- tailored to pt

- as severity increases, drugs added

 inhaled B2 adrenergic agents or cromolyn before exposure to allergents

- antinflammatory agent (inhaled steroid or Intal)

- theophylline

- consider leukotrient modifers

- depends on severity and response to therapy

- initial: B2 adrenergic agonists via nebuilizer or MDI

- corticosteroids: IV, PO, MDI

- epinephrine sq

- aminophylline or theophylline po

- dry powdered inhaler

- metered dose inhaler

- monitor resp and card systems

- monitor response to therapy

-administer O2

- decrease pt sense of panic

- position to maximize chest expansion

- pursed lip breathing

- continuing worsening of symptoms despite vigorous treatment

- run risk of needing intubation

- risk of pneumothorax

- high pulsus paradox

- corticosteroids IV, theophylline

- manage F/E balance, assure hydration

- O2 (humidified low flow)

- prepare for possibe intubation

- antibiotics

- pt carry out ADLs

- pt able to comfortably STTN

- avoid allergens

- knowledge of meds and use of MDI

- use peak expiratory flow meter

- know when to seek medical attention

- healthy diet and plenty of fluids

- rest and exercise

- avoid exposure to infection

- condition chracterized by chronic obstruction to air flow

- periods of exacerbation

- emphysema, chronic bronchitis

- problems with larger airways

- enlarged goblet cells, excessive mucus, destroyed cilia

- mucus and cough for 3 months for at least 2 years

- inflammtion of smaller airways/alveoli

- alveoli get destroyed, hyperinflated

- bullaue: blister like weak structures prone to rupture

- cigaretted smoking

- infection

- heredity: alpha/anti trypson defeciency (vacuum does not have off switch, destroys healthy tissue)

- aging

- environmental exposure

- inflammatory process

- destruction of lung parenchyma

- pumonary vascular changes

- cor pulmanle: right sided heart failure

- insidious onset

- cough that usually worse in morning

- dyspnea

- wheezing chest tightness

- flattened diaphragm

- weight loss, anorexia

- fatigue

- physical findings: barrell chest, activity intolerance, coarse dimished breath sounds, pursed lip breathing, clubbed fingers

- polycythemia

- ABG abnormalities

- cor pulmonale

- exacerbations of COPD

- acute respiratory failure

- GERD

- depression/anxiety

- smoking

- environemental

- flattened diaphragm

- hyperinflation

- weakened walls of lungs

- outpouching

- reduced FEV1

- increased residual volume

- increased TLC

- resp acidosis

- comp or uncomp

- polycythemia

- increased WBC

- impaired gas exchange

- ineffective breathing pattern

- ineffective airway clearance

- imbalaned nutrtion: less than body requirements

- anxiety

- activity intolerance

- prevent disease progression

-releive symptoms

- improve exercise tolerance

-prevent/treat complications

- promote participation in care

- prevent/treat exacerbation

- improve quality of life

- reduce mortality risk

- bronchodilators

- anticholenergics

- steroids

- cough and deep breath

- suctioing

- well hydrated

- mucinex

- sometimes decreased O2 levels can be stimulus to breath (hypoxic drive)

- in such cases, don't give too much O2

- CO2 narcosis acts as sedative

- mobilize

- acapala to break up secretions

- maintain BMI 21-25 kg/m2

- protein 1.2-1.9g/kg

- non protein calories divided evenly b/t fats and CHO

- calories to maintain 25-30 cal/kg/day

calories to gain: 45 cal/kg/day

- small frequent meals

- avoid foods that cuase bloating

- bronchdilator 30 minutes before meals

- increased fats

- multisystem disorder primarily affecting the exocrine (mucous producing glands)

- most common serious pulmonary and gastric disease in children

- inherited as an autosomal recessive trait

- 1:1600 births, increased in caucasians

- equal sex distribution

- impermeability of epitheltial cells to chloride

- exocrine gland dysfunction leads to thick, tenacious mucus causing mechanical obstruction

- patchy atelectasis and hyperinflation of lung

- child cannot expectorate

- infection common

- gas exchange affected

- severity does vary

- hemoplasis

- meconium ileum may be early sign

- pancreatic enzymes don't go into duodenum

- impaired digestion and absorption of nutrients

- steatorrhea

- complication: rectal prolapse

- DIOS/constipation

- if bile backs into liver, cirrhosis and liver damage possible

- deficiency in fat soluble vitamins

- may occure at birth or as late as early adulthood

- hx, family hx

- sweat electrolyte test: examine sweat, child with CF will show increase in sodium chloride, above 60me/L indicates CF

- fecal fat test: collect stool for 72 hous, test for amount of fat

- chest Xray: demonostrate pulmonary issues

- chest PT: manual, postural drainage, acapela, vest

- meds: bronchodilators, mycolytics, expectorants, antiobtiocs (avoid near meals)

- transplant: can give additional 10-20 years, 48% survival rate at 5 years

- kids should be exercising to increase lung capacity

- artificial enzymes (no set dose, goal is to reduce stools to 1-3 per day)

- multivitamins: can be give watermisable fat soluble vitamins

- increased calories

- increased protein

- fat as tolerated

-salty foods in hot weather

- improving ventilation

- improving nutritional status

- support child and family

- pt and family education (stress compliance with treatment, encourage f/u care, refer to CF foundation)

- an intermittent, reversible obstructive airway disease

- increased responsiveness of trachea and bronchi to various stimuli, hyperresponsiveness

- narrowing of airways with inflammation and obstruction (bronchospasm)

- symptoms can be mild to severe or even fatal

-exacerbation last minutes to hours

- allergens/irritants

- exercise (albuterol 15 min before exercise)

- respiratory infections

- nose and sinus problems

- drug and food additives (ASA and NSAIDS)

- GERD

- emotional stress

- 20 million in US/6.3 million children

- more prevalent in boys until puberty, then increased in women

- common in urban settings

- gerontoglogic considerations

- inflammation and edema of mucous membranes (guides treatment)

- spasm and hypertrophy of smooth muscle of bronchi and bronchioles

- accumulation of tenacious secretions

- hyperinflation of alveoli

- elderly do not respond as well to drugs

- only 1/2 of children outgrow asthma, it is a disease of elderly as well

- freq and severity of symptoms very

- onset abrupt or insidious, lasting hours to days

- prolonged expiration

- wheezing, cough

- dyspena, tachpneic

- chest tightness

- anxious, uncomfortable, acute distress

- acute episode may cause s&s of hypoexemia

- complications: pneumothorax

- hx: family hx, allergies, work environment

- allergy testing

- CXR: normal unless acute attack, hyperinflation

- WBC diff: eosinophils elevated w/ allergies

- IgE levels

- sputum sample: cultures and sensitives

- ABG in acute event (1st resp akl, 2nd resp acid)

- PFTs: decreased FVC, decreased FEV1 that increases w/ use of bronchodilators

- Peak Flow: gives overall pic of status

- nitric oxide levels are higher in pt w/ asthma

mild: increased

moder: more increased

severe: extremely increased or none at all

mild: wheezing

mod: unequal

severe: decreased or absent

mild: none

moderate: increased

severe: very increased

mild: acidic

mod: alkaline

severe: severely alkaline

intermittent: <2 days/week

mild: > 2 days/week

moderate: daily

severe: throughout day

intermittent: <2 days/week

milkd: > 2 days/week, but not daily

moderate: daily

severe: several times per day

intermittent: none

mild: minor

moderate: some

severe: extremely

MID, nebulizer

- albuterol (proventil, Ventonlin)

- metaproteronal (Alupent)

- pirbuterol (Maxair)

MDI, nebulizer, po, sq: terbutaline (Brethaire)

sq: epinephrine (Adrenaline)

neb: levalbuterol (Xopenex)

- stimulates beta 2 adrengertic receptors in smooth muscles and bronchiole

- bronchdilators

- sinus tach

- tremor

- hyopkalemia

- cardiac dysrhythmia

- papitations

- restlessness

- insomnia

- short acting agents provide quick relief

- cheaper but less convenient than long acting beta 2 agonists

- epinephrine may be given for emergency management

- rescute inhalers

- avoid over or double dosing which may lead to paradoxical wheezing

- take before other inhalers

- sustain release form of albuterol

- not a rescue inhaler

MDI:

beclomethasone (Vanceril)

budesonide (Pulmicort)

fluticasone (Flovent)

PO: prednisone

IV: methylpresdnisolone (Solumedrol)

Inhaled: hoarseness, cough, throat irritation, fungal infection of mouth and throat

systemic: hyperglycemia, euphoria, nervousness, personality/behavior changes, osteoporosis, edema, hypertension, kypokalemia, peptic ulcer disease, delayed wound healing

- take bronchodilators first

- rinse mouth out after using inhalers

- must taper oral and parenteral administration or risk Addisonian crisis

PO

- zafirlukast (Accolate)

- montelukast (Singulair)

- zileuton (Zyflo)

IV

- aminophylline

IV, po

- theophylline (Theodur, Uniphyll)

- dysrythmias

- seizures

- headaches

- insomnia

- nausea

- heartburn

- mild diuresis

- palpitations

- narrow therapeautic range

- interacts with many foods and medications

- maintain dedicated venous access for parenteral infusions

MDI, nebulizer: ipratropium (Atrovent)

MDI: tiotropoium (Spiriva)

- bronchodilators

- increase effectivness of beta 2 agnoists

- used for chronic prophylaxis of asthma or for COPD

- bitter, metallic taste

- nervousness

- occasionally prostatic symptoms

- dry mouth

- blurred vision

- headache

albuterol and ipratroprium (Combivent)

fluticasone and salmeterol (Advair)