RE: Discussion – Week 6
Respiratory Alterations
The respiratory system is responsible for gas exchange between the outside environment and the internal environment. Its primary mechanisms are ventilation (moving air in and out of the lungs), diffusion (moving air between gas spaces and blood), and perfusion (moving blood in and out of the capillaries to major organs and tissue) (Huether & McCance, 2017). When these functions do not occur, the respiratory system is altered causing acute and chronic conditions.
Scenario
I chose scenario two, in this scenario, a 6-year old boy has an unresolved deep “barking cough” that elicits vomiting intermittently. The cough is productive for mucus. The child is febrile at times and has no other known medical history. Immunization history and records are incomplete. This information would lead the practitioner to assume a diagnosis of acute epiglottis, because children who have received a failed vaccine or have encountered a bacterium such as Staph, Strep or Methicillin Resistant Staph Aureus (Huether & McCance, 2017). However, because the cough is barking in nature, and higher incidence in males, the diagnosis would have to be spasmodic croup. Spasmodic croup occurs in older children and has an unknown cause, but has been related to other viruses, bacteria, and asthma.
Pathophysiology
Croup is classified as an acute laryngotracheitis and tends to occur in children ages 6 months to 5 years of age (Huether & McCance, 2017). Croup can be viral, spasmodic, or bacterial. In viral croup, there is inflammation and swelling in the glottis because of bacteria. Mucous membranes in the larynx become constricted allowing for increased swelling of mucosal and submucosal tissues. In spasmodic croup, an obstruction is present, but with significantly less inflammation and swelling. Bacterial croup yields purulent secretions that lead to obstruction of the airway and mucosal sloughing (Huether & McCance, 2017).
Treatment
Treatment for croup depends on the severity of illness and is measured by the Westley croup score (Huether & McCance 2017). Most children do not need treatment, but for those that need treatment inhaled or injected glucocorticoids are used. If the child has stridor or more severe retractions, inpatient services are suggested for observation and treatment. In rare cases, croup may require mechanical ventilation and antibiotics.
Age and Gender
Croup is primarily a disease of infants and toddlers, with an age peak incidence of age 6 months to 3 years. In North America, occurrence peaks in the second year of life, with an incidence of about 5-6 cases per 100 toddlers. Although uncommon after age 6 years, croup may be diagnosed in the preteen and adolescent years, and rarely in adults (Zoorob, Sidani, & Murphy, 2011). The male-to-female ratio for croup is approximately 1.4:1. The disease occurs most often in late fall and early winter but may present at any time of the year. About 5% of children will experience more than 1 episode (Zoorob, Sidani, & Murphy, 2011).
Alterations in the respiratory system will continue to affect people of all ages. Many times, in children it is hard to determine what the problem is due to the age and cognitive abilities of the child. As practitioners, it is important to perform a thorough assessment of the child and actively listen to what the parents have to say to prevent further progression of the illness.
References
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
Zoorob, R., Sidani, M., & Murray, J. (2011). Croup: An Overview. American Family Physician, 83(9), 1067-1073.
RE: Main Question Post, Discussion – Week 6
Respiratory Alterations
Scenario 3:
Maria is a 36-year-old who presents for Assessment of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.
Cough
A cough is a protective physiologic reflex that serves to clear airways of secretions and is the most common symptom that causes people to seek outpatient medical treatment (Taliercio & Hatipoglu, 2014). Rapidly adapting receptors are activated by mechanical forces such as inflation and deflation, whereas C fibers are sensitive to chemical stimuli; they are both thought to play important roles in the regulation of coughing although the exact roles are not fully understood (Taliercio & Hatipoglu, 2014). Further, the role of the various afferent nerve subtypes is not well understood in cough regulation. Signals are sent to the medullary cough center via vagal afferents which can trigger coughing via efferents mediated by the vagal, phrenic, and spinal motor nerves (Taliercia & Hatipoglu, 2014).
An acute cough is considered to have a duration of fewer than three weeks. The most common causes of an acute cough are viral rhinosinusitis, acute bronchitis, acute sinusitis, allergic or irritant rhinitis, exacerbation of COPD, and pertussis (Taliercio & Hatipoglu, 2014).
Acute Bronchitis
Acute bronchitis is an infection of the tracheobronchial tree and is the hallmark sign is a productive cough (Worrall, 2008) and seems to be the cause of Maria’s cough. Viruses that cause the common cold are the same ones that cause acute bronchitis and are responsible for approximately 95% of the cases in otherwise healthy adults; they include rhinovirus, adenovirus, influenza A and B, and parainfluenza virus (Worrall, 2008). Those with viral bronchitis usually have a nonproductive cough that occurs suddenly and can be triggered by air temperature or quality (Huether & McCance, 2017). Sometimes, purulent sputum is produced, and the effort of coughing can lead to chest pain (Huether & McCance, 2017). The presence of colored sputum does not signify the cause has viral or bacterial origins (Worrall, 2008). Symptoms for acute bronchitis include a cough, production of mucus, fatigue, shortness of breath, slight fever and chills, and chest discomfort; other symptoms may include the same symptoms of a common cold such as headaches and body aches (Mayo Clinic, n.d.). The symptoms may last two to three weeks, but a cough lasting longer may be cause for concern. Approximately 10% of patients with a cough lasting longer than two weeks have evidence of pertussis infection (Kinkade & Long, 2016).
The treatment for acute bronchitis focuses on supportive care and symptom management. Medications include cough suppressants, expectorants, and beta2 agonists such as albuterol in certain situations. Kinkade and Long (2016) inform us that all major guidelines on bronchitis recommend against using antibiotics for the treatment of acute bronchitis unless the patient has a known pertussis infection; although antibiotics may still be prescribed in the treatment of acute bronchitis. Kinkade and Long (2016) report that the use of antibiotics decreased cough duration by0.46 days, illness by 0.64 days, and decreased limited activity by 0.49 days; which provided no net benefit for the use of antibiotics in otherwise healthy individuals.
Age and Behavior
The elderly, infants, and young children are at higher risk of acute bronchitis than those in other age groups. Exposure to environmental factors such as dust, smoking, and chemical fumes, increase the risk of developing acute bronchitis (National Heart, Lung, and Blood Institute, n.d.).
References
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Kinkade, S., & Long, N.A. (2016). Acute bronchitis. American Family Physician, 94(7), 560-565.
Mayo Clinic. (n.d.). Bronchitis. Retrieved from https://www.mayoclinic.org
National Heart, Lung, and Blood Institute. (n.d.). Bronchitis. Retrieved from https://www.nhlbi.nih.gov
Taliercio, R.M., & Hatipoglu, U. (2014). Cough. Cleveland Clinic. Retrieved from https://monkessays.com/write-my-essay/clevelandclinicmeded.com
Worrall. G. (2008). Acute bronchitis. Canadian Family Physician, 54(2), 238-239.
