CHAPTER 5:3 Flashcards by Kyle Pacariem

What is called the closure of a normal opening

ATRESIA

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it is a condition in which the posterior nares are obstructed by membranous septum or bone either bilaterally or unilaterally

CHOANAL ATRESIA

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Most common congenital malformation of the nose

CHOANAL ATRESIA

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Occurs in 1:7,000 live births, Often associated with other congenital anomalies in 50% of cases (craniofacial syndromes and
skull based defects (encephalocele

CHOANAL ATRESIA

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Types of CHOANAL ATRESIA:

UNILATERAL (usually the right-60% of cases
BILATERAL

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Type of CHOANAL ATRESIA that may go undiagnosed until the child presents with persistent one sided nasal drainage (if the neonate develops respiratory infection) and seem to have more nasal obstruction not proportional to the degree of infection

UNILATERAL (usually the right-60% of cases)

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Type of CHOANAL ATRESIA where Neonates become apneic or cyanotic at birth and require resuscitation in order to prevent asphyxia/severe hypoxia (artificial airway)

BILATERAL

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It is used to look into the nose to make sure the airways are open and to assess healing after surgery

Fiberoptic endoscope

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It is used to evaluate the extent of the choanal atresia once a feeding tube fails to pass through the nasal passage; it detects the composition (membranous or bony) and thickness of the atresia, the depth of the nasopharynx and any associated skull base anomalies

CT scan

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Surgery may be delayed until the child is how many years old if only one nasal passage is blocked-( anatomy is sufficiently developed to facilitate easy access to the posterior choanae, and intraoperative blood transfusion is not normally required for repair at
this age)

2 or 3 years old

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This approach requires less operative time and causes slightly less morbidity related to the incision, but the risk of the nasal passages closing later may be higher

transnasal

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This approach provides better exposure and more accurate bone
removal.

transpalatal

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A term applied to a broad classification of UPPER AIRWAY illness that result from inflammation and narrowing of the larynx (voice box), the trachea (windpipe) and the bronchi (larger branching air tubes)

CROUP

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It is most common in children age 5 and younger (3mos.) — particularly those who were born prematurely. Peak = 2nd year

Croup

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When does Croup usually occurs

in the winter or early spring

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A child can get croup more than once. TRUE OR FALSE

TRUE

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2 important changes in the upper airway in croup

the epiglottis and larynx swells thereby occluding the airway
the trachea swells against the cricoid cartilage causing restriction

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loud, harsh, “brassy” or “barking” cough (similar to a the noise of a seal barking)

CROUPY COUGH

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the result of swelling around the vocal cords (larynx) and windpipe (trachea). When the cough reflex forces air through this narrowed passage, the vocal cords vibrate with a barking noise.

CROUPY COUGH

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the medical term for HOARSENESS

DYSPONIA

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high-pitched or squeaking noise when breathing in created by narrowing of the airway

INSPIRATORY STRIDOR

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occurs due to swelling or obstruction of the larynx

RESPIRATORY DISTRESS

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What are the 4Ds as Manifestation for Acute Epiglotitis

Dysphonia
Dysphagia
Drooling
Distressed respiratory effort

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Specific kind of humidity that provides relief for most children (decreases swelling of laryngeal tissue)

High humidity with cool mist

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What medication causes mucosal vasoconstriction and subsequent decrease in edema

RACEMIC EPINEPHRINE (nebulized)

what medication does rapid action but sometimes symptoms “relapse” within 2 hours (assessment is important)

RACEMIC EPINEPHRINE (nebulized)

What medication that does anti-inflammatory effects to decrease subglottic edema

CORTICOSTEROIDS

WHat medications are for: - _____for bacterial croup - _____for fever

- ANTIBIOTICS - ANTIPYRETICS

Generally extubated until spasm and edema are no longer a problem and the child can manage secretions successfully (Usually within 24-36 hours)

ARTIFICIAL AIRWAY=ET intubation/tracheostomy

device that provides cool humidification with administration of O2 or compressed air

CROUPETTE

Lower respiratory illness that occurs when an infecting agent causes inflammation and obstruction of the bronchioles

BRONCHIOLITIS

What gender is more affected with bronchiolitis

boys

diagnostic test in determining the presence of RSV through enzyme linked immunosorbent assay (ELISA)/immunoflourescent antibody ( IFA)

Nasal or nasopharyngeal culture

diagnostic test that -shows hyperaeration and consolidation (similar to that of pneumonia); shows collapse of alveoli/atelectasis

Chest X-ray

Interferes with MMR and varicella vaccines (live virus vaccines)-deferred for 9 months after Respigam infusion

RSV-IGIV (RESPIGAM)

Volume of drug may not be well tolerated by infants (not given to children with congenital heart defects)

RSV-IGIV (RESPIGAM)

▪ Does not interfere with MMR, and varicella vaccine ▪ Pain and mild transient erythema at the site

PALIVIZUMAB (SYNAGIS)

A chronic multisystem disorder characterized by exocrine gland dysfunction, inherited as an autosomal recessive trait

CYSTIC FIBROSIS

The reason why the mucus produced by the exocrine glands is abnormally thick, causing obstruction of the small passageways of the affected organ

exocrine gland dysfunction

its characteristics include: * both parents are unaffected but carry trait * occurs in 1 of 4 children

autosomal recessive inheritance

* US=30,000 affected; worldwide=70,000 * Occurs in 1:3000 live births in US * Most common among Caucasians (whose ancestors came from northern Europe)

CYSTIC FIBROSIS

* About 1,000 new cases with this case are diagnosed each year. * More than 70% of patients are diagnosed by age two. * More than 40% of the its patient population is age 18 or older. * In 2005, the predicted median age of survival was almost 37 years.

CYSTIC FIBROSIS

3 most common manifestations of CYSTIC FIBROSIS

1. progressive chronic lung disease 2. pancreatic enzyme deficiency-acinar cells primarily affected 3. sweat gland dysfunction-electrolyte composition is greatly affected

these occurs as the airways become increasingly obstructed

emphysema and atelectasis

what causes contraction of the muscle fibers in pulmonary arteries leading to pulmonary hypertension (cor pulmonale)

chronic hypoxemia

what is produced by unabsorbed food fractions excreted in the stool

steatorrhea

4F’s of Cystic Fibrosis

❖ Frothy (bulky and large quantity) ❖ Foul-smelling ❖ Fat-containing (greasy) ❖ Float

What causes large bulky stools and lack of supportive fats

rectal prolapse

Alternative Names for SWEAT CHLORIDE TEST

Sweat Test; Sweat Chloride; Iontophoretic Sweat Test; Pilocarpine Iontophoresis

what is the normal sweat chloride concentration

less than 40 mEq/L

the standard diagnostic test for CF

SWEAT CHLORIDE TEST

This test is used to evaluate fat absorption as an indication of how the liver, gallbladder, pancreas, and intestines work. Normal fat absorption requires bile from the gallbladder (or liver if the gallbladder has been removed), enzymes from the pancreas, and normal intestines.

FECAL FAT TEST/ QUANTITATIVE STOOL FAT DETERMINATION

what is the chloride concentration that results in a (+) test result

greater than 60 mEq/L

a test of 24 hour stool collection (or sometimes 72 hours or days)

FECAL FAT TEST/ QUANTITATIVE STOOL FAT DETERMINATION

These tests are most often done in young children suspected of having cystic fibrosis.

TRYPSIN AND CHYMOTRYPSIN IN STOOL

This test is used as a screening tool for cystic fibrosis but it does not diagnose it. Other testing is needed to confirm a diagnosis of cystic fibrosis.

TRYPSIN AND CHYMOTRYPSIN IN STOOL

These are proteolytic enzymes released from the pancreas during normal digestion.

Trypsin and chymotrypsin

It is a hormone produced by the small intestine when partially digested food has moved into the intestine from the stomach.

Secretin

It normally causes the pancreas to release a fluid with a high concentration of bicarbonate

Secretin

what instrument shows hyperinflation

CHEST X-RAY

This test measures the ability of the pancreas to respond to secretin

SECRETIN STIMULATION TEST/ PANCREATIC FUNCTION TEST

Alternative names for PULMONARY FUNCTION TEST

PFTs; Spirometry; Spirogram; Lung function tests

what test determine the extent of lung involvement- atelectasis and emphysema are present (increased airway resistance)

PULMONARY FUNCTION TEST

insertion of a hollow needle through abdominal wall into the uterus to obtain cells from amniotic fluid around the baby. The fluid is then tested to see if both of the baby's CFTR genes are normal.

amniocentesis

It uses ultrasound to guide a thin tube through the vagina and cervix into the uterus and remove a tiny piece of the placenta to biopsy. The cells of the placenta are then tested to see if the baby has CF.

Chorionic villus biopsy

1) _____-loosens and liquefies pulmonary secretions 2) _____-opens large and small airway 3) _____-decreases viscosity of mucus (rh-Dnase)

- Mucolytics - Bronchodilators - Dornase alfa (Pulmozyme)

high frequency chest wall oscillation to loosen secretions

Devices Thairapy rest device

– a small handheld plastic pipe with a stainless steel on the inside that facilitate removal of mucus.

Flutter Mucus device

What is taken every meals and snacks =assist in digestion of nutrients and decreasing fat and bulk

Pancreatic enzyme supplements (Cotayza-S, Pancrease, Viokase)

CYSTIC FIBROSIS' last resort

Lung transplant

It is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history

Sudden Infant Death Syndrome

In 1998, it was the third leading cause of death in infants

Sudden Infant Death Syndrome

Peak age to Sudden Infant Death Syndrome

most likely to occur at 2-4 months, but 90% occurs by 6 months of age

4 Types of croup

Acute Spasmodic Laryngitis Laryngo-tracheo Bronchitis Bacterial Tracheitis Acute Epiglotitis

# Type of croup: Part affected: Glottic Severity: Least serious

Acute Spasmodic Laryngitis

# Type of croup: Part affected: Subglottic Severity: most common; most serious viral croup; progresses if untreated

Laryngo-tracheo Bronchitis

# Type of croup: Part affected: upper trachea Severity: guarded; close observation required

Bacterial Tracheitis

# Type of croup: Part affected: supraglottic Severity: most life threatening

Acute Epiglotitis

# Type of croup: **Causative Agent: ** Viral with allergic/ psychosomatic component **Onset:** sudden; typically occurs at night; tends to recur

Acute Spasmodic Laryngitis

# Type of croup: **Causative Agent: **Viral: parainfluenza, influenza A & B, RSV, Mycoplasma pneumonia **Onset: **gradual; starts as URI, progresses to symptoms of respiratory distress

Laryngo-tracheo Bronchitis

# Type of croup: **Causative Agent: **Bacterial: usually staphylococcus aureus **Onset: **progressive from URI

Bacterial Tracheitis

# Type of croup: **Causative Agent: **Bacterial: usually HIB **Onset:** rapidly progressive (hours)

Acute Epiglotitis

# Type of croup: **Manifestation: ** Afebrile Mild respiratory distress **Treatment: ** Humidity Severe: Racemic epinephrine Mild: home but must seek medical help if (+)s/s of respiratory distress

Acute Spasmodic Laryngitis

# Type of croup: **Manifestation: ** Low grade fever Non toxic appearance **Treatment: ** Humidity Racemic epinephrine

Laryngo-tracheo Bronchitis

# Type of croup: **Manifestation: ** High fever Thick purulent tracheal secretions URI appears as viral croupy cough but no response to LTB therapy **Treatment: ** antibiotics

Bacterial Tracheitis

# Type of croup: **Manifestation: ** High fever Toxic appearance 4Ds: Dysphonia Dysphagia Drooling Distressed respiratory effort **Treatment: ** Antibiotics Airway protection

Acute Epiglotitis

CHAPTER 5:3 Flashcards

RESPIRATORY DISORDERS