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Stack #38868
RRC Maintenance - CF/asthma
| question | answer |
|---|---|
| What ducts are affected by CF? | bronchi, small intestines, pancreatic ducts, bile ducts |
| How does CF affect the body | affects exocrine glands adn causes highly viscous, high protein secretions that obstruct/adhere to the lumen of ducts in the body |
| What type of inherited disease is CF? | autosomal recessive |
| clinical manifestations | cyanosis, adventitious sounds, cough, clubbed nails, barrel chest, steatorrhea, distended abdomen, thin extremities, wasted buttocks, increased perspiration, salty tasting skin, hyponatremia |
| definitive diagnostic test and results | SWEAT CHLORIDE TEST >= 60mEq/L -> definitive of CF 40-59mEq/L -> suspicion of CF, will be monitored closely |
| diagnostic tests | sweat chloride test, pulmonary function test, 72 hour stool collection for fat content (to assess for steatorrhea) |
| complications of CF | pneumonia, altelectasis, hemoptosis, pneumothorax, obstructive emphysema, failure to thrive, bronchiectasis, portal hypertension, narrowing/fibrosis of bowel lining, hypercapnia, hypoxia, respiratory acidosis |
| Medical interventions for CF | Positive expiratory pressure or "Flutter" mask; high frequency chest compression vest or lung transplant |
| Diet teaching | high-fat, high calorie diet, need to take pancreatic enzymes everytime they eat |
| What is the purpose of chest physiotherapy? | to mobilize secretions |
| Rationale for elevating HOB during exacerbation | promotes comfort and ease of breathing as gravity pulls down abdominal organs allowing for increased expansion of lungs |
| Why is O2 administered to a child with CF during an exacerbation? | to prevent hypoxia |
| Why is an IV line started during an exacerbation? | To provide a method for increasing fluids which will help liquify mucus secretions to allow for easier expectoration |
| The increase AP diameter in the chest of a child living with a chronic respiratory condition is a result of _______________? | air trapping |
| Name 3 signs and symptoms of CF and asthma in children that are the same | fatigue, shortness of breath, increased use of accessory muscles, headaches, anxiety |
| What are 2 signs and symptoms that are displayed by children living with asthma but not children living with CF? | rhinitis, turned-up nose, non-productive cough |
| A high-pitch wheeze is a sure indicator of ___________? | bronchial narrowing |
| Circumoral cyanosis and clubbing of the fingers result from ... | prolonged oxygen deprivation |
| Decreased forced expiratory volume and vital capacity are a result of what pathophysiological changes in the lungs? | bronchial inflammation, mucus plugs, consolidation of secretions in the lungs, collapse of the alveoli, collapse of the bronchioles |
| Steatorrhea is a result of what physiological change in the body of a child living with CF? | absence of adequate pancreatic enzymes |
| Why is a calm approach absolutely essential when caring for a child in respiratory distress? | calm approach decreases the release of epinephrine which can result in a decrease in RR and HR |
| Why do children require 100-150% hydration maintenance when they are experiencing respiratory distress? | increased respiratory effort results in increased evaporation losses |
| What nursing intervention would be implemented to prevent alveolar collapse? | relaxation and pursed-lip breathing |
| What are the benefits of chest physiotherapy for a child with CF? | removal of secretions prevents the consolidation of secretions which decreases the risk for infection, mucus plug formation and loss of alveolar sacs, creating dead space and weakening the bronchial tree |
| What do you assess when giving a bronchodilator? | assess airway, adventitious sounds, timing and location, assessory muscle use - degree and location, color, cough, pulse, resps, O2 sats |
| What medication would be most beneficial to a child in respiratory distress? | ventolin |
| What is the most concerning adverse effect when administering a bronchodilator? | increases in HR as it increases the risk for heart failure and in turn will increase the respiratory demand/expenditure |
| What nursing intervention would you implement for a child who is progressively loosing weight and is having frequent foul-smelling stools? | advocate on behalf of the child to the physician about increasing the child's intake of pancreatic enzymes; also encourage high calorie foods |
| Why do children with CF require twice the recommended dosage of antibiotics | increased BMR and inability to absorb all the medication |
| Name responder medications for asthma | ventolin, vaponephrine alpha and beta-adrenergic agonist bronchodilator |
| maintainer medications for asthma | atrovent/ipratropium (anticholinergic), prednisone (oral) or becolvent (inhaled anti-inflammatory steroid), intal (mast-cell anti-inflammatory) |
| Why is it important to include a school-aged child in planning his/her care? | they want to learn and need to know how to respond if they are experiencing respiratory difficulty when out with friends or at school |
| The greatest challenge of caring for an infant with chronic respiratory condition is ____________? | smaller airways, rapid deterioration, inability to verbalize |
| Teenagers living with CF may not follow the recommended treatment plans. What concept of chronic illness is being challenged? | compliance |
| Give 2 reasons why adolescents often minimize their symptoms | feeling they are invincible, fear of being different, present oriented |
| What are the 3 defining components of asthma? | reversible airway obstruction, airway inflammation, increased airway responsiveness/hyperactivity to stimuli |
| What is significant about where wheezing occurs in the lungs? | it will indicate where the bronchoconstriction is occuring |
| where does the wheezing in asthmatic children tend to be located? | upper lobes of lungs |
| Clinical manifestions of asthma | non-productive cough, chest tightness and SOB, increased WOB, wheezing, prolonged length of expiratory phase, fatigue, headache, turned-up nose, dark circles under eyes, decreased air entry to bases, crackle immediately if inflammatory response |
| What can trugger an asthma attack | allergen; exposure to cold; exercise |
| When should the parent seek medical attention for their child with asthma? | using ventolin inhaler q4h for longer than 24 hr and child's status not improving; cyanosis, has difficulty talking; needs reliever medication more frequently than q3h; displays supraclavicular indrawing, wheezing during rest or increase diff. breathing |
| What is drug of choice for treat asthma? | ventolin/salbuterol |
| What are systemic side effects that should be assess for with administration of ventolin? | irritability, tremors, nervousness, insomnia |
| What drug can be used if ventolin is ineffective after 3 attempts? Why isn't is used more commonly to treat asthma? | Vaponefrin; because it works on both alpha and beta receptor on both lungs and heart therefore causing more side effects |
| What is the purpose of administering Intal/Cromolyn in asthmatic children? | antihistamine which mediates endothelial response to allergens therefore preventing bronchospasms |
| What is status asthmaticus? What further complications can it result in? | severe unrelenting asthma attack; results in respiratory insufficiency, dehydration, hypoxia and possibly death if untreated |
| What should be taught to a child with asthma about the maximum effect of inhaled steriods? | the maximum effect will be felt if taken 10-15 mins after the administration of a bronchodilator |
| What pulmonary symptoms are displayed with an inflammatory asthma attack? | allergen -> inflammatory response -> bronchoconstriction/mucus producation -> WHEEZES & CRACKLES |
| What pulmonary symptoms are displayed with a non-inflammatory asthma attack? | Irritant (cold air/exercise/cigarette smoke) -> bronchoconstriction only -> WHEEZING -> can develop crackles if late onset |
Created by:
bella83
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