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Respiratory Nur 106

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Respiratory Nur 106 Slide 2 Respiratory System General Information Signs and symptoms of respiratory distress Common diagnostic tools Common medications and treatments Slide 3 General Information Fetus practices breathing in utero Normal to have amniotic fluid in lungs Absorbed as soon as takes first breath Meconium in the amniotic fluid is problem Surfactant reduces surface tension in lungs so that lungs will remain open Neonates are obligant nasal breathers Slide 4 General Information Normal respiratory rate: 3050 Lumen of respiratory system is smaller in children Eustachian tubes shorter and more horizontal Metabolic rates are higher than adults Slide 5 Respiratory Assessment Auscultation Absent or diminished lung sounds Adventitious lung sounds Cracklespassage of air through moisture WheezesNarrowed passageways Slide 6 Respiratory Assessment Observation Barrel Shaped Chest Slide 7 Respiratory Assessment Observation Cyanosis Club fingers Slide 8 Respiratory Assessment Observation Presence of retractions Occur when airway obstructed in young children Indication of severity of respiratory distress Slide 9 Respiratory Assessment Infants chest walls more flexible, muscles immature, retractions common Slide 10 Respiratory Assessment Retractions Suprasternal Substernal Intercostal Slide 11 Common Diagnostic Tests Chest xray Bronchoscopyvisualizes trachea and bronchi directly Under anesthesia Pulmonary function testsusually not until 5 to 6 years of age Sputum culturebest collected in morning Slide 12 Common Diagnostic Tests Arterial blood gases Heparinized syringe Place on ice Transport to lab immediately Pressure to site for 5 minutes Pulse oximetry Oxygen saturation SP o2 8793% safe levels of saturation Slide 13 Respiratory System Laryngotracheobronchitis (croup) Pnuemonia Respiratory distress syndrome Bronchopulmonary dysphasia Cystic Fibrosis Sudden Infant Death Syndrome (SIDS) Slide 14 Respiratory System Asthma Respiratory Syncyntial Virus Pharyngitis Allergic Rhinitis Tonsillitis/adenoiditis Influenza Slide 15 Laryngotracheobronchitis Generalized infection of larynx, trachea and bronchi Croup Frequently shows symptoms of mild URI during day; at night, awakens with hoarse barking cough and severe respiratory distress Most common organisms: RSV, parainfluenza virus and mycoplasma pneumoniae Slide 16 LTB Etiology Affects children under 5 (smaller airways) Affects boys more frequently than girls Inflammation causes narrowing of airways Onset gradual May reoccur several nights in a row Slide 17 LTB Symptoms Low-grade fever Barking cough Respiratory stridor Hypoxemia Tripod position Slide 18 Respiratory Distress Tripod Position Slide 19 LTB Treatment At home: Hot steamy bathroom Cool night air Sit upright Cool mist vaporizer in home made tent Elevate head of crib Increase fluids Slide 20 LTB Treatment Hospitalization Croup tent IV fluidsoral fluids may cause aspiration Bronchodilators Corticosteroids Intubation equipment available Slide 21 Epiglottitis Inflammation of epiglottis Life threatening obstruction Usually bacterial (hemophilus influenza) Sudden onset in healthy child: awakens with high fever, drooling and respiratory distress Do NOT examine throatmay lead to spasm and complete obstruction Slide 22 Pneumonia Inflammation/infection of bronchioles and alveloar spaces Causative agents bacteria, viral, mycoplasma Children under 5: ViralRSV. Influenza, adenovirus,rhinovirus Children over 5: Bacteriastreptococcus pneumoniae Slide 23 Pneumonia Symptoms Fever, cough, dyspnea, tachypnea Rhonchi, crackles, wheezes Decreased breath sounds with consolidation Diagnosis Xray Treatment Antibiotics, IV, fever control, airway management Slide 24 Respiratory Distress Syndrome Formally called Hyaline Membrane Disease Disease primarily of premature Infant of a diabetic mother White children more frequent than black Boys more often than girls Primary pathology is production deficiency in surfactant Slide 25 Surfactant Lung Compliance Atelectasis Work of breathing Ventilation CO 2 Acidosis PO 2 Anaerobic metabolism MetabolicMetabolic RespiratoryRespiratory Adapted from: London, M; Ladewig, P; Ball, J; and Bindler, R. 2007. Maternal & Child Nursing Care, 2nd ed. Upper Saddle River, NJ, Prentice Hall, p.820. Slide 26 Respiratory Distress Syndrome Diagnosis: x-raydiffuse bilateral density (white-out), and atelectasis Antenatal prevention treatment: betamethasone Slide 27 Respiratory Distress Syndrome Nursing Care Oxygenation/ventilation Transcutaneous oxygen/CO 2 monitoring Blood gas monitoring Oxygen Continuous positive airway pressure (CPAP) Respirator Slide 28 Respiratory Distress Syndrome Nursing Care Correction of acid-base imbalance Temperature regulation Nutrition Protect from infection Slide 29 Respiratory Distress Syndrome Surfactant Replacement Therapy At birth and repeated as necessary Endotracheal administration Slide 30 Bronchopulmonary dysplasia BPD Chronic lung disease Precipitating factors: prematurity, high oxygen concentrations, positive pressure ventilation Symptoms: Persistent respiratory distress Wheezing, tachypnea, pulmonary edema Failure to thrive Slide 31 Bronchopulmonary Dysplasia Nursing Care Oxygen Tracheostomy Recurrent respiratory infections Palivizumab, RSV immune globulin Promote growth and development Slide 32 Bronchopulmonary Dysplasia Medications: Bronchodilators Anti-inflammatory agents Diuretics Antibiotic Therapy Vitamin A Slide 33 Cystic Fibrosis Inheritedautosomal recessive Both parents must be carriers Each child has a 1 in 4 chance of being affected Affects primarily white children Father Mother (carrier) Carrier Unaffected Affected Carrier Slide 34 Cystic Fibrosis Multi-system diseaseaffects exocrine glands Bronchioles, small intestines, pancreas, bile ducts Exocrine secretionsthick and tenacious Abnormal sodium excretion Sweat Chloride test Heat Prostration Slide 35 Cystic Fibrosis LungsSecretions pool in bronchioles leading to infection and atelectasis Barrel shape chest Cyanosis Clubbing of fingers and toes Recurrent respiratory infections Slide 36 Cystic Fibrosis Pancreasabsence of pancreatic enzymes and malabsorption Small intestineMeconium hardens leading to meconium ileus Stools are bulky and fatty (steatorrhea) Large belly, wasted extremities Fat soluble vitamin deficiencies Slide 37 Cystic Fibrosis Males usually sterile due to blocked vas deferens Females may have trouble conceiving due to thick mucus in the reproductive tract Slide 38 Cystic Fibrosis Medical treatment Bronchodilators Antibiotics Pancreatic enzymes Vitamin supplements Salt supplements in hot weather? Slide 39 Cystic Fibrosis Nursing Interventions At birthmonitor for 1 st meconium Newborn screeningblood immunoreactive trypsinogen Genetic counseling Parent Education High calorie, high protein, low fat diet How to administer pancreatic enzymes Protect from infection Breathing exercises and care Slide 40 Cystic Fibrosis Breathing Exercises Physical activity Chest percussion and postural drainage Slide 41 Cystic Fibrosis Medications Aerosol Bronchodilatorsopens lungs Aerosol DNAseloosens secretions CorticosteroidsAnti-inflammatory AntibioticsTreats infections Pancreatic enzymesAids in digestion Water soluble ADEK Slide 42 Sudden Infant Death Syndrome Risk factors--infant Race: (decreasing order of frequency) American Indian, black, Hispanic, white, Asian Males more often than females 24 months of age Winter Exposure to passive smoke Prone sleeping Overheating Slide 43 Sudden Infant Death Syndrome Risk factors--maternal Age less than 20, short interval between pregnancies Prenatal smoking, binge alcohol, drug use Anemia Poor prenatal care, poor weight gain during pregnancy Hx of sexually transmitted disease or UTI Slide 44 Asthma Hyper-reactive lungs Chronic condition with acute exacerbations Responds to environmental irritants Bronchial spasm, increased airway resistance, air trapping Slide 45 Asthma--Etiology Triggers include: inhalants, airborne pollens, stress, weather changes, exercise, viral or bacterial agents, allergens, strong emotions, etc. Runs in familiesgenetics unclear Slide 46 Asthma--Pathology Exposure to irritant Constriction of bronchial smooth muscles Edema of lung tissues Increased respiratory secretions Airway narrowing Air trapping and hyperinflation of alveoli Slide 47 Asthma--Symptoms Wheezingcan be heard at http://jan.ucc.nau.edu/~daa/heartlung/breaths ounds/contents.html http://jan.ucc.nau.edu/~daa/heartlung/breaths ounds/contents.html Cough Air trapping and hyperinflation leads to prolonged expiratory phase Lipsdark red; may progress to cyanosis Anxiety Sitting upright, hunched over Slide 48 Asthma Treatment Quick relief medications Nebulizer (metered dose inhaler)note if contains steroids, spacer should be used to prevent yeast infections of the mouth Slide 49 Asthma Metered Dose Inhaler--Use Shake the inhaler well before use (3 or 4 shakes) Remove the cap Breathe out, away from your inhaler Bring the inhaler to your mouth. Place it in your mouth between your teeth and close you mouth around it. Start to breathe in slowly. Press the top of you inhaler once and keep breathing in slowly until you have taken a full breath. Remove the inhaler from your mouth, and hold your breath for about 10 seconds, then breathe out. www.asthma.ca/adults/treatment/meteredDoseInhaler.php Slide 50 Asthma Medications--Acute Corticosteroidsoral or inhaled Prednisone, Methylprednisolone -Adrenergic agonists (Bronchodilators) Albuterol, epinephrine, terbutaline Short acting (inhaled) used to relieve an on-going attack Long acting (oral or inhaled) to control frequent attacks Slide 51 Asthma Medications--Chronic Cromolyn sodiumused prophylactically Inhalant Suppresses inflammation Not bronchodilator Prevents release of histamine Slide 52 Asthma Reducing Triggers Smoke free environment Allergy proofing home: Bedroom of primary importance Pillows and mattress enclased in covers Eliminate stuffed toys, plants, carpets, drapes Do not store out of season clothing in room Slide 53 Status Asthmaticus The continued presence of severe respiratory distress despite vigorous therapeutic measures Medical emergency that can lead to respiratory failure and death Sudden onset of agitation or the agitated child who suddenly becomes quiet may be seriously hypoxic Slide 54 Bronchiolitis Inflammation of the bronchioles Edema, accumulation of mucus, air trapping and atelectasis Major concern for small infants Most common caustive agent is the respiratory syncytial virus (RSV) Often fatal Slide 55 RSV Most important respiratory pathogen in infancy and early childhood Not airborne Can remain viable for hours on nonporous surfaces Most frequent problem in winter and spring Slide 56 RSV Prevention Infants up to 24 months with chronic lung disease RSV Immune Globulin (RSV-ICIV): Antibodies against RSV. Given monthly IV beginning of season Palivizumab (monoclonal antibody): Given monthly IM Slide 57 Pharyngitis Sore throat Most are caused by viruses Most common bacteriagroup A beta- hemolytic streptococcus (strept throat) Symptomsfever, sore throat, dehydration Treatmentsymptomatically If bacterial10 days of penicillin Slide 58 Tonsillitis/adenoiditis Tonsils: Masses of lymphoid tissue located in pharyngeal cavitiy. Purpose: Filter pathogens Size: Children relatively large Infection can be viral or bacterial If greater than 3 infections per year, may do tonsillectomy Slide 59 Tonsillectomy Surgical removal of palatine tonsils Adenoidectomysurgical removal of pharyngeal tonsils Pre-op prep same as for all surgeries Slide 60 Tonsillectomy Recovery room Position on abdomen or side Suction with care Slide 61 Tonsillectomy Post op care Bedrest for day Clear liquids advance to full then soft Cold Avoid red coloring Ice collar Analgesics Slide 62 Tonsillectomy Post op riskhemorrhage Up to 10 days post op Symptoms Bright red bloody emesis Frequent swallowing Pulse greater than 120 Slide 63 Tonsillectomy Recommendations to prevent post-op hemorrhage Avoid irritating foods Avoid gargles or vigorous toothbrushing Discourage coughing or throat clearing Use ice collar Avoid medications known to promote bleeding Limit activity Slide 64 Allergic Rhinitis Hay fever Seen mostly in older children and adults Treatment: antihistamine, allergy avoidance Slide 65 Influenza Viral Symptoms last 4 to 5 days Complications include pneumonia, encephalitis, otitis media Do not treat with aspirin because of possible link to Reye Syndrome Slide 66 General Treatment for Respiratory Conditions Position to promote oxygenation Humidification Fluid intakeclear liquid, avoid milk Oxygen??? Medications include bronchodilators, anti-inflammatories, antibacterial and antiviral agents Slide 67 Foreign Body Aspiration Peak age: under 3 Leading cause of death under 1 FB usually lodge in right main bronchus Partial or complete obstruction Sudden onset of coughing Heimlich Maneuver Surgical removal