugars)
D Drink plenty of fluids (keep secretions thin, increase Na intake, HCHP)
Nursing Prescriptions for CF patients
Assist w/ tests
Maintain oxygenation & airway
Provide pulmonary hygiene: CPT, aerosols
Encourage HCHP diet & NaCl intake
Support parents and child
Assist with home care
Imagine adding additional care into your daily routine....
Aerosols w/CPT that last 30-45mts TID, extra meds & money, decreased time at work. STRESS on family
Provide counseling for family.
Parents are taught about disease when child diagnosed.
What kind of diet should CF patients be on?
High Calorie High Protein Diet:
Calories -Cottage Cheese
Sanely -Soy beans
High Sodium Diet: "Hot Dog" Sauerkraut, ketchup, relish, chili
What labs to monitor with CF patients?
Culture and sensitivity
Peak and trough levels
With a CF patient, do you do breathing treatment first or percussion vest first?
One of the leading causes of fatal injury in older infants and children ages 1 to 3 years
Aspiration of Foreign Objects
Severity of Aspiration of Foreign Objects is determined by:
type of object aspirated
extent of obstruction
Signs and symptoms of ineffective coughing
Unable to speak
Not moving air
No chest movement
High pitched sound / wheeze
What are some commonly aspirated objects?
Seed, nut, carrot, and popcorn, hot dog, round candy, peanut, cookie, biscuit,( account for 40% of aspirated foods) meat, apple, peanut butter
What shaped things are commonly aspirated?
Pathophysiology of Aspiration of Foreign Objects-
Most objects lodge in mainstem or bronchus
May remain in same location or move and be respirated into a different portion
**most lodge in right bronchus
Airways enlarge with inspiration & become narrow with expiration
Wheezing may be heard with expansion of airways
Obstructive emphysema may occur with narrowing and if air cannot escape
Clinical Manifestations of Aspiration of Foreign Objects-
Coughing, choking, gagging.
Asymmetrical breath sounds
Most common symptoms of Aspiration of Foreign Objects-
stridor, wheezing, retractions, coughing
How will you know if there is a foreign object lodged in the larynx?
unable to breathe or speak
Diagnostic Evaluation for Aspiration of Foreign Objects
CXR ( may not detect some objects such as vegetable)
Bronchoscopy: definitive diagnosis of objects in the larynx and trachea
Fluroscopy: detecting FBs in the bronchi
Endoscopy: Endoscopy **must be trained
must have equipment
must be able to have equipment and personnel to handle any emergency
Recognize: signs of choking and when intervention is needed
Children die within __ minutes of aspiration of foreign objects
How big is your airway?
about the size of your pinky finger
The two physiologic changes that occur in the body in response to chronic hypoxemia are --
Polycythemia & clubbing of fingers
Epstein Barr Virus
Transmission of Mononucleosis :
Contact with fluids
direct contact w/oropharyngeal & genital tract secretions, blood transfusions.
*Ha, fever, abd pain
*sore throat, lyphadenopathy (swollen lympnoids)
Mononucleosis Incubation period:
Complications of Mononucleosis
: myocarditis, encephalitis, guillian barre syndrome, meningitis,
rare cns symptoms encephalitis, meningitis, guillianbarre syndrome.
Splenic rupture, resp failure, thrombocytopenia (low platelets count)
Liver functions elevate
Should not consume alcohol
Antipyretics for fever
Monospot test (antibody) or Epstein Barr antibody
Good-virus remains latent in the lymphoid system and reactivates during periods of immunosuppression.
Treatment of mono
symptomatic, avoid kissing until fever gone for several days, contact sports should be avoided until the liver & spleen are normal in size (about 4weeks). Alcohol should be avoided at least for 3 mths after liver function test return to normal.
Do not participate in contact sports because the spleen could rupture
Until the spleen has gone down in about 6 weeks
THIS SET IS OFTEN IN FOLDERS WITH...
Peds, Unit 3
Peds, Unit 6
Peds, Unit 4
Peds, unit 7
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