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Kimberly Ambruso

NU 102- Fall 2012

Respiratory Disorders I

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Pertussis (whooping cough)

Bordetella Pertussis

Incubation: 7-21 days

Unimmunized children

Low grade fever and resp

symptoms

Paroxysmal cough

Apneic episodes

Prevention

vaccination

Treatment

Erythromycin,

azithromycin (Z-pack)

Droplet precautionsfor 5 days after abx start

Humidification

Suctioning

Fluids Cardio-resp monitoring

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Acute Tracheobronchitis

Preceeds URIs pneumonia

Causes

bacterial or fungal

microorganisms Ingestion of irritants or

fumes

Manifestations Dry, irritating cough

Scant sputum

Inspiratory stridor,expiratory wheeze

purulent sputum

Treatment

Fluids

humidification

Suctioning PRN

Avoid antihistamines

May use expectorants

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Asthma

Increased airway responsiveness to astimuli

, causinginflammation of the airways

Inflammation causes the normal protective

mechanisms to react excessively in

response to the

stimulus, and

cause obstruction

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Reactive Airway Disease (RAD)

History of wheezing, coughing, or shortness of

breath due to undetermined cause

Generally used as a diagnosis for children < 4-5

yrs old

http://images.essentialbaby.com.au/2009/08/05/665790/asthma_420w-420x0.jpg

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Asthma Manifestations

Wheezing

Coughing

Tachypnea, orthopnea

Recurrent difficulty breathing

Recurrent tightness in chest

Retractions

Stridor

Nasal flaring

Restlessness

Tripod positioning

Fatigue Worsening of

symptoms at night

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Tripod position

Retractions

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Severe Respiratory Distress

In severe respiratory distress the patient may notwheeze because of decreased air movement

With treatment, increased wheezing may actually

signal an improvement

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Asthma Diagnostic Studies

History and Physical

Environmental

assessment

Pulmonary Function tests Peak expiratory flow

monitoring

Chest X-Ray

CBC

Allergy skin testing

Serum IgE levels

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Peak Flow Meter

Device used to monitorbreathing capacity

Measures the flow

of air in a forced

exhalation in liters/minute Accurate indicator of

impending asthma attack

Higher numbers = less risk for

attack

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Asthma Medications

Long term

Oral

Inhaled

Nebulizer

Quick relief

Oral

Inhaled

Nebulizer

Intravenous Combination

inhaled

http://blogs.babycenter.com/momformation/files/2008/11/nebulizer.jpghttp://10thlife.com/wp-content/uploads/2009/09/inhaler.jpg

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Nursing CareAssessment

Precipitating factors Environment

Changes in activity

Recent stressors/illness

Current medication regimen

History of acute episodes,attacks

Physical exam Appearance

Mental status

Vital signs

Respiratory assessment

Effort, quality ofrespirations

Color

Moving air?

Interventions

Monitor respiratory status Pulse oximeter, ABGs

Medications. Respiratorytreatments

Supplemental 02

Chest Physiotherapy

Peak expiratory flowmonitoring

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Patient/family education

Signs and symptoms of attack

Keep a symptom diary

Compliance with meds

Carrying PRN meds

Conditions in which meds are increased

Use of equipment

Smoking cessation

Influenza vaccination

Exercise