flu

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Influenza

Orthomyxo Virus. Inflammation and infection of the major airways

Spread

Person to person, contaminated clothing

Infectious

first onset of symptoms within the first 24 hrs, and last up to the next 5 days.

most affected

Preschool and school age

H1N1

Swine flu, subtype or influenza A

Treatment

Oseltamivir(tamiflu) or Zanamir (Relenza)

Oseltamivir

Tamiflu- not recommended for children under 1. Take 2 times a day for 5 days and total of 10 doses, can be taken up to 6 weeks, has to be taken at the 1st onset of illness or within 48hrs.

Managment

Uncomplicated Influenza: Symptomatic tx: Acetominophen or ibuprofen for children. Fluids to maintain hydration.
Antivirals: Oseltamivir Tamiflu

Prevention

Annual flu shot: 6mos to 18 yrs.
TIV Trivalent influenza vaccine: any healthy children 6 mos and older. Do not give if egg allergy.

Bronchitis

Inflammed large airways: Trachea and Bronchi. Associated with upper respiratory infection usually will get bronchitis 1-2 days later.

Symptoms

Hacking dry cough, runny nose, dry thorat, fever tachypnea.

Assessment:

Auscultate: Rhonci and Crackle, rales.

Diagnostic test

Chest x-ray, will see diffuse aveolar hyperinflation and markins on the hilus lungs

Treatment for Bronchitis

Antibiotic, cough suppressant, analgesics,antipyretics, humidity.

Nursing

Medication administration, encourage fluid, parent teaching, prevent spreading, handwashing

Bronchiolitis/Respiratory syncytial virus

Accute inflammation and obstruction of the fine bronchioles and small bronchi.

Peak incidence

between 2 and 6 mos, winter and spring.

common cause

RSV: attacks resp mucosa, in 1st year of life can represent development of asthma.

pathiophysiology

RSW can affect epithelial cells of Resp tract. Ciliated cells:swell. Bronchiloar mucosa swells, lamina fills with mucus and exudate.

Transmission

predominately direct contact with respiratory secretions from hand to eye, nose droplets and inanimate objects.

Initial Manifectations of bronchiotis/rsv

Inital: Rhinorrhea and low grade temp, Pharyngtid, coughing sneezing, wheezing possible otis media and conjunctivitis.

Progression and Bronchiolitis/RSV

Increased cough, wheezing, fever, tachypnea, coastal retractions- sees ribcage on inspiration, refusal to bottle feed,copius secretions, crackles, dyspnea, dimished breathe sounds.

Clincal Manifestations

Severe: Tachypnea > 70 breaths/min, listlessness- no life, apneic spells, poor air exchange, cyanotic from hypoxia.

Diagnostics

CBC: luekocytosis; e-lyte.
ESR: elevated
CXR: Pulmonary infiltrate or atelactosis
ABG: in severe cases
NAsal or nasopharyndeal secretions: positive dx RSV

Management

oxygen, if infant fails to maintain consistant 02 saturation of at least 90% after nasal suctioning and repositions, antipyretic, adequate hydration PO or IV preferred 1st 1 or 2 days, Hospitaliization: need vent Vent Support, observe apnea,

Medical treatment

Ribavirin (virazole") Synthetic nucleoside antiviral agent:only tx for hospitalize child- reduce bronchiolitis as a result of rsv. Aerosol tx, teratogenic.

Therapuetic managment

Palivizumab(synagis)

Paliviumab(synagis)

Monoclonal antibody, Give IM injection (monthly) Candidates: are infants born weeks gestation and require medical treatments such as 02 and ventilation. Given at onset of RSV season and terminated at the end.

Therapy

Lyophillized powder, form of palivizumab, administered within 6 hours of reconstitution with streile water.

Outcomes: Bronchiolitis

Room air O2 >90%, Resp rate <60 breath/min, Adequate PO intake.

Nursing Management

Contact isolation, 2 children with RSV can be in same room. limit visitors, teach parents to instill nasal drops and suctioning.
Monitor o2 and pulse ox, admin med, monitor temp, provide support

Asthma

Immediate hypersensitivity(Type1) response. Reversible and chronic, Most common illess in children, occurs initially before age 5. inflammatory disorder of the airway, limitation or obsruction (reversible)

Stats of Asthma

more affected in boys than girls, 3rd cause for hospitlaization in children under 15, primary cause of school absence, 23.3 mill americans have asthma, Most common chronic disorder in childhood.

Risk factors for Asthma

Age, IgE: response to allergens, heredity, gender, mother < 20yrs, smoking, ethnicity africans increase risk, lack of medical care,

Causes of Asthma

Hyperrseponsiveness of lower airways, allergens, WEATHER CHANGES

Allergens/Triggers to Asthma

Seasona;: grass, tree week and pollen
Perennial: mold dust roaches animal dander
Triggers: smoke, pollution cold heat weather strong odors or perfumes, meds, stress, foods(chinese)

Pahtophysiology of Asthma

small airway affects: 3 processes, Bronchospasm, inflammed bronchial mucosa,increase secretiong and obstruction

Exacerbations of Asthma

When gets worse. Short of breath, wheezing or chest tightness, decreases in expiratory flow.

Classification of Asthma

In terms of severity.
Intermittent- sym less than 2 days/week
Mild persistant: more than 2 times/wk but less that one a day
Moderate persistant- daily
severe: throughout the day( if hear wheez on inhalation)

Clinical manifestations:

Cough- 1st attack usually 3-8 yrs old hacking and nonproductive.Dyspnea, Wheezing, sternal refractions, audible wheeze (if heard on inspiration= Severe*) malar, flush, lips dark red, sweating hypoxia. Older children may tripod. broken speach, unequal breathe sounds, crackles, barrell chest, club fingers, wide pulse(decrease strenght and sys pressure)

Assessment Dx: asthma

Pulse ox:o2 is decreased, ABG initially resp alk, than increase in PaCO2 (res acid) Complete H&P, CBC increase bands = rsp infection. Decrease airflow, decrease fev-1 and fvc (Force volume and foce vital capacity) Diminshed breathe sounds(not
good, indicates obstruction) Hyperresonance

Testing

CXR:show hyperinflation and infliltrates
Allergy testing- indicates allergens

Peak flow monitoring

measures the highest airflow during a forced expiration, daily for moderate of severe, measure before and after nebulizer.

Asthma Sone

Red <50% -med alert- narrowing,Give; beta 2 antagonist-arbuterol- contact pediatrician if not in green after adminstering.
Yellow 50-79% caution-may be beginning asthma attack not well controlled continue therapy.
Green 80-100%

Meter-dose inhaler

handheld device that delivers a measured dose of medication directly to the lungs. With spacer- provides med in accurately measured

Using MDI

open mouth, hold inhaler 1-2 inches away, use spacer attached to inhaler, hold inhaler to mouth. hold upright,shake,tilt head back and breathe out. press down med release med as you breathe in slowly. Breathe in slowly 3-5 seconds. Hold your breath for 10 sec, repeat as directed. wait 1 min between puffs

Therapuetic Management

avoid allergens, skin tests, relief of symptoms with meds

Medical management

Quick short acting meds (rescue drugs): acute exacerbations and excerise
Beta-2 adrenergic agonists(Arbuterol)

long acting meds

Controllers- Gluccocortosteroids- inhaled and systematic (acute Prednisone- IV-siumedrol
Leukotriene modifiers: montelkast (singular) not effective in acute attack.
Methylxanthine(Theophylline)- combine meds; measure blood levels

Interventions

assess respiratory and card status, monitor VS,modify environment avoid allergic reactions, rinse mouth after inhaled gluccoridicosteroid, exercise induced give prophylactic tx cromolyn-10-15min befreo, Encourage Hydration. avoid milk products,

Acute Attack

Child upright, RESCUE DRUGs,Oxygenation, monitor urine for glucose-bc of steroids blood sugar goes up, admin MDI

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