ch 40: respiratory dysfunction of UR tract Flashcards
EXAM 2 content -- all the most important things to know (imo)
what is considered part of the upper & lower respiratory track?
- UPPER = oronasopharynx, pharynx, larynx, & upper trachea
- LOWER = lower trachea, bronchi, bronchioles & alveoli
what influences the risk of getting respiratory infections?
- infectious agents
- age, size
- resistance & seasonal variations
how does each age range play a role is getting respiratory infections? what increases with age?
- < 3 mo: maternal antibodies
- 3-6 mo: infection rate increases
- toddler + preschool: high rate of viral infections
- > 5 yo incr of mycoplasma pneumoniae & beta hemolytic strep infections
immunity increases with age!!
how does size play a role of getting respiratory infections?
small size = smaller structures = infections spread faster
- diameter small
- distance between structures are shorter –> move fast
- Eustachian tubes (to the ear) are short & open
what influences resistance to infection?
- immune system
- malnutrition & asthma
- preterm
- cardiac anomalies
- cystic fibrosis
- DAY CARE
- 2nd hand smoke
what seasons increase risk of respiratory infection?
mostly winter & spring
- mycoplasmal infections – fall & winter
- infection related asthma – cold weather
- RSV – winter & spring
what are the general s/s for respiratory infections?
- fever & meningismus –> neurological symptoms
- GI symptoms are big indicators – anorexia, vomit, diarrhea, abdominal pain
- cough, sore throat, nasal block or discharge
- respiratory sounds
what causes meningeal inflammation?
movement of spinal cord or nerves against meninges
how do we assess for respiratory infection?
- resp effect: rate, rhythm, depth, using accessory muscles, retraction, & nasal flaring
- oxygenation: pulse oximetry & skin color
- temperature
- activity level: lethargic –> show concern
- level of comfort
how do we care for the child w respiratory infection/dysfunction
- ease resp rate
- promote rest & comfort
- prevent spread of infection
- reduce temp
- hydration & nutrition
- support & reassurance
nasopharyngitis, UR tract infection – what do we need to know?
nasopharyngitis = common cold
- cause: different viruses
- fever (varies w age)
- can be managed at home
- no specific treatment
acute strep pharyngitis, UR tract infection – what do we need to know?
- cause: group A – beta hemolytic strep infection
- risk for: rheumatic fever
- inflamed tonsils
- nursing care: medication & hydration
what are the s/s of strep pharyngitis?
- sudden onset
- fever of 103-104
- sore throat
- erythema
- exudate
- tonsilitis
- abd pain
- HA
- pos. RST & high WBC
what are the s/s of viral pharyngitis?
- gradual onset
- low grade fever
- slight sore throat
- less erythema
- hoarseness
- cough & rhinitis (MOST COMMON SIGN)
- neg. RST, slight elevation of WBC
tonsillitis, UR tract infection – what do we need to know?
- occurs usually with pharyngitis
- frequent infection
- treatment: tonsillectomy & adenoidectomy
nursing care: education
- avoid dairy & red colored food
- avoid berries –> incr mucous
- avoid coughing
- ice cream day 2 post op
- GIVE cold drinks
if a kid has a tonsillectomy & post op he is constantly swallowing, what does that mean
early sign of bleeding
- day 2-14 = bleeding risks
influenza, UR tract infection – what do we need to know?
influenza = flu
- cause by: orthomyxovirus type A B & C
- manifestations: fever, chills, headache, sore throat, dry cough, rhinitis
- prevent: flu shot at 6 mo old
nursing care:
- hand hygiene + flu shot
- sneeze in elbow
- hydration
- meds at right age
- support
- educate
otitis media – UR tract infection, what do we need to know?
- diagnostic eval: tugging ear + doesnt want to drink bc of incr pressure
- medications & surgery
- nursing care: watchful waiting
- prevent reoccurance
what are the general s/s of otitis media?
- crying & irritable
- pulling ears
- decr PO
- acute hearing loss
- fever
what are the physical s/s of otitis media?
AOM: acute otitis media
- bright red bulging TM with thick fluid, worm looking
- fever 101 , tugging ear, not drink
OME: otitis media w effusion
- dull gray TM with clear fluid or fluid level
how do we treat otitis media?
- AOM: antibx for 10-14 dyas
- analgesics –> incr PO, decr pain
- decongestants –> taper off, no strong evidence
- if frequent ear infections > 3 episodes in < 6 mo –> consider adenoidectomy
- comfort
infectious mononucleosis – UR tract infection, what do we need to know?
- cause: herpes like epstein barr virus
- manifestations: low grade s/s, fatigue, puffy eyes, nose bleeds, fever, sore throat
- nursing care: no contact sports for 4-6 weeks – prevents obstruction
what are croup syndromes? what is it characterized by? what are the types of croup syndromes?
- BARKING COUGH, hoarse, inspiratory stridor & carrying degrees of respiratory distress (bc of constricting of airways)
- < 5 yo (3mo - 3yo)
- cause: H influenzae type B
effects the larynx, trachea & bronchi –> types of croup syndromes: epiglottitis, laryngitis, laryngotracheobronchitis (LBT), tracheitis
what are the manifestations of LBT, UR tract infection, type of croup?
- preceded by UR tract infection
- INSPIRATORY STRIDOR
- BARKING SEAL LIKE COUGH
- suprasternal retractions
- incr respiratory distress & hypoxia
- progress to respiratory acidosis & respiratory failure
how do we manage LTB croup syndrome?
- maintain airway
- hydration
- nebulizer: epinephrine & steroids
- hot shower with the mist
acute spasmodic laryngitis, UR tract infection, type of croup infection – what do we need to know?
aka SPASMODIC CROUP
- paroxysmal attacks of laryngeal obstruction
- happens at night
- inflammation is mild or absent
- 1-3 yo
- management: similar to LTB croup – taking a hot shower is the best benefit
what are the manifestations of bacterial tracheitis, UR tract infection, type of croup infection? what is the biggest difference between this one and the other croup infections?
- infection of mucosa of upper trachea
- features of croup & epiglottitis
- manifestations similar to LTB
- can be a complication OF LTB
biggest difference:
- thick, purulent secretions –> respiratory distress
how do we manage bacterial tracheitis?
vigorous management
- humidified o2
- antipyretics
- antibx
- maybe intubate
- mechanical vent – due to inflammation & secretions –> hard to get air in
acute epiglottitis, UR tract infection – what do we need to know?
A MEDICAL EMERGENCY – dont try to examine, get a provider and airway cart ASAP
- sore throat, pain, tripod
- drooling, cant swallow
- inspiratory stridor, mild hypoxia, distress
- increase pulse
- retractions & restless
- anxiety
management
- prevent progression of obstruction
- intubation or tracheostomy
