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Peds Exam 2 > Croup syndromes > Flashcards

Croup syndromes Flashcards

1
Q

what is croup

A 
barking cough
swelling or obstruction in region of larynx
hoarseness
inspiratory stridor
varying degrees of respiratory distress
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2
Q

acute laryngotracheobronchitis (LTB)

A

viral croup

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3
Q

what is viral croup

A

inflammation of the mucosal lining of larynx, trachea, and bronchi causing narrowing of the airway
effects children 5yrs and younger
may develop with flu or bronchitis

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4
Q

how many stages of croup are there?

A

4

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5
Q

at what stage do you need to catch croup to keep from respiratory distress?

A

1-2

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6
Q

stage 1 clinical manifestations of croup

A 
fever
fear
hoarseness
brassy cough
inspiratory stridor when disturbed
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7
Q

stage 2 clinical manifestations of croup

A 
continuous stridor
lower lip retraction
retraction of soft tissue of neck
use of accessory muscle of respiration
labored breathing
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8
Q

stage 3 clinical manifestations of croup

A 
signs of anoxia and CO2 retention
restlessness
anxiety
pallor
sweating
rapid respirations
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9
Q

stage 4 clinical manifestations of croup

A

cyanosis

cessation of breathing

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10
Q

what is the priority goal of therapeutic management of croup?

A

airway, breathing

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11
Q

therapeutic management of croup

A

high humidity with COOL mist
humidified oxygen
adequate fluid intake
AVOID cough syrups and cold meds

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12
Q

what medication must you watch for rebound when administering for croup?

A

racemic epinephrine

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13
Q

what meds are not helpful for croup?

A

bronchodilators (albuterol/Proventil) and antibiotics

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14
Q

nursing considerations for croup

A

conserve energy
continuous and accurate respiratory status
measures to decrease anxiety, PARENTS AT BEDSIDE
assess for and prevent dehydration

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15
Q

at what respiratory rate do we keep infants NPO?

A

<60

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16
Q

signs of increasing severity of croup

A

increased RR
increased agitation, restlessness, anxiety
decreased LOC
cyanosis

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17
Q

what is bacterial croup?

A

epiglottitis

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18
Q

what is epiglottitis

A

serious, life threatening obstructive inflammatory process

occurs usually between 2-5 yrs

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19
Q

clinical presentation of epiglottitis

A 
abrupt onset, starts with sore throat
high fever
mouth open with tongue protruding and drooling
agitation
tri-pod position 
looks very sick
muffled voice, inspiratory stridor, no spontaneous cough
PREPARE FOR SEDATION AND INTUBATION
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20
Q

Emma Grace, 18m is your next door neighbor. Emma’s mother phones you at 1-pm to ask for advice. Emma has been fussy all day. She has a fever of 100.6 and is making a funny crowing noise when she breaths. You go next door and find a fussy toddler with mild inspiratory stridor. What action should you take at this time?

A

Advise her mother to turn the shower on hot, close the door and set in the bathroom for 15 min.

21
Q

Your next door neighbor phones you to ask advice about her 4 year old son. He has a sore throat, pain on swallowing, and a fever of 103.4. You go next door and find an acutely ill child setting upright and drooling. What action should you take?

A

call an ambulance to have the child transported to the nearest ED

22
Q

bacterial tracheitis

A

NO tongue blades, DO NOT look in the throat
avoid x-ray and transport
let parents be with child
prepare for sedation and intubation

23
Q

bronchiolitis (RSV)

A

acute viral infection resulting in inflammation of the smaller bronchioles, characterized by thick mucus

24
Q

what age does RSV usually affect?

A

less than 2 years, peaks at 2-5 months

25
Q

causes of RSV

A

adenovirus

parainfluenza virus

26
Q

pathophysiology of RSV

A

epithelial cells swell, protrude into lumen, lose cilia bronchiolar mucosa swell, Lumina fill with mucus and exudate.
Walls of bronchi and bronchioles are infiltrated with inflammatory cells
peribronchiolar interstitial pneumonitis develops
dead luminal epithelial cells are shed into bronchioles
small airway obstruction leads to hyperinflation
obstructive emphysema

27
Q

Transmission of RSV

A

Direct Contact

28
Q

how long can RSV live on countertops?

A

hours, can also live hours on gloves, paper and cloth

29
Q

how long RSV live on skin?

A

1/2 hour

30
Q

how long is the incubation period for RSV

A

5-8 days

31
Q

s/s of RSV bronchiolitis

A 
Apnea may be the first sign in infancy
rhinorrhea
pharyngitis
wheezing, crackles, decreased breath sounds
difficulty feeding
irritability
32
Q

s/s of RSV if left untreated may progress to

A

tachypnea
air hunger
retractions
cyanosis

33
Q

diagnostic testing for RSV

A

polymerase chain reaction (QT-PCR) (most sensitive)
SNOG ( identifies RSV virus, done on mucous)
ELISA
DFA

34
Q

what is the primary management goal of RSV

A

airway maintenance

35
Q

name of vaccine for at risk infants and children under 2 for RSV

A

palivizumab (synagis)

Given IM monthly November-April

36
Q

what do you do for a child that is congested before giving oxygen?

A

suction

Standard of care for infants saline drops and bulb suctioning

37
Q

what type of isolation do you use for RSV?

A

contact and droplet

38
Q

supportive care for RSV

A 
saline drops and bulb suctioning
increased humidity
humidified oxygen
antipyretics
monitor pulse ox
monitor hydration
39
Q

complications of bacterial pneuonia

A

empyema
pyopneumothoroax
tension pneumothoroax
pleural effusion

40
Q

what are type of illnesses that make a child high risk and eligible for the RSV vaccination?

A

<32 week gestation
chronic lung disease
congenital lung disease
severe immune deficiencies

41
Q

whooping cough

A

Bordetella pertussis

42
Q

what ages are effected by whooping cough

A

unimmunized children <4 years and >10 years
Infants <6 months present with apnea
>6 months have paroxysmal cough

43
Q

what med do we use to treat pertussis?

A

erythromycin

44
Q

infants less than 6 months of age may require what type of support if they have pertussis?

A

ventilator

45
Q

childhood TB

A

caused usually by family member or close visitor

46
Q

increased risk for TB

A

heredity
gender (girls higher morbidity/mortality)
age
stressed states (illness, injury, steroids)
nutritional deficit
concurrent infection (HIV, MMR)

47
Q

what does a positive Mantoux test show

A

indicates that the person has been exposed to the disease or has developed antibodies
once a person tests positive they always will

48
Q

care of a child with tb

A

isolation
medication adherence
adequate nutrition is as necessary as adherence to medcations

Peds Exam 2 (13 decks)

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