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118 Cards in this Set
- Front
- Back
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This is a protein in RBC that transports 99% of O2.
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Hemoglobin
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O2 + Hemoglobin = ?
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Oxyhemoglobin
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Is dyspnea an objective or subjective report of breathlessness?
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Subjective
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True or false - dyspnea can be caused by airflow obstruction, low lung compliance, low chest wall compliance, muscle weakness, alveolar hyperinflation, and acute hypercapnia
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True
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True or false - there is a strong correlation between report of dyspnea and quantitative measure of airflow
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False - there is a weak correlation between them.
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__ involves the exchange of oxygen and CO2 between cells, alveoli, and outside air, and __ involves inhalation and exhalation.
Choose between respiration and ventilation. |
Respiration; ventilation
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This pediatric lung condition involves a bacterial infection of larynx and trachea and presents with a barking cough and stridor.
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Croup
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How is croup often treated (what medication class)?
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Steroids
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In this serious pediatric respiratory bacterial infection, a child will lean forward and drool, but healthcare providers are encouraged to keep both child and parent as calm as possible.
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Epiglottitis
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This pediatric respiratory condition is uri-viral and transmitted from adult to infant within the first 0 - 24 weeks with peak incidence at 6 months and involved inflamed bronchioles.
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Bronchiolitis
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What are the signs and symptoms of bronchiolitis?
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Dyspnea, hypoxemia, hypercapnia
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What is Sudden Infant Death Syndrome? When are infants most at risk?
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Unexpected, unexplained death of healthy child; 1 week to 1 year, highest between 2 - 4 months
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What are risk factors for SIDS?
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Prematurity, male gender, small gestational age, URI 1 week prior to death, sibling who died of SIDS, prolonged apnea
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What are some theories to account for SIDS?
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Immature CNS does not respond to CO2 buildup; prolonged ventricular polarization; suffocation while on tummy; shaken baby syndrome
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True or false - only severe cases of asthma can result in death.
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False - many asthma-related deaths are from patients with only mild asthma
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Asthma related to smooth muscle dysfunction can be treated with __ (what med class).
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Beta Agonists
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Asthma related to airway inflammation can be treated by ___ (what meds?).
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Inhaled steroids or leukotriene inhibitors
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What are the signs and symptoms of asthma?
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Chest tightness, cough, increased respiratory rate, wheezing, anxiety, dyspnea, ineffective gas exchange
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What is Status Asthmaticus?
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Severe prolonged asthma attack that does not respond to treatment; can cause death
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What are some triggers of asthma?
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Respiratory infections, allergens, work, temperature change, strong odors, exercise, cold air, stress and emotions, tobacco, gastric reflux, pollutants, medication, additives, and reruns of American Idol.
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What are some nonpharmalogical ways of dealing with or preventing asthma attacks?
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Face mask to warm air + retain humidity; desensitization; air filters; no smoking; hard wood floors instead of carpets and rugs
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What are some causes of asthma?
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Occupational exposure (when not at work, events decrease); exercise (beginning 5 - 10 minutes after exercise); pregnancy (smooth muscle hyperreactivity; increase in O2 consumption and metabolic rate; diaphragm elevation; etc); ASA-NSAIDS; nocturnal (related to circadian rhythm).
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What is the relationship between ASA/NSAIDS and asthma?
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ASA/NSAIDS may trigger or cause asthma; there may be a delayed reaction (as long as 12 hours); there may be a cross sensitivity (if patient has asthma attacks with ASA, may also have asthma attacks with NSAIDS); both ASA and NSAIDs stimulate leukotriene production which leads to bronchoconstriction
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What are the nocturnal causes of asthma?
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Occurring between 3 and 7 am and related to circadian rhythm; cortisol and epinephrine production decreased, and histamine increased, leading to bronchoconstriction; 50% decrease in airway diameter; may be caused by GERD, dry or cool air, or delayed reaction to allergens
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What are the extrinsic triggers of asthma?
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Allergies; leukotrienes cause bronchoconstriction; histamine causes airway edema; prostaglandins cause mucous production; other triggers include dust mites, food additives, pet dander, mold, ASA and NSAIDs, etc.
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What are the intrinsic triggers of asthma?
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Idiopathic asthma (no known cause); more common in men over 35; triggers include URI, air pollution, cigarette smoke, emotional stress, exercise, cold air
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How is asthma diagnosed?
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Allergy Test: CBC = increased neutrophils, increased IgE, pin prick test, reaction to allergens
Challenging Test: Exercise induced Signs and Symptoms of Typical Asthma: Pulmonary Function Test: Low Peak Expiration Flow |
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How often will a patient have bronchitis signs and symptoms in order to be considered a patient with chronic bronchitis?
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S/S for @ least 3 months of the year for 2 consecutive years
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What causes chronic bronchitis?
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1. Airborne irritants =inflammatory response
mucus gland hyperplasia edema Increased thick mucus bronchoconstriction cough 2. Ciliary damage + decreased phagocytic activity ***increased infections + resp. failure 3. Airway resistance to both inspiration + expiration hypoventilation hypoxemia; hypercapnea Cyanosis Increased RBC production [polycythemia] clubbing of fingers SOB @ rest |
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Another name for right sided heart failure is ___.
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Cor Pulmonale
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Chronic hypoxia of Cor Pulmonale leads to __
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Chronic hypoxia causes reflexive pulmonary vasculature narrowing
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Describe senile emphysema.
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Results from normal degenerative change
No symptoms |
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What is Centrilobular emphysema associated with and what does it affect?
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Associated with smoking, CB, air pollution Affects bronchioles
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What happens to the alveoli in emphysema?
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They are destroyed:
(A) Loss of surface and capillary bed area (B) Large ineffective air spaces (C) Reduction of gas exchange (D) Decreased surfactant production |
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What is the etiology of emphysema?
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Due to alveolar destruction:
Loss of elastic recoil air trapping during expiration hyperinflation of alveoli narrowing of terminal bronchioles ***inspiration is not affected |
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What will a nurse assess in a patient with emphysema?
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1. Use of accessory muscles
2. barrel chest r/t hyperinflation 3. pursed-lip breathing increased resistance to expiration creates increased airway backpressure prevents alveolar collapse 4. tripod position supports rib cage = expansion 5. No cough unless CB or infection also present 6. Decreased breath sounds 7. rapid, resp pattern 8. dyspnea on exertion 9. weight loss 10. hypercapnia |
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What diagnostic tests are used to identify emphysema in a patient?
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1. Pulmonary function tests
2. Chronic resp acidosis 3. Blood gas analysis 4. Pulse oximetry - below 95% is normal for pts with emphysema 5. high H/H 6. WBC increase with shift to the left 7. Doppler echocardiogram = cor pulmonale |
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What are the best ways to prevent emphysema?
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no smoking
yearly flu vaccine clean air legislation antibiotics prn increase fluids bronchodilators steroids |
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What is the best way to manage emphysema?
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Mechanical vent for resp failure
percussion/postural drainage pulmonary rehab programs support groups emotional support increased calorie diet + vitamins continuous low flow O2 |
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What will continuous low flow O2 do for a patient with emphysema? What are the recommended guidelines?
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Continuous low flow O2
1-2 L/min goal is PaO2 above 60 mm Hg Their drive to breath is r/t PaO2 level ***you breath because of CO2 build-up They always have a high CO2 level in pts with CAL--high O2 levels will decrease respiratory drive |
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What is the leading cause of death from infection?
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Pneumonia
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What type of pneumonia accounts for 75% of cases?
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Streptococcus Pneumonia
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True or false - bacterial pneumonia is usually mild.
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False - viral pneumonia is usually mild
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What causes pneumonia?
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Lung normally sterile
pathogens/foreign matter enters via: Bloodstream or Inhalation Etiology: pathogens including viruses, bacteria, fungus suctioning aspiration chemical fumes intubation thick secretions |
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What is lobar pneumonia?
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Occurs in single lobe
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What is bronchopneumonia?
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Patchy pneumonia in several lobes
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What is an atypical pneumonia?
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Pneumonia from virus (flu) or legionella bacteria
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What is nocosomial pneumonia?
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Hospital-acquired pneumonia
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What happens during the 1st stage of pneumonia? What are the signs and symptoms?
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Process:
24 hr congestion stage capillary bed edema serous fluid leaks into alveoli S&S: Fever and Chills aching chest Malaise Dyspnea watery phlegm, increased WBCs fine crackles over affected area |
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What happens during stage 2 of pneumonia? What are the signs and symptoms?
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Process:
RBCs and fibrin enter alveoli red, firm lung appearance S&S: lung sounds absent in affected area dyspnea, tachypnea |
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What happens during stage 3 pneumonia? What are the S&S?
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Process:
fibrin, disintegrating RBCs in affected area S&S: cough = blood tinged, purulent |
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What happens during the resolution stage of pneumonia?
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Process:
clean-up stage enzymes digest/remove products of inflammation lung tissue necrosis possible |
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How is pneumonia diagnosed?
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Chest x-ray = areas of consolidation
C/S of phlegm CBC ABGs |
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How is pneumonia treated?
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1. antibiotics—for all pts ??
2. bronchodilators 3. O2 4. swallowing studies r/t prevention of aspiration pneumonia--tube feeding |
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What are the characteristics of respiratory acidosis?
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Reduced gas exchange
Carbon dioxide retained Excess carbonic acid produced Too little bicarb Cerebral vessels dilate Cardiac/neuro function decline K moves out of cells Lactic acid produced pH below 7.35 |
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What are the characteristics of respiratory alkalosis?
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Rapid gas exchange
Carbon dioxide eliminated Reduced carbonic acid produced Too much bicarb Cerebral vessels constrict Cardiac/neuro function decline pH above 7.45 |
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What is the etiology of respiratory acidosis?
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Slow Respiratory Rate
Anesthesia ETOH drugs CNS injury = < resp. drive Cardiac/resp arrest Sleep apnea Pneumonia mucous plug emphysema |
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What is the etiology of respiratory alkalosis?
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Rapid Respiratory Rate
Anxiety Fever ASA toxicity Rapid mechanical ventilation CNS injury |
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What are the signs and symptoms of respiratory acidosis?
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Restlessness
Confusion Apprehension Somnolence Coma Dyspnea Headache Dysrhythmia |
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What are the signs and symptoms of respiratory alkalosis?
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Agitation
Deep, rapid breathing Vertigo seizures apnea Circumoral/peripheral paresthesia Muscle weakness dysrhythmia |
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Who are most at risk for TB?
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HIV+, chemo, malnutrition, ETOH, poverty, homelessness
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Of the people who are exposed to TB, how many will be infected?
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10% - 30%
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Of the people who are infected with TB upon exposure, how many will actually develop the active form of TB?
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10%
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How is TB classified?
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1. Primary:
occurring 2 yrs after infection 2. Reactivation occurs later than 2 years after infection 3. Pulmonary affects lungs 4. Miliary other tissues |
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How is TB transmitted?
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Airborne droplets from person with active disease
5-15% of those infected have active disease high concentrations of bacteria in nonventilated, small space numerous exposures |
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How does TB form after the transmission stage?
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1. Inhaled bacilli travel to alveoli
usually settle in upper lobe inflammatory process begins bacilli are isolated and phagocytized not all destroyed some enter dormant state 2. 1-3 weeks post infection tubercules form [granulomatous lesions; Ghon focus] fused, elongated macrophages surrounded by lymphocytes have engulfed bacilli 3. Central section of tubercule becomes necrotic forms yellow, cheesy mass caseous necrosis scar tissue forms around tubercule--calcifies 4. Breakdown of tubercule years later means active disease reactivation TB r/t weakened immune system; malnutrition etc. |
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What are the signs and symptoms of TB?
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1. Initially asymptomatic
nonspecific symptoms pneumonia 2. active disease: low grade fever weight loss, anorexia weakness night sweats 3. Advanced disease: hemoptysis chest pain cough |
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How is TB diagnosed?
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1. Positive chest x-ray
2. Positive culture = diagnosis early AM cultures 3 consecutive specimens culture takes 10 days to grow |
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How is TB treated?
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1. 9 months of antimycobacterial meds
2. high rate of mutation with monotherapy so multiple meds given 3. public health risk--meds provided free by PH department 4. Bacilli Calmette-Guerin vaccine |
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What is the Bacilli Calmette-Guerin vaccine?
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TB vaccine used in developing countries and the US
**subsequent TB skin tests will be positive |
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What is cystic fibrosis?
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1. Exocrine gland dysfunction
exocrine glands: control digestion and salt balance 2. 1-2000 Caucasian children affected defect in chromosome responsible for producing a protein that regulates the flow of salt through cells 3. secretions become tenacious and obstructive average life span --28 years 4. Thick pulmonary mucous high risk: Pneumonia chronic bronchitis atelectasis chronic inflammation leads to: alveolar scarring bronchial passage destroyed reduced lung compliance and ventilation |
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What does the thick mucous formed by cystic fibrosis block? What are some results?
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1. Thick GI mucous blocks digestion and absorption of nutrients
2. pancreatic ducts clogged 3. failure to thrive 4. destruction of pancreas = diabetes |
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What are the S&S of cystic fibrosis in infants?
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1. protuberant abdomen @ birth--cannot pass meconium
2. salty taste when kissed on skin 3. resp. infections 4. chronic rhinitis, cough, phlegm 5. failure to thrive |
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What is Ghon Focus?
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A Ghon focus is a primary lesion usually subpleural, often in the mid to upper zones, caused by mycobacterium bacilli (tuberculosis) developed in the lung of a nonimmune host (usually a child). It is named for Anton Ghon (1866–1936), an Austrian pathologist.
It is a small area of granulomatous inflammation, only detectable by chest X-ray if it calcifies or grows substantially. Typically these will heal, but in some cases, especially in immunosuppressed patients, it will progress to miliary tuberculosis (so named due to the granulomas resembling millet seeds on a chest X-ray). |
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This term is used to refer to the ability of the lungs to expand.
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Compliance.
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What is hypercapnia?
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When CO2 levels in the blood increase; the primary stimulus for respirations (to get rid of excess CO2)
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Hypercapnia causes respiratory (acidosis/alkalosis).
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Acidosis
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Hypocapnia causes respiratory (acidosis/alkalosis).
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Alkalosis
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What is eupnea?
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Normal respiration rate (10 - 20 respirations per minute for adults)
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Severe dyspnea may be accompanied by __ of the nostrils and __ of the muscles between or above the ribs.
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Flaring; retraction
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What is hemoptysis?
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Blood-tinged (bright red) frothy sputum that is usually associated with pulmonary edema.
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Clubbed fingers sometimes results from chronic __ associated with respiratory or cardiovascular disease.
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Hypoxia
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Laryngotracheobronchitis is another name for __.
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Croup
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The flu differs from the common cold in that __
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It usually has a rapid acute onset with fever, marked fatigue, and aching pains in the body
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Most deaths during flu epidemics result from __
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Pneumonia (secondary condition)
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Influenza is a (bacterial/viral) infection
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Viral
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What is SARS?
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Acute respiratory infection with high fatality rate (higher than 50% in people over 60). Caused by SARS-CoV, an RNA virus that is transmitted by droplet during close contact; first discovered in China
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What is COPD?
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Chronic Obstructive Pulmonary Disease, a group of common chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction in airways of the lungs. This includes emphysema, chronic bronchitis, and chronic asthma.
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True or false - the damage of COPD is irreversible.
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True
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__ TB affects only the lungs, whereas __ TB affects other tissues such as the kidneys and bone as well.
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Pulmonary; miliary
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Explain the significance of a positive PPD
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Tuberculosis testing, also known as the PPD test, is a skin test used to determine if someone has developed an immune response to the bacterium that causes tuberculosis (TB). This response can occur if someone currently has TB, if they were exposed to it in the past, or if they recently received the BCG vaccine against TB (which is not performed in the U.S.) A positive response to a TB skin test does not mean that you have active TB. Rather it means that you have been exposed to TB, and need further evaluation.
Take Care Health Providers will inject a small amount of fluid that contains components of the TB organism under the skin. If a patient has been exposed to TB before or has received the BCG vaccine, the patient will react to the injection by forming a hard, raised area at the injection site. The patient needs to return to the healthcare professional administering the test 48-72 hours after the injection, at which time the healthcare professional will examine and measure the injection site to determine if the patient does or does not test positively for tuberculosis. Patients will be sent for further evaluation if a TB test comes back positive. Blood tests and x-rays are needed to confirm an active infection. State regulations require healthcare providers report suspected or diagnosed TB to state health departments. |
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What are leukotrienes and what is their relationship to asthma?
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Leukotriene molecules are produced naturally in the body. They can manage the response of the immune system during sickness, trauma or injury by sending messages to other cells.
When leukotrienes signal mast cells to move to the area of injury, inflammation and constriction of the airways begin to increase. Inflammation is a major cause of asthma, so the more leukotrienes that are produced, the greater the risk of asthmatic symptoms. When airways become blocked by inflammation, an asthma attack is often started. Symptoms of an attack include shortness of breath, tightness in the chest, wheezing and coughing. Asthma can be fatal, so immediate treatment during an attack is essential. Oral medications can be taken daily to block leukotrienes, preventing inflammation. This type of drug is not intended to be used for immediate asthma relief, but rather for long term prevention. It may take a few weeks before you begin to notice any decrease in asthmatic reactions. |
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What is histamine and what is its relationship to asthma?
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Histamine is an important protein involved in many allergic reactions. Allergies are caused by an immune response to a normally innocuous substance (i.e. pollen, dust) that comes in contact with lymphocytes specific for that substance, or antigen. In many cases, the lymphocyte triggered to respond is a mast cell. For this response to occur, a free-floating IgE (an immunoglobulin associated with allergic response) molecule specific to the antigen must first be attached to cell surface receptors on mast cells. Antigen binding to the mast cell-attached IgE then triggers the mast cell to respond. This response often includes the release of histamine.
The release of histamine (hist = because it's made up of histidine residues, amine = because it's a vasoactive amine) causes several allergic symptoms. 1) It contributes to an inflammatory response. 2) It causes constriction of smooth muscle. Histamine's second type of allergic response is one of the major causes for asthma. In response to an allergen (a substance that triggers an allergic reaction), histamine, along with other chemicals, causes the contraction of smooth muscle. Consequently, the muscles surrounding the airways constrict causing shortness of breath and possibly complete trachial-closure, an obviously life-threatening condition. If the effects of histamine during an allergic reaction are inhibited, the life of an allergic person can be eased (in the case of inflammation) or even saved by preventing or shortening asthma attacks. |
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A nurse is caring for an infant with bronchiolitis is assessing for signs of dehydration. The nurse checks which of the following, knowing that it is the most reliable method of determining fluid loss?
a) weight b) fontanels c) intake and output d) mucous membrane |
A
- Weight is the most reliable method of measurement of body fluid loss or gain. A weight change of 1 kg represents 1 L of fluid loss or gain. Although options B, C, and D identify components of the assessment for dehydration, these are not the most reliable determinants, because they require more subjective interpretation than weight, which is more objectively determined. |
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An emergency room nurse is caring for a child diagnosed with epiglotitis. Assessing the child, the nurse monitors for which indication that the child may be experiencing airway obstruction?
a) the child exhibits nasal flaring and bradycardia b) the child is leaning forward, with the chin thrust out c) the child has low-grade fever and complains of sore throat d) the child is leaning backward, supporting himself or herself with the hands and arms |
B
- Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, tachycardia, a high fever, and a sore throat. Option D is an incorrect position. Options A and C are incorrect because epiglottitis causes a high fever and tachycardia. |
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A student nurse is caring for a 2-year old child diagnosed with croup and the nursing instructor asks the student about the clinical manifestations associated with the illness. Which statement by the student indicates a need for further research?
a) the cough is harsh and brassy b) inspiratory stridor and a low-grad fever may be present c) symptoms usually worsen at night and are better during the day d) symptoms usually worsen during the day and are relieved during sleep |
D
- Croup often begins at night and may be preceded by several days of upper respiratory infection symptoms. Croup is characterized by a sudden onset of a harsh, brassy cough, sore throat, and inspiratory stridor. Symptoms usually worsen at night and are better in the day. Croup usually is accompanied by a low-grade fever, but occasionally the temperature may be as high as 104° F. |
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The client is diagnosed to have COPD (Chronic Obstructive Pulmonary Disease). Which of the following signs and symptoms needs priority intervention by the nurse?
a) temperature of 37.5 C b) tachycardia c) cough d) 91% oxygen saturation |
C
- cough in COPD is caused by copious, tenacious mucous secretions. Problems with airway should be given highest priority. In COPD, 91% oxygen saturation is considered normal, because the client is breathing due to low oxygen levels in the blood. |
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Mr. Tan admits to the nurse that he takes the following medications. Which medication may cause asthma attack?
a) milk of magnesia b) pepcid ( famotidine) c) acetylsalicylic ( aspirin) d) benadryl ( diphenhydramine) |
C
- Common Factors Triggering an Asthmatic Attack Aspirin and NSAID - can trigger allergic reaction, its anti-inflammatory effect decreases histamine secretion and mucus secretion causing pooling of thick mucus that obstructs the airway and triggers an asthmatic attack |
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Which of the following organisms most commonly causes community acquired pneumonia in adults?
a) haemophilus influenzae b) klebsiella pnemoniae c) streptococcus pneumoniae d) staphylococcus aureus |
C
- pneumonia is inflammation of the bronchioles and alveoli that is usually accompanied by increased interstitial or alveolar fluid. Infectious pneumonia is caused by the following microorganisms: Microorganisms that causes Pneumonia Streptococcus pneumoniae - most common cause of community acquied pneumonia Mycoplasma pneumoniae and hemophillus influenza - are other causes of community acquired pneumonia Pneumocystiis carinii - affects immunocompromised individuals such as those with AIDS Staphylococcus aureus, kleibsiella pneumoniae, P. aeruginosa and E. coli are common caused of nosochomial pneumonia. Non-infectious pneumonia is caused by aspiration of gastric contents (aspiration pneumonia) and inhalation of toxic gases, dusts, smoke or chemicals. |
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Your finding in an asthma attack assessment would include the following except:
a) ability to speak words without taking deep breath b) tachycardia, cool and moist skin c) air hunger and presence of wheezing sound d) tachycardia, warm and moist skin |
A
- common assessment findings in asthma include: wheezing, chest tightness, breathlessness, coughing, anxiety, apprehension, tachypnea and tachycardia. Patients experiencing asthmatic attack can usually speak only one or two words between breaths because of severe dyspnea, anxiety, fatigue and apprehension |
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What's one of the first symptoms of SARDS?
A. Dry cough B. Shortness of Breath C. Hypoxemia D. High Fever |
D. SARS typically begins with a high fever, chills, and achiness. Other symptoms may develop later.
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Patients with Cor Pulmonale usually have what other respiratory disorder?
A. TB B. Emphysema C. COPD D. SARS |
C. COPD
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What is the most important predisposing factor of COPD?
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Smoking
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If pH is 7.35 and HCO3 is 20, with the PaCO2 being 35, what is this called?
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Compensated Metabolic Acidosis (Ph is in normal range but more acidotic; it is thus following the HCO3, which is also acidotic; the paCO2 is alkalotic because it is compensating for the acidotic HCO3, putting the pH in the normal range)
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If the pH is 7.45, HCO3 is 20, and the PaCO2 is 30, whas it this called?
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Compensated Respiratory Alkalosis (pH is in normal range but more alkalotic; the PaCO2 is also alkalotic, suggesting that the lungs are driving the alkalosis; the bicarb is acidotic, suggesting that it is compensating for the alkalosis of the PaCO2, keeping the pH within normal limits)
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What is the normal range for pH? What pH is acidotic? What pH is alkalotic?
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Normal pH = 7.35 - 7.45
Acidotic pH <7.35 Alkalotic pH >7.45 |
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What is the normal range for PaCO2? What range of PaCO2 is acidotic? What range is alkalotic? What system drives the PaCO2?
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Normal PaCO2 = 35 - 45
Acidotic PaCO2 >45 Alkalotic PaCO2 < 35 Lungs (Respiratory) |
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What range of HCO3 is normal? What range is acidotic? What range is alkalotic? What system drives the HCO3?
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Normal range of HCO3 = 22 - 26
Acidotic HCO3 <22 Alkalotic HCO3 >26 Renal System - Kidneys (Metabolic) |
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pH 7.31
PaCO2 49 HCO3 22 What is this? |
Metabolic Acidosis (pH and HCO3 are acidotic; PaCO2 is in normal range)
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pH 7.46
PaCO2 44 HCO3 30 What is this? |
Metabolic Alkalosis (pH and HCO3 are alkalotic; PaCO2 is in normal range)
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This substance in the alveoli keeps them from sticking together upon deflation and inflation
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Surfactant
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This is a subjective feeling of breathlessness
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Dyspnea
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True or false - dyspnea should be reported using a dyspnea scale since it is subjective
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True
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If a person cannot tell you that they are feeling dyspnea, what behavior should be observed?
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Agitation can indicate dyspnea
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This is a viral infection of the trachea and layrnx that produces a barking cough and hoarse voice
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Croup
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Epiglottitis is a (bacterial/viral) infection.
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Bacterial
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Why should a child with epiglottitis be encouraged to remain calm and remain with parents?
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If a child with epiglottitis begins crying, the epiglottis may become completely shut off and the child will stop breathing
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This is a common respiratory disease caused by the RVS virus and affects babies up to 2 years of age
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Bronchiolitis
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