Sids aw disorders asthma plural disorders chapters 31 32 33 43
This presentation is the property of its rightful owner.
Sponsored Links
1 / 46

SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43 PowerPoint PPT Presentation


  • 34 Views
  • Uploaded on
  • Presentation posted in: General

SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43. Walsh E. Chavez RRT-NPS. Definition of SIDS. Sudden and unexpected death of an infant for which sufficient cause cannot be found by a death scene investigation, review of the history, and a postmortem

Download Presentation

SIDs, AW disorders, Asthma, & Plural Disorders Chapters: 31,32,33 & 43

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Sids aw disorders asthma plural disorders chapters 31 32 33 43

SIDs, AW disorders, Asthma, & Plural DisordersChapters: 31,32,33 & 43

Walsh

E. Chavez RRT-NPS


Definition of sids

Definition of SIDS

  • Sudden and unexpected death of an infant for which sufficient cause cannot be found by a death scene investigation, review of the history, and a postmortem

  • 1week-1 year old (2-4 months < 6months)

  • ALTE (Apparent life-threatening event)

    • Color change

    • Hypotonia

    • 70% found in the morning…..


Risk factors

Risk Factors

  • Lending for intervention

    • Prone positioning

    • Maternal smoking

    • Bottle-feeding vs Breast feeding????


Normal control of heart rate and breathing

Normal Control of Heart Rate and Breathing

  • Breathing

    • Brainstem

  • Heart rate

    • Autonomic nervous system


Sids aw disorders asthma plural disorders chapters 31 32 33 43

SIDS

  • Etiology:

  • Brainstem: controls breathing(Prematurity?)

  • Central Apnea & periodic breathing

  • Tests for assessing risk factors

    • NO test that predicts risk for SIDS

    • Polysomnography/ pneumogram

    • Frequency of apnea


Polysomnography

Polysomnography

  • Parameters: Pg. 547 Fig 31-3

    • EEG (Brain activity)

    • EOG (Bilateral Eye Movement)

    • EMG (Muscle tone) impendence belt

      -EtcO2

      -POX/ TCOM

      -ECG

      -Ph Probegraph Figure 31-2 (pg 546)

  • LaboratorySupervision: PediatricianWho Scores?

  • Setting: Pediatric Staged with Parent near

  • Personnel: knowledge of the child's behavior developmental stages


Polysomnography cont

Polysomnography (cont.)

  • Normal sleep development:

    • REM and NON-REM

  • Apnea (3 categories)

    • Rapid base line

    • Central: (B’sD’s andColor change) 10-25%

    • Obstruction:hypopnea & apnea

    • OB lasting >10sec or 6-8 sec (UAW OB)

    • Complications: Desat/ > CO2;Day time Sleepiness, behavior changes, cor pulmonale

    • Treatment:

    • Removal of adenoidal & tonsils

    • NCPAP

    • NICU: Reflux, PofA, Hypoxia, anemia, IVH, Seditaives, seizures, incoordiation with feedings


Home cardiorespiratory monitors apnea monitors

Home Cardiorespiratory Monitors= Apnea Monitors

Alert the caregiver to a cardiorespiratory abnormality

Diagnostic devices

Training

Social/parental implications


Sids aw disorders asthma plural disorders chapters 31 32 33 43

Chapter 32

Pediatric Airway Disorders and Parenchymal Lung Diseases


Pediatric airway

Pediatric Airway

Upper airway (Pg. 555 fig. 32-1)

Above C3-4 Peds

non expandable Cricoid rings(Narrowest portion)

-obligate nose breathers 3-6 months

Poor coronation between rr& oropharngeal motor skills & large tongues

Developement up to 8 years of age

  • Lower airway:

  • Trachea > Subdivisions 17-16: adults23 generations…..RSV ?

  • Airway obstruction:

  • AP/ Lateral Neck-XRAY

  • Assessments: RDS, Auscultate UAW: Air movement muffled/stridor


Upper airway disorders lesions inflammatory abnormal tissue tone

Upper Airway Disorderslesions, inflammatory, abnormal tissue, tone

  • Supralaryngeal obstruction

    • Choanal atresia

    • Pierre Robin syndrome

    • Deep neck infections

    • Tonsillar enlargement/Peritonsillar abscess

    • Obstructive apnea


Upper airway disorders cont

Upper Airway Disorders (cont.)

  • Periglottic obstruction (around the glottis)

    • Epiglottis

    • Laryngotracheobronchitis (LTB-CROUP)

    • Table 32-1 Differential Diagnosis

    • Pg. 559


Epiglottitis life threatening bacterial infection h influenza b

Epiglottitis Life Threatening =Bacterial infection (H influenza B)

  • Incidence and etiology

    • <6 years old

    • Noninfectious: aspiration of hot liquid, traumatic intubations, blind finger sweep

  • Signs and symptoms: ABRUPT

  • Fever, soar throat, dysphagia(drooling)

  • MUFFLED, retractions, RDS, upright sniffing position

  • Diagnosis: lateral NECk (Thumb sign) C&S, ABG

  • Treatment: (small?) ETT, RSI, ceftriaxone, Extubate leak?Bronchoscope, antibotcs


Epiglottitis cont

Epiglottitis (cont.)


Laryngotracheobronchitis ltb croup 6 months 6 years

LaryngotracheobronchitisLTB-CROUP(6 months-6 years)

  • Incidence and etiology:

  • Parainfluenza Virus 1

  • Over several days

  • Signs and symptoms:

  • Low grade fever, malasise, rhinorrhea, hoarse voice BARKY COUGH

  • Diagnosis:

  • Lateral neck-xray: Steeple sign (SUBglottic)

  • Treatment: Racemic Epi, hydration, temp ……………..control, humidification, Mist tents, O2,

    >0.35Fio2= impending resp Failure

    Intubations


Laryngotracheobronchitis cont

Laryngotracheobronchitis (cont.)


Lower airway disorders

Lower Airway Disorders

  • Obstruction of the trachea and major bronchi

    • Tracheomalacia

    • Congenital tracheal or bronchial stenosis


Lower airway disorders pg563

Lower Airway Disorders pg563

  • Foreign body aspiration

    • Incidence:

      • Leading cause of accidental death

    • Signs and symptoms:

      • Degree of AW OB

      • Unilateral Wheezing/ reoccurring PNA

    • Diagnosis: AP CXR/neck and lateral

    • Laryngeal level

    • Hyperinflation/Ball valve effect

    • Bronchoscopy

    • Treatment:

    • Removal of object continue to monitor patient


Foreign body aspiration

Foreign Body Aspiration


Lower airway disorders1

Lower Airway Disorders

  • Atelectasis

    • Etiology and pathophysiology:

      • Failure to reinflate

    • Signs and symptoms:

      • Dyspnea

      • (Severe) V/Q mismatch

      • RDS

    • Diagnosis: CXR, B/S, tracheal deviation

    • Treatment: Hyperinflation therapy, Bronchial hygiene therapy,


Lower airway disorders2

Lower Airway Disorders

  • Bronchiectasis:

  • Irreversible dilation of the bronical tree

    • Etiology and pathology

      • CF/ frequent respiratory infections

      • Left lower lobes mostly involved

    • Signs and symptoms:

      • Chronic cough w/ copious amts of purulent sputum

    • Diagnosis: CXR and CT

    • Treatment: CPT, hydration, antibotics,


Lower airway disorders3

Lower Airway Disorders

  • Acute bronchiolitis

    • Etiology: Viral Respiratory Tract infection related to RSV

    • Incidence:<1 year of age with BPD, CF, PPHN & CHD

    • Signs and symptoms: coryza, cough, RDS, wheezing (APNEA), dehydration

    • Diagnosis:Nasal Swab: +RSV

    • Treatment:O2, (MV), IV, Supportive care

    • Prognosis: GOOD


Pneumonia

Pneumonia

  • Viral

    • 1st:Respiratory syncytial virus (RSV)

      • Coryza, NASAL CONGESTION, cough & fever

      • Supportive Care vs. Ribavirin

    • 2nd:Parainfluenza virus Types1(LTB), 2, and 3(children<5yr)

      • O2 and supportive care

    • Influenza virus:

      • Winter seasons

      • Vaccinations yearly

    • Adenovirus:

      • High rates of M & M.

      • Overwhelming sepsis

      • Supportive care


Pneumonia1

Pneumonia

  • Bacterial

    • Incidence: Compromised immune function, recurrent aspiration, malnutrition, daycare, passive cigarette

    • Etiology: microorganisms colonize in the URT

    • Signs and symptoms: same as viral

    • Diagnosis: CXR, > total band count>1500, CRP, Blood Culture

    • Treatment: oral/ IV antibiotics

    • 7-14 days

      • Pox & ABG


Sids aw disorders asthma plural disorders chapters 31 32 33 43

Chapter 33

PG. 582-597

Asthma

Most common chronic childhood disease


Pathogenesis

Pathogenesis

  • Definition:Chronic inflammatory disorder of the AWs

    • Mast cells, eosinophils, T lympocytes, IgE, Macrophages, neutrolphils, & epithelial cells

    • Wheezing &Breathlessness


Pathogenesis of asthma

Pathogenesis of Asthma

  • Pathophysiology

    • Chronic airway inflammation

    • Bronchial hyperresponsiveness

    • Hypersecretion of mucus

  • Components of Asthma:

    • Inflammation-A remodeling

    • Bronchial constriction-Mucous plugging

    • AW edema-AW Hyperreponsiveness

    • RESULTS:

      • HYPERinflation, atelectasis, hypoxia, V/Q mismatch, Hypercarbia


Risk factors for developing asthma

Risk Factors for Developing Asthma

  • Allergic response:

    • IgE

    • Reversible vs. irreversible

    • AW remoding=fibrosis

  • Environmental triggers

    • Intervention

    • Remediate & eliminate

      • Tobacco

      • Cockroaches/ Dust mites

      • Molds


National asthma education and prevention program

National Asthma Education and Prevention Program

  • Purpose:

  • to serve as a comprehensive tool to diagnosis and manage asthma

  • Goals: Box 33-1:

    • Prevent: Chronic asthma, recurrent

    • Maintain: NL ADLs, NL/near NL pulmonary function

      • Optimal pharmacology

      • Meet family & patient’s expectations


Diagnosis

Diagnosis

  • Medical history:

    • Symptoms & triggers

  • Physical examination:

    • History a stronger factor

    • Prolongs expiratory phase

    • RDS, Hyperexpansion

  • Pulmonary function testing:

    • FVC, FEV1 <80% predicted, FEV1/FV(< 65% predicted), FEF25-75%

  • Bronchoprovocational challenges (methacholine 20% decrease=+test)

  • Exercise: running/biking

    • Less sensitive HR > 170


Management

Management

  • Pharmacologic therapy

    • Long-term control medications

      • Taken daily

      • Antiinflammatoryagents/ corticosteroids

      • Long acting B2 agonist(LABAs)

        • Salmeterol & Formoterol 30-90 minutes

      • Methylxanthines

      • Leukotriene modifiers: inhibits

      • Cromolyn sodium (Stablizes mast cells)

      • Immnuomodulators: Binds to IgE


Management1

Management

  • Quick-relief medications: (5-15 minutes)

    • Short acting B-agonist last 4-6 hours

    • “rescue”

    • Anticholenergics

  • Delivery systems

    • MDI (Spacers & holding chambers)

    • DPI

    • SVN


Management cont

Management (cont.)

  • Control of triggers

    • Identification of allergens

    • Avoidance and control measures

    • Immunotherapy

      • controversial


Management cont1

Management (cont.)

  • Peak flow monitoring

    • Peak flow meter

    • Peak flow diary

    • Personal best reading

    • Peak flow zone system

      • Pg. 593


Patient and family education

Patient and Family Education

Asthma disease process

Medication skills

Identification and control of triggers

Self-monitoring techniques


Managing asthma

Managing Asthma

  • Exacerbations in the ED

    • Assessment: PF of airflow, POX

    • Beta-2 agonists

    • Corticosteroids


Managing asthma cont

Managing Asthma (cont.)

  • Hospitalization and respiratory failure

    BOX 33-8 (Criteria for hospitalization)

    • Intubation

      • Elective

      • Respiratory Fatigue

    • Mechanical ventilation

      • Low Vt

        • PS ventilation Based on the degree of sedation

        • I:E ratio for adequate ventilation

        • Prone to pneumothorases, barotrauma, per > PIP, & hypotension


Asthma

Asthma

  • Exercise-induced bronchospasm (EIB)

    • 5-10 minutes after activity

  • Asthma at school

    • Teachers

    • Self esteem

  • Asthma camps

    • AHA

      • SCAMP CAMP


Sids aw disorders asthma plural disorders chapters 31 32 33 43

Chapter 43

Pg. 706-714

Disorders of the Pleura


Pleural effusion

Pleural Effusion

  • Clinical signs:

    • Decrease in B/S, Dullness to percussion compared to the contralateral

    • Tachypnea and pain

  • Diagnosis: CXR

  • Tx:Thoracentesis

  • Laboratory studies: Transudate vs. Exudate, empyema (-Tube)

  • Causes:BOX 43-2 & 43-3 (pg. 708)

  • Complications:

  • pneumothorax

  • Hemorrhage

  • Infections


Pleural effusion1

Pleural Effusion


Pneumothorax

Pneumothorax

  • Clinical signs:

    • Chest pain & SOB

    • Decrease breathsounds on affected side with hyperresonnance

  • Diagnosis: CXR

  • Treatment:

    • Nitrogen washout

    • Needle aspiration

    • CT


Hydropneumothorax cont

HydroPneumothorax (cont.)


Thoracostomy drainage

Thoracostomy Drainage

  • Indications: Drainge of air/ fluid

  • Procedure for placement

    • Conscious sedation

    • Role of the respiratory therapist

    • Assist/ Place

    • Drainages system (3 bottles)


Thoracostomy drainage cont

Thoracostomy Drainage (cont.)


Surgery in the pleural space

Surgery in the Pleural Space

Treatment of empyema

Thoracoscopy

Chemical pleurodesis


  • Login