Peak Expiratory Flow Rate: deep breath & exhale, big puff, how bad is asthmaTx: inhaled steroid & fast acting bronchodilator, asthma action plan stop light, bronchodilate then corticosteroidsDaily controllerOral leukotriene modifierMontelukast (Singulair)Daily controllerInhaled corticosteroidBudesonide, beclomethasone, fluticasone (Flovent)Daily controllerLong acting beta 2 agonist (LABA)Salmeterol, famoterol, combination ofthe 2- Advair, symbicortQuick ReliefShort Acting Beta 2 agonist SABAAlbuterol, levalbuterol, terbutalineQuick ReliefAnticholinergics (only if with SABA)Ipratropium, tiotropium SteroidsOral or IV corticosteroidsPrednisolone, methylprednisoloneConsiderations: maintain normalcy, maintain fluid balance, help child gain control, home support, planning & teaching, access to meds, allergy testingTeaching: discuss triggers, S&S, promote calm, med use, pursed lip breathing, asthma action plan, school considerationsStatus Asthmaticus: unrelenting asthma attack despite treatment, respiratory failure, continuous nebulizers, intubation with paralysis, can be fatal Cystic Fibrosis: autosomal recessive disorder of exocrine glands, deletion in chromosome 7 at the cystic fibrosis transmembrane regulator, thick mucous production, excessive chloride production by sweat glands, thick mucus blocks alveoli, ovarian duct, vas deference, pancreatic duct (lipase, amylase, insulin), hepatic duct, gallbladder ductS&S: chloride cant go out of cellNa follows & H20= thick mucus, GI- fatty steatorrhea (floats), constipation- meconiumileus, don’t absorb fat soluble vitamins A, D, E, K, constipation, rectal prolapse, pancreatic insufficiencyDx: prenatal testing, newborn screening, needle stick 24-48 hrs, sweat test (chloride) 40 mEq normal, 50-60 suspicious, 60 + diagnostic with other signs, genetic testing Pulmonary Complications: respiratory infections, poor gas exchange, paroxysmal cough, nasal polyps, lung crackles, wheezes, barrel chest, nail clubbing (capillaries expand to increase O2)Therapy: nebulized meds, bronchodilators, abx, dornase alfa- enzyme (helps expel mucus), hypertonic saline to thin secretions, chest physiotherapy, tune ups when ill or with decreased pulmonary function GI Tx: + calories to food, snacks, multivitamins, appetite stimulation, pancrealipase with meals & snacks, laxatives Complications: reproductive, mucus blocks, can become pregnant but fetus has nutritional deficiencys, strain on lungs (abdominal cavity compressed), cervical mucus is thick which makes it difficult for sperm Cephalosporins= cardiac irregularities, electrolyte imbalancesAminoglycosides= ototoxicity, nephrotoxicityLung Transplants: 1 year survival 90%, 5 year 50%
Evaluation: enhance self care activities, enzymes, snacks, maintain normalcy, monitor growth, encourage hand hygiene, monitor respiratory status, resp treatments, nutrtion, transition to adult care, life goals, quality of lifeBronchopulmonary Dysplasia: micro premies, no surfactant, no immuglobulins, vents cause issues (pressure), some go home on O2, resp tx, risk for poor wt gain, resp infectionsTx: meds, prevention, fluids
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- Spring '17
- cough, fine motor skills, yrs, 1-3 yrs