NR 602 WEEK 2 QUIZ ANSWERS

NR 602 WEEK 2 QUIZ ANSWERS Restrictive Processes Restrictive disease is less common in pediatric patients and is characterized by decreased lung compliance with relatively normal flow rates. Examples of causative factors include neuromuscular weakness, lobar pneumonia, pleural effusion or masses, severe pectus excavatum, or abdominal distention. Key findings of restrictive lung disease are rapid respiratory rate and decreased tidal volume/capacity (Carter and Marshall, 2011). Defense Systems The respiratory defense system includes mechanical and biologic processes. Mechanical defenses include: • Filtering of particles • Warming and humidifying of inspired air • Clearing of airway through mucociliary and coughing actions • Spasm and breathing changes Approximately 75% of inspired air is warmed as it passes through the nose, paranasal sinuses, pharynx, larynx, and upper portion of the trachea. Final warming and humidifying of the airstream take place in the trachea and large bronchi. Heat and moisture are removed during the expiratory phase of respiration. The nose has a large surface area on which particles larger than 5 mm are trapped and filtered to prevent them from entering the lower airways. The trachea and bronchioles are lined with various defensive cells and mucus glands. Goblet cells secrete the mucous layer that lies on the tip of cilia. Particles entering the conducting airway are quickly cleared by the mucociliary defenses. Coughing is a reflex mechanism that has three phases: (1) inspiratory, (2) compressive, and (3) expiratory. Through forceful expiration FBs and other materials can be removed from the airways; coughing propels particles. Young infants and children cannot effectively expectorate mucus, so they swallow it. Loss of the cough reflex leads to aspiration and pneumonia. Temporary breathing cessation, reflex shallow breathing, laryngospasm, and even bronchospasm are compensatory efforts aimed at stopping foreign matter from further entry into the lower respiratory tract. 797However, these respiratory efforts offer limited protection and have significant drawbacks. Biologic processes that protect the respiratory system include: • Phagocytosis • Absorption of noxious gases in the vasculature of the upper airway • Absorption of particles by the lymph system Phagocytosis, aided by the secretory IgA plus interferon, lysozyme, and lactoferrin, is the principal antimicrobial defense. Particles reaching the alveoli can be phagocytized by alveolar macrophages and polymorphonuclear (PMN) cells, cleared from the lung by the mucociliary system, or carried by lymphocytes into regional nodes or the blood. These particles can take days to months to clear. The respiratory defense system is at risk for compromise from numerous environmental factors. Damage to epithelial cells is caused by a variety of substances and gases, such as sulfur, nitrogen dioxide, ozone, chlorine, ammonia, and cigarette smoke. Hypothermia, hyperthermia, morphine, codeine, and hypothyroidism can adversely alter mucociliary defenses. Dry air from mouth breathing during periods of nasal obstruction, tracheostomy placement, or inadequately humidified oxygen therapy results in dryness of the mucous membrane and slowing of the cilia beat. Cold air is also irritating to the lower airways. Phagocytic ability is also reduced by many substances, including ethanol ingestion and cigarette smoke. Hypoxemia, starvation, chilling, corticosteroids, increased oxygen, narcotics, and some anesthetic gases also impair phagocytosis. Recent acute viral infections can reduce antibacterial killing capacity. Damage from infection and chemical irritants may or may not be reversible. Recurrent respiratory infections in children merit investigation for immunodeficiency or other underlying diseases, such as primary ciliary dyskinesia or CF. The mnemonic SPUR (Bush, 2009) can help determine which children need further workup: Severe infection Persistent infection and poor recovery Unusual organisms Recurrent infection Immunodeficiencies should be considered if the child has four or more new ear infections in a year, two or more serious sinus infections, two or more pneumonias in a year, persistent oral candidiasis, failure to thrive, two or more deep seeded skin abscesses, 2 or more months on antibiotics without improvement, and/or the need for intravenous (IV) antibiotics to clear infections. Also consider immunodeficiencies if there is a family history of immunodeficiency or two or more deep skin infections (Modell et al, 2014). Assessment of the Respiratory System The history provides valuable information about the causes, progression, and potential complications of a child's respiratory condition. The physical examination and diagnostic testing allow the provider to determine the extent of respiratory distress. History