alterations in gas exchange/respiratory disorders prt 2

foreign body aspiration

-when any solid or liquid is inhaled into the respiratory tract

-object may lodge in upper or lower airway (can cause varying degrees of respiratory difficulty)

*frequently occurs in ages 6 months - 3 yrs

foreign body aspiration complications

-pneumonia

-abscess formaiton

-hypoxia

-respiratory failure

-death

foreign body aspiration s/sx

-sudden onset of cough

-wheeze

-stridor (generally loud)

foreign body aspiration tx

-surgical removal via bronchoscopy

-prevention

foreign body aspiration nursing

-anticipatory guidance of avoidance

-no peanuts or popcorn until 3 years old

-chop food

-avoid playing with latex ballons

foreign body aspiration: batteries

-can carrode and cause serious damage within 2 hours

foreign body aspiration: magnets

going to try and find each other = spesis and death quickly

-can cause holes/perforations

-twisting of the bowels

respiratory distress syndrome

-specific to neonates/often premature infants

-due to lung immaturity and deficiency in surfactant

ONSET: within hours of birth, shows signs of respiratory distress

respiratory distress syndrome complications

-bronchopulmonary dysplasia

-congestive heart failure

-retinopathy of prematurity

-developmental delay

respiratory distress syndrome tx

-surfactant administration via ET tube after delivery

-mechanical ventilation

respiratory distress syndrome nursing

*usually in the NICU

-assessment of adequate lung expansion

-maintain normothermia (warmer/isolet)

-fluid and electrolyte balance

-adequate nutrition (NG tube or TPN)

allergic rhinitis

-chronic condition associated with atopic dermatitis and asthma

-intermittent or persistent inflammatory state mediated by IgE

*found on mast cells >>> histamine and leukotrienes = inflammation

perennial allergies

-year-round allergies

*indoor mold, pet dander, dust mites, cockroach antigen

seasonal allergies

*pollen, trees, weeds, fungi, outdoor molds

allergic rhinitis s/sx

-watery nasal discharge (rhinorrhea)

-nasal congestion

-pruritis

-sneezing

-mouth breathing

-snoring

-red rimmed eyes

-tearing

-allergic shiners (gray/blue cast under the eyes)

-allergic salute

allergic salute

rubbing the nose in response to nasal discharge

-transverse line from whipping upwards

allergic rhinitis nursing

-avoiding known allergens (perennial and seasonal)

-encourage saline nasal washes/prays

allergic rhinitis meds

-nasal steroid sprays (fluticazone)

-second-generation antihistamines (cetirizine and loratadine)

*doesn't cause drowsiness

-leukotriene modifiers (montelukast)

*blocks leukotrienes

asthma

-chronic inflammatory airway disorders characterized by: airway hyperresponsiveness, airway edema, and mucus production

*most common chronic illness of childhood

*more susceptible to serious bacterial and viral respiratory infections

asthma acute complications

-status asthmaticus (EMERGENCY)

-respiratory failure

asthma core management

-control and prevent inflammatory episodes

airway remodeling

-may occur with poorly controlled asthma

-causes decreased responsiveness to therapy

*decreased response to medication and pulmonary functions

intermittent asthma

SX: day 1-2x a week, night 1-2x a month

INTERFERENCE: does not limit

SABA USE: 1-2 days/week

mild persistent asthma

SX: day > 2x a week; night 3-4x month

INTERFERENCE: minor limitation

SABA USE: >2 per week

moderate persistant asthma

SX: daily, night >1x week

INTERFERENCE: some limitations

SABA USE: daily

severe persistent asthma

SX: throughout the day, night often 7x/week

INTERFERENCE: extremely limited

SABA USE: several times per day

asthma s/sx

-difficulty breathing with coughing

-SOB

-chest tightness

-dyspnea with exercise

-wheezing mostly on inspiratory

-family hx of atopy (any of the 3)

-known allergies

asthma dx

-decreased pulse oximetry

-hyperinflation on chest x-ray

-pulmonary function tests to show progression

*not useful during an attack

-peak expiratory flow rate

*decreased during exasterbation

*should use daily

-allergy testing for triggers (last thing we do)

asthma: bronchodilators (SABA)

relaxes smooth muscle

-for acute tx of bronchoconstriction

*albuterol

asthma: bronchodilators (LABA)

control/maitenence medication

-daily use to prevent bronchospasms

-usually given with inhaled corticosteroids

*salmeterol and formuterol

asthma: corticosteroids (inhaled)

anti-inflammatory

-can suppress the immune system

-increased risk for thrush

*recommend spacers

*rinse mouth after use

*fluticason and budinide

asthma: corticosteroids (oral)

anti-inflammatory

-can suppress the immune system

-for severe types

*methylprednison or dexaprednison

asthma: leukotriene modifiers

anti-inflammatory

-causes constriction of smooth muscles and increases mucous production

*montelukast (oral)

asthma: mast cell stabilizers

stops cells from secreting histamine

-decreases mucous production and decreases inflammation

*cromolyn sodium (only inhaled)

asthma: theophylline

useful when client has nighttime symptoms

-risk of toxicity = weekly blood draws

-no caffeine, increase risk of toxicity

assess asthma control

-ongoing with use of peak flow meter

-childhood asthma control test (19 or less may inidcate poor control)

exercise induced bronchospasm

asthma sx associated with exercise

-SABA for when this happens

-sometimes given a LABA

child and family asthma education

-symptom-free and decreased exacerbation

-importance of maintenance medications

-asthma action plan

-appropriate use of nebulizers, MDIs, spacers, and dry powder inhalers

asthma action plan

-peak flow meter use

-inhaler

-nebulizer

-how to use equiment

device side effects

-white patches, sores in mouth should be reported

-montelukasts can cause depression/suicidal ideations

*educate and encourage to report any feelings of this

status asthmaticus nursing management

-patient unresponsive to tx and meds for attack

*prolonged bronchospasm (throat is closing)

GO TO THE ER:

-continuous albuterol tx

-oxygen therapy (amount depends on response to albuterol)

asthma stepwise approach management

1st: chest adherence, inhaler technique, environmental control, and comorbid conditions

-assess how well it's controlled (peak flow meter and childhood asthma controlled test)

-step up if needed

-step down if possible

*steps 1-6 (preferred and alternative)

step 1 asthma management

*intermittent

PREFERRED: SABA prn

ALT:

step 2 asthma management

*mild persistent

PREFERRED:

-daily low-dose inhaled corticosteroids and SABA prn

OR

-age 12+: SABA with inhaled corticosteroid prn

ALT: daily leukotriene modulator OR cromolyn and SABA prn

step 3 asthma management

*moderate persistent

PREFERRED: daily and prn

-combination of low-dose inhaled corticosteroids and LABA (formoterol)

ALT: daily medium-dose inhaled corticosteroids and SABA prn

step 4 asthma management

*moderate persistent

PREFERRED: daily and prn

-combination medium dose inhaled corticosteroids and LABA (formoterol)

ALT: daily medium-dose inhaled corticosteroids + leukotriene modifiers and SABA prn

step 5 asthma management

*severe persistent

PREFERRED: daily high-dose inhaled corticosteroids + LABA and SABA prn

ALT: daily high-dose inhaled corticosteroids + leukotriene modifiers and SABA prn

step 6 asthma management

*severe persistent

PREFERRED: daily high-dose inhaled corticosteroids and LABA + oral corticosteroids and SABA prn

ALT: daily high-dose inhaled corticosteroids + leukotriene modifiers + oral corticosteroids and SABA prn

asthma peak flow meter

-do it daily and at the same time every day

-not used during an attach

*measures peak expiratory flow rate (PEFR)

-use this with severe asthma to determine daily control

green peak flow meter

good control

-keep doing what your doing

>80% personal best

yellow peak flow meter

caution

-call the doctor and tell them what's going on

-take SABA

*50% to 80% personal best

red peak flow meter

medical alert

-take SABA and go find help

<50% personal best

peak flow meter use

-slide arrow to zero

-stand up straight

-deep breath, close lips around the mouthpiece and blow out hard and fast

-note number arrow moves to

-repeat 3x and record the highest reading

-keep a record of daily readings

-ensure it's at the same time each day

nebulizer

-delivers inhaled medications

-through mask or mouthpiece

*plug in and connect tubing

*add medication to the medicine cup

*attach mask or mouthpiece to medication cup

*mask onto the child

*get the child to place their lips around the mouthpiece and breathe through the mouth

-tap to ensure all medications fall to the bottom near the end

*wash and air dry after use

metered dose inhalor

-use with a spacer or holding chamber

-ensure a good seal

-compress the inhaler and inhale slowly and deeply

*hold for 10 seconds or as long as they can and blow out with pursed lips

-wait at least one minute before second inhalation

chronic lung disease

-seen most commonly in premature infants

*usually home on O2

-alveoli may reduced by half = decreased gas exchange

-come in low birth weight, male, white

*whimpy white boy syndrome

chronic lung disease complications

-pulmonary artery hypertension

-CHF

-severe pneumonia (viral or bacterial)

chronic lung disease common sx

-tachypnea

-labored respirations

-wheezing

-FTT dye to dyspnea while feeding

chronic lung disease tx

-inhaled anti-inflammatory meds (corticosteroids)

-SABA

-supplemental long-term O2 may be needed

-may need fluid restrictions/diuretics

-high-calorie formulas (24kcal/oz)

chronic lung disease education

-pulse ox use

-how to use the machine

-no exposure to smoke

-keep them isolated

cystic fibrosis

autosomal recessive disorder (both parents are carriers)

-testing on newborn screening

-median age survival = late 30s

*thickened tenacious secretions in the glands, GI tract, pancreas, and respiratory tract >>> become obstructed

-infertility due to thickened seminal fluid and cervical mucus

-bulky, greasy stools, poor weight gain, chronic cough

cystic fibrosis respiratory sx

-wheezing

-coughing

-dyspnea

-cyanosis

-barrel chest

-clubbing

-chronic respiratory infections

cystic fibrosis GI sx

-striatoreah

-poor weight gain

-deficiency in fat-soluble vitamins (vitamin A, D, E, K)

-bulky stool (increases the risk for blockages)

cystic fibrosis skin sx

-increased levels of sodium chloride

-sweat, saliva, tears

-electrolyte imbalance/dehydration

cystic fibrosis labs

-sweat chloride test (>60 mEq/L)

cystic fibrosis dx

-O2 sat decreased (esp in exacerbations)

-chest x-ray (hyperinflation, bronchial wall thickening, atelectasis, infiltration

-pulmonary function test (decreased vital capacity and decreased forced expiratory volume)

-stool high in fat

-DNA testing

forced expiratory volume

how much air a person can exhale during a forced breath

cystic fibrosis nursing

-maintain airway

*chest physiotherapy

*positive expiratory therapy (vibrations to mobilize)

-prevent infection

*inhaled antibiotics

*respiratory medications (SABAs, anticholinergic, fluticasone propionate

-encourage physical exercise

-maintain growth (pancreatic enzyme supplements, vitamin A, D, E, and K, high cal/high protein diet)

-promote family coping

*chronic disease

*physical, emotional, and financial stress

*lung/pancreatic transplants

-terminal illness

chest physiotherapy

-bronchodilator (30 min - 1 hour before)

-loosen secretions = goal

-don't do to close to meals

*use vibrations to mobilize secretions

cystic fibrosis inhaled antibiotics

levafloxacin and tobramycin

cystic fibrosis respiratory medications

-SABA (albuterol) - relaxes smooth muscles

-inhaled anticholinergic (ipratropium bromide) - bronchodilators

-fluticasone propionate/salmeterol (advair) - open airway, decrease inflammation, decrease mucus

inhaled dornase alfa

decreases how thick the mucus is and allows for easier expulsion

-store in fridge

apnea

-absence of breathing for longer than 20 seconds

*associated with bradycardia followed by

*may excist alone or along side another disease

*not a precursor to SIDS

apnea risk factors

-prematurity

-anemia

-hx of metabolic disorder

-cardiac or neurologic disturbances

-respiratory infection

-sepsis

-child abuse

-poisoning

infant apnea

-gentle stimulation (rubbing chest/tapping soles of feet)

-unsuccessful = give rescue breathing or bag mask ventilation

Acute Life Threatening Event (ALTE)

-combination of apnea, color change, muscle tone alteration, coughing or gagging

-monitor the pulse ox and cardiac monitor if needed

apnea nursing

-avoid

-neutral thermal environment

-avoid excessive vagal stimulation/taking rectal temp

-administer caffeine or theophylline (helps stabilize pressure and increase cerebral blood perfusion)

recurrent apnea or ALTE nursing

-monitor at home with a belt over the chest

-train family in CPR, and when to call the doctor

*lots of education

sudden infant death syndrome

sudden death of previously healthy infant younger than 1 year of age

sudden infant death syndrome risk factors

-maternal smoking during pregnancy

-secondhand smoke

-co-sleeping

-prone or side-lying sleeping

-LBW

-prematurity

-twin or multiple birth

Sudden Infant Death Syndrome Prevention

-back to sleep

-firm surface

-avoid soft bedding

-pillows

-stuffed animals

-avoid tobacco smoke exposure

-sleep separately from parents

-avoid overbundling or overdressing

-encourage pacifier use dyring naps and at bedtime