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what does the respiratory system consist of
- nose
- pharynx
- trachea
- bronchi
- bronchioles
- lungs
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what does the upper airway consist of?
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what does the lower airway consist of?
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Pediatric respiratory differences include?
- Smaller lower airways- 50% smaller than adults
- Infants breathing pattern and style- infants are obligatory nose breathers and have difficulty breathing through the mouth
- breathing rate is faster than adults
- brief periods of apnea (10-15 secs) irregular rhythm normal in infants
- Muscles of breathing- intercostal muscles not well developed; infants often use diaphragm, abdominal muscles
- Lung development- lung surface increases until age 5-8; actual growth continues into adolescence
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Acute vs chronic respiratory illnesses
- Acute- Bronchiolitis/RSV and pneumonia
- Chronic- Asthma and cystic fibrosis
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what is bronchiolitis/RSV?
- Inflammation/infection of the bronchioles
- RSV-respiratory syncytial virus
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Bronchiolitis vs RSV
you can have bronchiolitis w/o having RSV
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What to watch for in bronchiolitis/RSV
- Respiratory difficulty- nasal flaring, retractions/use of accessory muscles, SOB, the tachys
- Cough
- Rhinorhea (runny nose)
- perhaps cyanosis
- wheezing
- Many symptoms mirror that of the common cold
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what population are at greatest risk for bronchiolitis/RSV?
- infants
- chronically ill
- immunocompromised
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what to do for bronchiolitis/RSV
- lab testing for RSV
- antibiotic therapy- only if there is underlying pneumonia or bacterial infection
- suction as necessary-with small tube to clear nasal passageway
- oxygentation as necessary
- fluid volume maintenance as necessary
- Cool humidification to slow down respirations
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Types of pneumonia
- aspiration- object swallowed and goes down wrong tube
- viral- most common, easy to get
- bacterial
- many others- usually attached to/triggered by other respiratory infections (colds, RSV/bronchiolitis)
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what to watch for in pneumonia
- fever
- cough-may be productive
- respiratory distress-retractions, nasal flaring, possibly cyanosis
- behavioral changes- irritability, restlessness, or lethargy depending on severity
- may have GI symptoms- vomiting, excessive tiredness
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what are you going to do for pneumonia
- depends of factors
- where its treated
- what kind of pneumonia
- causative agent
- if bacterial-give antibiotics
- if aspiration- treat symptoms and give antibiotics
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Respiratory support for pnwumonia
- supplementary O2
- secretion management
- chest physiotherapy
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pharmalogical support for pneumonia
- depends on causative organism or problem
- maybe antibiotics
- IV fluids
- trial of albuterol/racemic epinephrine (not always effective)
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Aasthma/RAD (reactive airway disorder)
- most common chronic disease of childhood
- primary cause of school absences
- major proportion of admissions to ED and hospitals
- prevalence, morbidity and mortaility rates increasing
- can be casued by pets, dust, environment
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what happens in asthma/RAD
- airway inflammation/associated with swelling
- bronchospasm
- airway obstruction
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triggers for asthma/RAD
- allergens
- irritants-smoke
- exercise
- changes in weather/temp
- acute respiratory infections
- animals
- GERD
- foods
- emotions/fear
- medications (NSAIDS, aspirin, antibiotics)
- endocrine factors-mensses, pregnancy, thyroid disease
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what to watch for in asthma/RAD
- cough
- respiratory distress
- behavioral changes
- tripod breathing position
- difficulty speaking
- wheezing
- prolonged respiratory phase
- skin color changes
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what is PFT?
Pulmonary Function Test
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what is PEF
Peak expiratory flow
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what is PEFR
Peak expiratory flow rate
•Maximum air forcefully exhaled in 1 second
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what is PEFM?
Peak expiratory flow machine (measures PEF)
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what is FEV?
Forced expiratory volume
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Severity classifications of asthma/RAD
- –Step 1 (mild intermittent)-symptoms fewer than 2 wks; frequent nighttime symptoms
- –Step 2 (mild persistent)- symptoms more than 2x a wk but less than 1x a day;
- –Step 3 (moderate persistent)-daily symptoms; nighttime symptoms- 3-4x a month
- –Step 4 (severe persistent)-continual symptoms throughout the day
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what to do fro asthma/RAD
- Respiratory support- supplemental O2
- Pharmacologic support- bronchodilators and β-adrenergic agonists (rescue medications, long-term medications) and corticosteroids
- Education
- Emotional support
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what is cystic fibrosis?
- –An inherited autosomal recessive trait
- –An exocrine gland problem- affects everything
- •produces excess amt of thick secretions from exocrine glands
- •Can block pancreatic ducts
- •Affects lungs
- –Mutated gene
- •Long arm of chromosome 7
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what is involved in cystic fibrosis?
- –Exocrine gland dysfunction
- –Increased viscosity of secretions
- –Increased electrolyte levels in sweat
- –Abnormalities in autonomic nervous system function
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Primary systems invloved in cystic fibrosis
- –Respiratory
- –Gastrointestinal
- –Endocrine/exocrine
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more about cystic fibrosis
- •Most commonly in hospital for respiratory
- dysfunction
- •“CF cleanout”-shake out excess fluids
- •CF-related diabetes
- •Mucous and MDRO
- •Will need to be on antibiotics
- •Lung sounds-diminished bases
- •Diagnosed early
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what to watch for in cystic fibrosis
- –Wide variety in breath sounds
- •diminished
- •crackles
- •rales
- –Dyspnea
- –Respiratory distress
- –Cough
- –Secretions
- •Different colors-can be yellow, green
- •VERY thick
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what to watch for in cystic fibrosis
- –Sometimes barrel chest
- –Clubbed fingers from lack of oxygen
- –Appetite
- •Voracious early
- •May be really hungry or not eat at all
- •Loss\late
- –OFTT
- •Organic failure to thrive
- –Vitamin deficiency-cannot absorb nutrients
- •A, D, E, K
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more to watch for in cystic fibrosis
- –Anemia
- –Weight loss
- –Large, bulky, loose, frothy, foul-smelling stools
- –May also see constipation
- –Liver, gall bladder, pancreas issues
- –Increase of symptoms as progression through disease occurs
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what to do for cystic fibrosis
- –Respiratory support
- •SupplementalO2
- •Chest physiotherapy-cupping, vest
- •Different machines
- –Pharmacological interventions
- •Bronchodilators
- •Antibiotics
- •Supplemental gastric enzymes-help with digestion
- •Vitamin supplements
- –Emotional support
- –Dietary support
- •Encourage dietary intake
- •High fat, high calorie diet
- •LOTS of snacks
- •Problems with diabetes and diet
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