Introduction Waking up in the middle of the night when sick is flat out frustrating for the adult. Waking up in the middle of the night to your three-year-old toddler not being able to breathe is flat out terrifying. Three thoughts seem to circulate in your brain as you rush into their room in the middle of the night. The first is: what it wrong with them? They seemed fine when you put them to bed hours ago. As you assess the big picture, your mind can’t help but wonder what to do for them or how to help them because you have no idea why they seem to have to trouble breathing. You attempt to try not to panic at the little lips that look like they might be turning blue while at the same time the thought of ambulance or driving to the emergency room flashes through your mind. This can be just one scenario to children who are stricken with a Respiratory syncytial viral infection. Definition and Epidemiology Respiratory Syncytial Virus or RSV is “a virus that causes infection in the respiratory tract” (“Diseases and Conditions, 2013”). Normal healthy infants and children can tolerate respiratory syncytial virus, however, many cannot, and need to be hospitalized to receive treatment. Respiratory syncytial virus is very common in young children, so common that most children have been infected with RSV by the time they turn two (“Diseases and Conditions”), 2013). There is what doctor’s phrase as a “RSV season”. This basically means that there is a specific period of time where young children are at a high risk of contracting this very contagious virus. Children usually present to their pediatricians between December and April in temperate climates (Grob, Brune, Jorch, & Hentschel, 2000). Children who attend public child-care centers a... ... middle of paper ... ...er with adjacent cells to form a large, multinucleated cell creating large masses of cells” (Cooper, Banasiak, & Allen, 2003). In other words, the virus spreads along the epithelial cells of the respiratory tract through cell-to-cell transfer. The “bronchiole mucosa ultimately begins to swell, and the lumina fill with mucus and exudate. Inflammatory cells infiltrate the area resulting in the shedding of dead epithelial cells” (Cooper, Banasiak, & Allen, 2003). The dead epithelial cells then obstruct the small airway passages. The bronchiole cells normally dilate during inhalation and narrow on exhalation, however since the mucosa is inflamed the there is not good movement of air. With the obstruction of the bronchioles “air trapping, poor exchange of gases, increased work of breathing, and a characteristic expiratory wheeze” occur (Cooper, Banasiak, & Allen, 2003).
The presented case is of a patient named R.S. who has a smoking history of many years, which can be directly tied to his development of chronic bronchitis, a chronic obstructive pulmonary disease (COPD) specified as Type B. It is estimated that in 90% of chronic bronchitis or “blue bloaters”, cigarette smoking is the major cause. Chronic bronchitis involves persistent and irreversible airway obstruction, due to the constant inflammation of the bronchial mucosa, leading to hypertrophy and hyperplasia of bronchial glands. The latter exposes the individual to higher risks of bacterial infections; often colonization of organisms such as Streptococcus or Staphyloccocus pneumoniae can be exhibited. This is due to the lost or impaired function of mucociliary clearance action which results from the replacement of certain sections of ciliated columnar epithelium by squamous cells in the bronchi. (Copstead &Banasik, 546-547)
Bronchospasm is an abnormal contraction of the smooth muscle of the bronchi, narrowing and obstructing the respiratory airway, resulting in coughs, wheezing or difficulty in breathing. The chief cause of this condition is asthma, although it may also be caused by respiratory infection, chronic lung disease or an allergic reaction to chemicals. The mucosa lining of the trachea may become irritated and inflamed, which secretes mucus, causing it to be caught in the bronchi and triggers coughing.
Respiratory assessment is a significant aspect of nursing practice. According to the National Institute for Health and Care Excellence, respiratory rate is the best indicator of an ill patient and it is the first observation that will demonstrate a problem or deterioration in condition (Philip, Richardson, & Cohen, 2013). When a respiratory assessment performed effectively on a patient, it can result in upholding patient’s comfort and independence in progress of symptom management. Studies have acknowledged that in spite of the importance of the respiratory rate (RR) it is documented rarely than the other vital signs in the hospital settings (Parkes, 2011). This essay will highlight the importance of respiratory assessment and discuss why nurses
Accurso (1997) found that at birth the lungs of CF babies are normal but soon, many become infected with bacteria. This bacterial infections cause chest exacerbations in the patients. A 14-day course of intravenous antibiotics is usually given to the patients (CF Trust, 2011). CF patients constantly seek medical attention for various reasons and in most cases, because of the exacerbations. However, hospital-based care is not always favoured by the patients, as it is disruptive for them and their families, taking patients away daily, work activities and social lives for considerable amounts of time (Sequeiros and Jarad 2009). Both consultants and physiotherapist encourage less interruptive patient-administered homecare....
Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Ventilator-associated pneumonia (VAP) remains to be a common and potentially serious complication of ventilator care often confronted within an intensive care unit (ICU). Ventilated and intubated patients present ICU physicians, nurses, and respiratory therapists with the unique challenge to integrate evidence-informed practices surrounding the delivery of high quality care that will decrease its occurrence and frequency. Mechanical intubation negates effective cough reflexes and hampers mucociliary clearance of secretions, which cause leakage and microaspiration of virulent bacteria into the lungs. VAP is the most frequent cause of nosocomial infections and occurs within 48 hours of intubation. VAP is a major health care burden with its increased morbidity, mortality, longer ventilator days and hospital stay, and escalating health care cost.
Croup: Croup is another common airway inflammation caused by virus that can affect the trachea, larynx and possibility the bronchi (Murray, Sidani, & Zoorob, 2011) thus causing infection in the upper respiratory tract. Murray et al. describes it as the most common illness in children under the age of 6 to 36 months and cause for cough mostly when a child cries; acute stridor and hoarseness in febrile children (Murray et al., 2011). It can be a life-threatening situation in the life of the young infant and the family. Croup symptoms exhibit as hoarseness, barking cough, inspiratory stridor, and respiratory distress. I chose this diagnosis as my first preference because when I read the mother’s subjective report it matches that of croup symptoms: a barking cough, no fever, severe at night and when the baby cries, fatigue due to excessiveness of the tears, pain due to inflames and swollen of the airway. Murray et al., led us to understand that the etiologies of this viral causing agent can be traced to the parainfluenza viruses, type 1. (2011). This virus is commonly spread through contact or droplet secretion.
Today I will be explaining the importance and details of tracheobronchitis also referred to as bronchitis. Tracheobronchitis as the name gives off is an inflammation of the trachea and bronchitis. The trachea and bronchi’s main role is to extend air into the lungs, so that they are able to reach the alveoli which are responsible for gas exchange in the lungs. Tracheobronchitis is often times not contagious depending upon the cause of inflammation, inflammation can result from an allergic reaction, bacterial infection or virus. Some important clinical manifestations that you may see include wheezing which are a result of inflamed airways,fever, dry or phlegm cough, night sweats, headache and sore throat. Tracheobronchitis does not always have to be severe it can also be acute and last only a few weeks.
Healthy lung tissue is predominately soft, elastic connective tissue, designed to slide easily over the thorax with each breath. The lungs are covered with visceral pleura which glide fluidly over the parietal pleura of the thoracic cavity thanks to the serous secretion of pleural fluid (Marieb, 2006, p. 430). During inhalation, the lungs expand with air, similar to filling a balloon. The pliable latex of the balloon allows it to expand, just as the pliability of lungs and their components allows for expansion. During exhalation, the volume of air decrease causing a deflation, similar to letting air out of the balloon. However, unlike a balloon, the paired lungs are not filled with empty spaces; the bronchi enter the lungs and subdivide progressively smaller into bronchioles, a network of conducting passageways leading to the alveoli (Marieb, 2006, p. 433). Alveoli are small air sacs in the respiratory zone. The respiratory zone also consists of bronchioles and alveolar ducts, and is responsible for the exchange of oxygen and carbon dioxide (Marieb, 2006, p. 433).
Liam is a previously healthy boy who has experienced rhinorrhoea, intermittent cough, and poor feeding for the past four days. His positive result of nasopharyngeal aspirate for Respiratory Syncytial Virus (RSV) indicates that Liam has acute bronchiolitis which is a viral infection (Glasper & Richardson, 2010). “Bronchiolitis is the commonest reason for admission to hospital in the first 6 months of life. It describes a clinical syndrome of cough tachypnoea, feeding difficulties and inspiratory crackles on chest auscultation” (Fitzgerald, 2011, p.160). Bronchiolitis can cause respiratory distress and desaturation (91% in the room air) to Liam due to airway blockage; therefore the infant appears to have nasal flaring, intercostal and subcostal retractions, and tachypnoea (54 breathes/min) during breathing (Glasper & Richardson, 2010). Tachycardia (152 beats/min) could occur due to hypoxemia and compensatory mechanism for low blood pressure (74/46mmHg) (Fitzgerald, 2011; Glasper & Richardson, 2010). Moreover, Liam has fever and conjunctiva injection which could be a result of infection, as evidenced by high temperature (38.6°C) and bilateral tympanic membra...
Friedman JF, Lee GM, Kleinman KP, Finkelstein JA. "Acute Care and Antibiotic Seeking for Upper Respiratory Tract Infections for Children in Day Care: Parental Knowledge and Day Care Center Policies." JAMA Pediatrics 157.4 (2003): 369-374. .
Air then travels to the bronchioles which are narrow (bronchoconstriction) due to the natural defence in keeping irritants out of the airway, causing wheezing breath sounds.(Eldridge, 2016) The air then proceeds to the alveoli, which are weakened and damaged air sacs due to the progression of the disease, that are unable to efficiently move O2 into the blood stream and gas exchange CO2 to be expelled through exhale, causing hypoxemia, lethargy, dyspnoea and high CO2 reading. (“Lung conditions - chronic obstructive pulmonary disease (COPD),”
Person, A. & Mintz, M., (2006), Anatomy and Physiology of the Respiratory Tract, Disorders of the Respiratory Tract, pp. 11-17, New Jersey: Human Press Inc.
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
When you get the “flu” in the lungs, the lining of the respiratory tract is damaged by becoming swollen and inflamed. But the damage is not always permanent, and tissue heals within a couple of weeks. It is a respiratory disease, even though it infects the whole body.