NSB231 Lecture Notes - Lecture 5: Allergic Rhinitis, Cystic Fibrosis, Wheeze
Week 5: Childhood Chronic Illnesses Lecture
Impact of chronic disease in childhood/adolescence
• Developmental milestones may be delayed
• Psychosocial development may be delayed
• Growth- effect of disease or meds
• Education
• Peer relationship
• Anxiety and mental health issues
• More at risk of abuse or neglect
• Disrupt normal family function
• Sexuality
• Employment
Paediatric Respiratory Considerations
• Position of ribs
• Diaphragmatic- abnormal breathing
• Non-developed respiratory muscles
• Obligatory nose breathers
• Narrow nasal passages
• Less alveolar surface available
• Soft floor of mouth
• Large tongue
• Narrow airways
• Higher BMR
• Primary cause of paediatric arrest
o Respiratory in origin
ONLY 41% of children have a written asthma action plan
Cool- decreased perdfiosn to spare what oxygen is there
Diagnosing Asthma
• Based on history of recurrent wheeze
• Clinical response to an inhaled bronchodilator
• Spirometry
Other causes pf wheezing
• Transient infant wheezing
• Cystic fibrosis
• Inhaled foreign body
• Sudden onset
• Milk aspiration-cough
• Structural abnormality
• Cardiac failure
Physical Assessment
• Wheezing is suggestive of asthma but not diagnostic
• Absence of signs doesn't exclude asthma
• Crackles on auscultation refers to fluid in the lungs which may be caused by chest infection
• History of allergic rhinitis
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• Chest x-ray
Asthma Management
• Pharmacological Management
o Bronchodilators
o Anti-Inflammatory
o Long-acting beta 2 agonist
o Oxygen if required
• Education to improve asthma control
o Allergen avoidance/control
o Use of written asthma action plan
o Smoking cessation, diet and exercise
• Positioning
o Semi to high fowler or forward leaning posture
o Functional residual capacity increases
o An increase leads to a decrease in air flow resistance
Nursing Interventions
• Correct inhaler techniques
• spacer
•
Cystic Fibrosis
• Genetic disease of autosomal recessive
• Disease of the exocrine glands where they oversecrete or under secret
• 1 in 25 have the carrier
Manifestation
• Chronic suppurative lung disease
• Sinusitis
• Nasal polyps
• Exocrine pancreatic insufficiency
• Endocrine pancreatic insufficiency
• Liver disease
• Distal intestinal obstruction syndrome
Diagnosis
• Newborn screening (Guthrie test and DNA)
• Sweat test (pilocarpine on skin to measure chloride concentration >60mmol
• Pancreatic insufficiency (fat globules in stool, malnutrition)
• Family Hx
• Clinical feature
Respiratory Disease in CF
• Occurs in early children
• Asymptomatic
• Dehydrated, viscous sputum
• Chronic inflammation
• Chronic bacterial infection
• Lung damage
• Bronchiectasis, haemoptysis
find more resources at oneclass.com
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Document Summary
Paediatric respiratory considerations: position of ribs, diaphragmatic- abnormal breathing, non-developed respiratory muscles, obligatory nose breathers, narrow nasal passages, narrow airways, higher bmr, primary cause of paediatric arrest. Only 41% of children have a written asthma action plan. Cool- decreased perdfiosn to spare what oxygen is there. Diagnosing asthma: based on history of recurrent wheeze, clinical response to an inhaled bronchodilator. Sudden onset: transient infant wheezing, cystic fibrosis, milk aspiration-cough. Physical assessment: wheezing is suggestive of asthma but not diagnostic, absence of signs doesn"t exclude asthma, crackles on auscultation refers to fluid in the lungs which may be caused by chest infection, history of allergic rhinitis, chest x-ray. Cystic fibrosis: genetic disease of autosomal recessive, disease of the exocrine glands where they oversecrete or under secret, 1 in 25 have the carrier. Sinusitis: chronic suppurative lung disease, nasal polyps, exocrine pancreatic insufficiency, endocrine pancreatic insufficiency, distal intestinal obstruction syndrome.
