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Respiratory

Respiratory. Nur 106. Respiratory System. General Information Signs and symptoms of respiratory distress Common diagnostic tools Common medications and treatments. General Information. Fetus practices breathing in utero Normal to have amniotic fluid in lungs

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Respiratory

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  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: 30—50 • 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 • Crackles—passage of air through moisture • Wheezes—Narrowed 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 • Infant’s chest walls more flexible, muscles immature, retractions common

  10. Respiratory Assessment • Retractions Suprasternal Intercostal Substernal

  11. Common Diagnostic Tests • Chest xray • Bronchoscopy—visualizes trachea and bronchi directly • Under anesthesia • Pulmonary function tests—usually not until 5 to 6 years of age • Sputum culture—best 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 • 87—93% 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 fluids—oral 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 throat—may lead to spasm and complete obstruction

  22. Pneumonia • Inflammation/infection of bronchioles and alveloar spaces • Causative agents bacteria, viral, mycoplasma • Children under 5: Viral—RSV. Influenza, adenovirus,rhinovirus • Children over 5: Bacteria—streptococcus 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 PO2 Anaerobic metabolism Acidosis CO2 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-ray—diffuse 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 • Inherited—autosomal 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 disease—affects exocrine glands • Bronchioles, small intestines, pancreas, bile ducts • Exocrine secretions—thick and tenacious • Abnormal sodium excretion • Sweat Chloride test • Heat Prostration

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

  36. Cystic Fibrosis • Pancreas—absence of pancreatic enzymes and malabsorption • Small intestine—Meconium 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 birth—monitor for 1st meconium • Newborn screening—blood 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 Bronchodilators—opens lungs • Aerosol DNAse—loosens secretions • Corticosteroids—Anti-inflammatory • Antibiotics—Treats infections • Pancreatic enzymes—Aids 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 • 2—4 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 families—genetics 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 • Wheezing—can be heard at http://jan.ucc.nau.edu/~daa/heartlung/breathsounds/contents.html • Cough • Air trapping and hyperinflation leads to prolonged expiratory phase • Lips—dark 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 • Corticosteroids—oral or inhaled • Prednisone, Methylprednisolone • Β-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

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