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Respiratory

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Respiratory Nur 106 Respiratory System General Information Signs and symptoms of respiratory distress Common diagnostic tools Common medications and treatments ... – PowerPoint PPT presentation

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Title: Respiratory


1
Respiratory
Nur 106
2
Respiratory System
  • General Information
  • Signs and symptoms of respiratory distress
  • Common diagnostic tools
  • Common medications and treatments

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

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

5
Respiratory Assessment
  • Auscultation
  • Absent or diminished lung sounds
  • Adventitious lung sounds
  • Cracklespassage of air through moisture
  • WheezesNarrowed passageways

6
Respiratory Assessment
  • Observation
  • Barrel Shaped Chest

7
Respiratory Assessment
  • Observation
  • Cyanosis
  • Club fingers

8
Respiratory Assessment
  • Observation
  • Presence of retractions
  • Occur when airway obstructed in young children
  • Indication of severity of respiratory distress

9
Respiratory Assessment
  • Infants chest walls more flexible, muscles
    immature, retractions common

10
Respiratory Assessment
  • Retractions

Suprasternal
Intercostal
Substernal
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

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
  • SPo2
  • 8793 safe levels of saturation

13
Respiratory System
  • Laryngotracheobronchitis (croup)
  • Pnuemonia
  • Respiratory distress syndrome
  • Bronchopulmonary dysphasia
  • Cystic Fibrosis
  • Sudden Infant Death Syndrome (SIDS)

14
Respiratory System
  • Asthma
  • Respiratory Syncyntial Virus
  • Pharyngitis
  • Allergic Rhinitis
  • Tonsillitis/adenoiditis
  • Influenza

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

16
LTBEtiology
  • 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

17
LTB Symptoms
  • Low-grade fever
  • Barking cough
  • Respiratory stridor
  • Hypoxemia
  • Tripod position

18
Respiratory DistressTripod Position

19
LTBTreatment
  • At home
  • Hot steamy bathroom
  • Cool night air
  • Sit upright
  • Cool mist vaporizer in home made tent
  • Elevate head of crib
  • Increase fluids

20
LTBTreatment
  • Hospitalization
  • Croup tent
  • IV fluidsoral fluids may cause aspiration
  • Bronchodilators
  • Corticosteroids
  • Intubation equipment available

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

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

23
Pneumonia
  • Symptoms
  • Fever, cough, dyspnea, tachypnea
  • Rhonchi, crackles, wheezes
  • Decreased breath sounds with consolidation
  • Diagnosis
  • Xray
  • Treatment
  • Antibiotics, IV, fever control, airway management

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

25
Surfactant
Lung Compliance
Atelectasis
Work of breathing
Ventilation
Metabolic
Respiratory
CO2
Acidosis
PO2
Anaerobic metabolism
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.
26
Respiratory Distress Syndrome
  • Diagnosis x-raydiffuse bilateral density
    (white-out), and atelectasis
  • Antenatal prevention treatment betamethasone

27
Respiratory Distress Syndrome
  • Nursing Care
  • Oxygenation/ventilation
  • Transcutaneous oxygen/CO2 monitoring
  • Blood gas monitoring
  • Oxygen
  • Continuous positive airway pressure (CPAP)
  • Respirator

28
Respiratory Distress Syndrome
  • Nursing Care
  • Correction of acid-base imbalance
  • Temperature regulation
  • Nutrition
  • Protect from infection

29
Respiratory Distress Syndrome
  • Surfactant Replacement Therapy
  • At birth and repeated as necessary
  • Endotracheal administration

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

31
Bronchopulmonary Dysplasia
  • Nursing Care
  • Oxygen
  • Tracheostomy
  • Recurrent respiratory infections
  • Palivizumab, RSV immune globulin
  • Promote growth and development

32
Bronchopulmonary Dysplasia
  • Medications
  • Bronchodilators
  • Anti-inflammatory agents
  • Diuretics
  • Antibiotic Therapy
  • Vitamin A

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)
Carrier Unaffected Affected
Carrier
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

35
Cystic Fibrosis
  • LungsSecretions pool in bronchioles leading to
    infection and atelectasis
  • Barrel shape chest
  • Cyanosis
  • Clubbing of fingers and toes
  • Recurrent respiratory infections

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

37
Cystic Fibrosis
  • Males usually sterile due to blocked vas deferens
  • Females may have trouble conceiving due to thick
    mucus in the reproductive tract

38
Cystic Fibrosis
  • Medical treatment
  • Bronchodilators
  • Antibiotics
  • Pancreatic enzymes
  • Vitamin supplements
  • Salt supplements in hot weather?

39
Cystic FibrosisNursing Interventions
  • At birthmonitor for 1st 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

40
Cystic FibrosisBreathing Exercises
  • Physical activity
  • Chest percussion and postural drainage

41
Cystic FibrosisMedications
  • Aerosol Bronchodilatorsopens lungs
  • Aerosol DNAseloosens secretions
  • CorticosteroidsAnti-inflammatory
  • AntibioticsTreats infections
  • Pancreatic enzymesAids in digestion
  • Water soluble ADEK

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

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

44
Asthma
  • Hyper-reactive lungs
  • Chronic condition with acute exacerbations
  • Responds to environmental irritants
  • Bronchial spasm, increased airway resistance, air
    trapping

45
Asthma--Etiology
  • Triggers include inhalants, airborne pollens,
    stress, weather changes, exercise, viral or
    bacterial agents, allergens, strong emotions,
    etc.
  • Runs in familiesgenetics unclear

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

47
Asthma--Symptoms
  • Wheezingcan be heard at http//jan.ucc.nau.edu/d
    aa/heartlung/breathsounds/contents.html
  • Cough
  • Air trapping and hyperinflation leads to
    prolonged expiratory phase
  • Lipsdark red may progress to cyanosis
  • Anxiety
  • Sitting upright, hunched over

48
AsthmaTreatment
  • Quick relief medications
  • Nebulizer (metered dose inhaler)note if contains
    steroids, spacer should be used to prevent yeast
    infections of the mouth

49
AsthmaMetered 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
50
AsthmaMedications--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

51
AsthmaMedications--Chronic
  • Cromolyn sodiumused prophylactically
  • Inhalant
  • Suppresses inflammation
  • Not bronchodilator
  • Prevents release of histamine

52
AsthmaReducing 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

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

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

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

56
RSVPrevention
  • 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

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

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

59
Tonsillectomy
  • Surgical removal of palatine tonsils
  • Adenoidectomysurgical removal of pharyngeal
    tonsils
  • Pre-op prep same as for all surgeries

60
Tonsillectomy
  • Recovery room
  • Position on abdomen or side
  • Suction with care

61
Tonsillectomy
  • Post op care
  • Bedrest for day
  • Clear liquids advance to full then soft
  • Cold
  • Avoid red coloring
  • Ice collar
  • Analgesics

62
Tonsillectomy
  • Post op riskhemorrhage
  • Up to 10 days post op
  • Symptoms
  • Bright red bloody emesis
  • Frequent swallowing
  • Pulse greater than 120

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

64
Allergic Rhinitis
  • Hay fever
  • Seen mostly in older children and adults
  • Treatment antihistamine, allergy avoidance

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

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

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
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