Peds Test 2 Respiratory

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Age group most affected by acute epiglottitis; etiologic agent
2-5 years old; bacterial
Acute epiglottitis onset symptoms
-Rapidly progressive
-Dysphagia.
-Stridor aggravated when supine.
-Drooling (medical emergency in older children!!).
-High Fever
-Toxic appearance
-Rapid pulse and respsirations
Acute Laryngotracheobronchitis (LTB) age and etiologic agent
Infant or child younger than 5 years old; viral
Treatment for LTB
-Racemic epinephrine
-Corticosteroids to maintain epi
-Fluids
-Reassurance
-Administer humidification (can put NS in nebulizer)
-Administer O2 to keep SATs >92%
MEDS: Beta-agonist (albuterol, racemic epinephrine) and corticosteroids (dexamethasone)
Treatment for acute epiglottitis
-Airway protection
-Racemic epinephrine
-Corticosteroids
-Fluids
-Abx
-Reassurance
Symptoms of LTB
-Slowly progressive
-URI
-Stridor
-Brassy cough
-Hoarseness
-Dyspnea
-Restlessness
-Irritability
-Low grade fever
-Nontoxic appearance
Age and etiologic agent for acute spasmodic laryngitis
1-3 years. Viral with allergic component.
Treatment of acute spasmodic laryngitis
-Cool mist
-Reassurance
Age and etiologic agent for acute tracheitis
1 month - 6 years; viral or bacterial with allergic component
Symptoms of acute tracheitis
-Moderately progressive
-URI
-Croupy cough
-Purulent secretions
-High fever
-No response to LTB therapy
Treatment of acute tracheitis
-Abx (antibiotics)
-Fluids
Acute spasmodic laryngitis symptoms
-Sudden; at night
-URI
-Croupy cough
-Stridor
-Dyspnea
-Restlessness
-Symptoms awakening the child but disappearing during day
-Tendency to recur
Looks like a thumb on x ray
Acute epiglottitis on x ray
Important to keep them CALM... getting upset can close off their airway
Acute epiglottitis tip
Infants less than 6 months may have this to help with infections
Maternal antibodies
Infection rate increases during these months of life
3-6
These are the years of high viral infections
Toddler and preschool
After 5 years old, there is an increase in this
Mycoplasmal pneumonia and B-streptococcal infections
RSV season
October to March
Respirations: Newborn-1 year
30-35
Respirations: 2-6 years
21-25
Respirations: 1-2 years
25-30
Respirations: 12 years and older
16-19
Respirations: 6-12 years
19-21
"Common cold"
Nasopharyngitis
Causes of nasophargyngitis
-RSV
-Rhinovirus
-Adenovirus
-Influenza
-Parainfluenza virus
Infection affecting the pharynx and tonsils
Pharyngitis
Rare in children under 1, usually 4-7
Common age for pharyngitis
____% of pharyngitis caused by viruses
80
____-____% of pharyngitis is group a beta-hemolytic strep (aka strep throat)
20-40
Oral penicillin for 10 days
Treatment of strep pharyngitis
Strep symptom duration
Should resolve in 24 hours after abx and this is when child stops being contagious
For tonsillitis, teach parents to replace toothbrush every ___ days after antibiotics to avoid reinfection
2
Infection or inflammation of palatine tonsils
Tonsillitis
For this illness, symptoms are the same as severe pharyngitis and treated the same way
Tonsillitis
Can be bacterial or viral
Otitis media agent
Otitis media results from this
Malformation of eustachian tubes
Predisposing factors for otitis media
-URI
-Down syndrome
-Cleft palate
-Exposure at daycare
-Formula fed
Treatment for otitis media delayed for _____ to _____ hours after diagnosis without severe symptoms or uncertain diagnosis
48-72 hours
-First-line therapy is Amoxicillin PO 80-90 mg/kg/day. 10 days in children under 6, 5-7 days in children 6 and older.
-Ibuprofen/acetaminophen for pain/fever
-Anesthetic eardrops (if membrane not ruptured)
-No decongestants!!!!!!!! (not used for child under 6)
Otitis media treatment
Myringotomy
Surgical incision of the tympanic membrane
Infectious monocnucleosis
Principle cause is Epstein-Barr virus, no specific treatment... hydration and rest!
Considered the "reactive" portion of the lower respiratory tract
Lower airway
Cartilaginous support not fully developed until ________
Adolescence
Bronchiolitis
Lower respiratory tract illness that occurs when virus or bacteria cause inflammation and obstruction of small airways
6 months
Peak age for bronchiolitis
Responsible for 90,000 hospital admissions and 4,500 deaths per year (a good reason to push breast feeding!)
Bronchiolitis morbidity and mortality
The cause of bronchiolitis (annual epidemic during winter and early spring...)
RSV
Symptoms of bronchiolitis
-Ill with URI for few days --> lower resp problems
-Inspiratory and expiratory wheezing
-Deeper, more frequent cough
-Retractions
-More labored breathing
-Marked retractions, crackles, cyanosis and diminished breath sounds indicate severe respiratory distress!
Rales
Sounds like fizzy soda or rubbing hair together, aka crackles
Wheezing
Sounds like whistling. Something is narrow! From constriction of the bronchioles.
Stridor
Upper airway closed off
Nursing care for bronchiolitis
-Contact/droplet isolation
-Assess/maintain hydration
-Suction nares and mouth, esp. before feeding
-Assess resp. status and administer humidified O2 PRN
-Ventilation support may be needed
-Bronchodilators
-Elevate HOB
-Reduce anxiety!!!! Mom's anxiety too.
Put on mask before
ambulating a droplet precautions patient
Bipap support, Intubation and ECMO (extracorporeal membrane oxygenation)
Keep alveoli open, even during exhalation
Palivizumab (synagis)
-Recommended for high-risk infants
-Given IM Qmonth for 5 months beginning in early Nov. to prevent RSV infection.
-Costs a lot!!
-Do not need if greater than 1 year
Pneumonia
Treat all with an abx!! (usually started viral and goes bacterial!)
Smoking
This increases the risk for ALL respiratory illnesses. Increases the risk for asthma even if done outside
Coughing
#1 symptoms of asthma
Asthma med: Beta-2 agonist
Serevent Diskus (Salmeterol)
Asthma med: Cotrticosteroid
Pulmicort (Bedesonide), Advair Diskus (Fluticasone)
Asthma med: Leukotriene Modifiers
Singulair (Montelukast)
Asthma rescue meds: beta 2 agonist
ProAir (Albuterol)
Asthma rescue meds: corticosteroid
Medrol = solu-, Depo- (Methylprednisolone), Prelone (Prednisone)
Cystic fibrosis
-Inherited chronic disease that affects the lungs (defect gene on chromosome 7)
Cystic fibrosis morbidity
30,000 children and adults in the U.S. (70,000 worldwide)
Cystic fibrosis gene
A defective gene and its protein product cause the body to produce unusually thick, sticky mucous
Cystic fibrosis presentation (One of three...)
-Newborn meconium ileus (usually first sign in babies)
-Malabsorption or failure to thrive (FTT)
-Recurrent respiratory infections
CF diagnosis
-Family history
-Usually in infancy or early childhood
-Newborn screen (immunoreactive trypsinogen) with DNA confirmation
-Sweat chloride test (WNL = <40, >60 = indicative of CF)
Test that is only ever used for CF
Sweat chloride test
Males with CF
Often infertile (thick secretions --> consistency of semen changed)
CF respiratory symptoms
-Thick, sticky mucous causes recurrent respiratory infections
-Chronic, moist, productive cough
-Chronic sinus infections
-Signs of chronic hypoxia (clubbing, barrel chest)
CF GI symptoms
-Meconium ileus (small bowel obstruction in newborn's first 48 hours of life)
-Stools: frothy, bulky, large, foul smelling, contain fat, greasy, float
-Constipation is common, intestinal obstruction and rectal prolapse possible
-Malabsorption and FTT (don't grow --> delayed puberty)
CF musculoskeletal symptoms
Short stature, delayed bone age
Misc. CF symptoms
Chronic pain, headaches, delayed onset of puberty, infertility
Ways to maintain resp. function in CF
Chest physiotherapy, bronchodilators, corticosteroids, montelukast
Manage infection in CF
Immunizations, abx (PO, IV, inhalation)
Promotion of optimal nutrition and exercise in CF
Pancreative enzyme supplements, multi-vitamins, iron supplements
Prevent GI blockage in CF
Lactulose
Wack them on the back
When child is choking, do NOT do this
If you are going to wack them, do this
Flip them upside down
Never do this to a chest tube
Clamp