Exam 2: Respiratory Flashcards

Question

Vaccines for Otitis Media

Answer 1

Hib and Prevnar Hib: for influenza Prevnar: for pneumococcal infection

Answer 2

1. Fluid persists in the middle ear for weeks-months but it's not infected 2. the ear looks fine but you may see fluid/bubbles; can see bony prominences and other landmarks 3. Mild to moderate hearing loss 4. No complaints of severe pain, but complains of fullness or ear popping sensation during swallowing

Answer 3

Myringotomy (ventilating tube put in during surgery) if fluid persists for more than 3 months and is associated with hearing loss BENADRYL AND OTHER ANTIHISTMAINES IS NOT AN ADEQUATE TREATMENT FOR KIDS!

Answer 4

1. Three or more episodes of OM in a 6 month period OR 4 episodes during a 1 year period 2. Bilateral OME that has been unresponsive to non-surgical therapy for three months or more 3. An associated hearing loss

Answer 5

Ventilation tube to treat chronic otitis media; tube allows for drainage of fluid to go into the nasal pharynx * Stays in for ~6 months (could be up to a year) then falls out on its own * Wax may help bring it out, and if it doesn't come out it will need to be removed

Answer 6

1. Don't go swimming/avoid water in the ear | 2. Get wax earplugs for when the child showers or gets wet

Answer 7

Characterized by hoarseness, cough, varying degrees of inspiratory stridor and respiratory distress resulting from swelling or obstruction in region of larynx * Will sound like a seal * There is sub-glottic edema which makes it very difficult to breath

Answer 8

1. Acute epiglotitis [MEDICAL EMERGENCY] 2. Acute laryngotracheobronchitis (LTB) 3. Acute spasmodic laryngitis 4. Acute tracheitis

Answer 9

1. Parainfluenza 2. RSV 3. Influenza A and B 4. Mycoplasma pneumonia

Answer 10

Viral infection and the most common type of croup Occurs mainly with ages 3 months-8 years *Assocaited with seal-like cough

Answer 11

1. Hoarseness 2. “Barking” cough 3. Inspiratory stridor 4. Respiratory distress 5. Higher incidence in boys 6. Age – 6 months to 3 years with peak at 2 7. Occurs mainly during late autumn through early winter

Answer 12

1. Gradual onset 2. Begins with URI 3. Runny nose 4. "Seal-like” cough 5. May have inspiratory stridor and suprasternal retractions - ---> Upper respiratory: suprasternal retractions - --->Stridor may tell you whether or not they need to come into hospital 6. Increased RR - --> As they get more tired from increased RR, RR may drop 7. Distressed and frightened 8. May develop symptoms of hypoxia - --->Not getting enough oxygen because they are trying to breath past a narrow airway

Answer 13

- -If child has increased RR with croup, after a period of time of trying to breath very hard past the obstruction they will become very exhausted - -May initially see an increase in RR, but as they get more tired you will start to see RR drop - -They can then experience respiratory suppression - -Ability to blow off CO2 will go down and they can become ACIDOTIC - -Need to keep an eye on children with this to ensure that it doesn’t progress to this level * *Always monitor RR very closely! * *Number 1 cause of cardiac arrest in children= respiratory arrest

Answer 14

Mild LTB= No Stridor at rest * Managed at home 1. Elevate the head of the bed - -If they are really young, take crib mattress and put pillows under crib mattress - -Roll a towel stick it under their butt to prevent them from sliding down 2. Keep comfortable 3. Antipyretics 4. High humidity with cool mist - -Cold humidifies air calms down inflammation - -If no cold air humidifier, then they can be wrapped up nice and warm then stand outside in cold moist air (if it’s in winter) or they can be near freezer 5. Encourage fluids 6. Rx Medications not given 7. Call if there are any SandS of respiratory distress!!

Answer 15

Severe LTB= Stridor at rest *Managed in the hospital 1. Cool mist 2. IV fluid --No oral fluids because there is a difficult time coordinating breathing and swallowing and will be at risk for aspirations 3. NPO 4. Monitor respiratory status 5. Give O2 when necessary **Never plain nasal canulas or mask **All O2 should be humidified; helps with dilation 6. Include parents to reduce stress 7. Medications: A. Corticosteroids, IV of Solumedrol -May get IM in ER B. Racemic epinephrine via nebulizer -Decreases the sub-glotic edema

Answer 16

1. Corticosteroids IV (Solumedrol) | 2. Racemic Epinephrine via nebulizer to decrease the sub-glottic edema

Answer 17

1. Caused by bacterial infection, most frequently by haemophilus influenza (can also be by staph or strep) 2. Occurs more commonly in adults because they do not get the haemophilus vaccine 3. Can progress very quickly 4. If you suspect acute epiglotitis, do not tell parent to take child to ER, you call the ambulance and have them come get the child; NEVER LOOK INTO THE THROAT UNLESS IN ER WITH INTUBATION STUFF READY

Answer 18

1. Abrupt onset of severe sore throat 2. Fever 3. Muffled voice and pain with swallowing * **DO NOT LOOK IN THEIR THROAT UNLESS YOU’RE IN AN ER AND YOU HAVE EVERYTHING YOU NEED TO INTUBATE*** This is because inspecting the throat can cause airway spasm and collapse of the airway 4. Cough usually NOT present 5. Assumes upright position, leaning forward with mouth open, drooling and tongue protruding; If they are laying down it completely obstructs the airway * *Drooling because they don’t want to swallow 6. Irritable, restless and frightened expression They will look very sick!!

Answer 19

Patient develops signs of respiratory obstruction with froglike croaking sound, suprasternal and supraclavicular retractions and cyanosis may develop

Answer 20

1. In primary care setting, proper assessment and swift management to transport to ER. Throat should NEVER be inspected because it can cause airway spasm 2. Lateral neck films in ER to diagnose it *If acute epiglotitis is confirmed: A. Most cases require intubation or tracheotomy B. Within 3-5 days their WBC, fever, inflammation reduces C. Within a week or less they can be extubated or have trach removed 3. Will be in ICU to receive proper respiratory treatments

Answer 21

HIB vaccine

Answer 22

1. Occurs primarily in winter and spring 2. Greatest occurrence between 2 – 6 mths. with the peak between 2 -3 months. * *Responsible for at least 50% of children admitted for bronchiolitis and most important respiratory pathogen in infancy and early childhood 3. Immunity does not occur, but incidence & severity decreases with age 4. By age 3 all children have been infected with RSV at least once. 5. Sited as risk factor for developing Asthma up to 13 years of age 6. Two strains, Strain A and Strain B. Strain A is more severe and more common

Answer 23

1st: RSV invades the bronchiolar epithelial cells and causes both inflammation and edema in the airway. 2nd: The epithelial cells affected by the virus end up dying and then shedding and obstructing the airway passes 3rd: This shedding of necrotic cells causes air trapping, poor gas exchange, hyperinflation, and atelectasis by obstructing the small airway passeges

Answer 24

* These put the patient at higher risk for getting sicker by the virus, not higher risk for getting it 1. Male 2. Prematurity (Due to immature lungs or problems with surfactant) 3. Chronic Lung Disease 4. Bronchopulmonary Dysplasia (BPD) (Can be caused by being intubated or getting O2 for a long period of time) 5. Congenital Heart Disease 6. Cystic Fibrosis 7. Immunodeficiency 8. Tobacco smoke exposure

Answer 25

1. Begins with symptoms of upper respiratory tract infection (URI) then progresses to a lower respiratory tract infection 2. Low grade fever 3. Cough may be present 4. Can progress to lower respiratory tract infection (increase coughing, wheezing, retractions, crackles, dyspnea, tachypnea, decreased breath sounds & prolonged expiratory phase); Has the similar symptoms of asthma 5. Must distinguish between RSV & asthma – use nasal pharyngeal secretions 6. Chest X-Ray: There are mild peribronchial infiltrates and the lungs are hyperinflated because of air trapping because of mucous necrotic debris in the airways * *Much lower on diaphragm

Answer 26

1. Direct contact not air born - -Patient will be on contact isolation in the hospital - -Hand washing, gloving, gowning is very important - -Use disposable stethoscope instead of your own 2. RSV can live on skin or paper for up to 1 hour and cribs for 6 hours

Answer 27

First 2-4 days, but can be infectious for 1-3 weeks after symptoms subside

Answer 28

Most can be managed at home 1. cool air humidity, 2. fluids, 3. antipyretics, 4. elevate HOB, 5. instruct caretaker on symptoms of respiratory distress

Answer 29

Occurs if child is tachypneic, has marked retractions, listless and/or poor PO intake **Listless: a child not acting as they usually do * Management begins as if they have asthma; when they realize it’s RSV not asthma, they put them in contact isolation for RSV 1. Albuterol (bronchodilators) and corticosteroids don’t work with RSV; Will make them tachycardic, irritable, jittery !!!!!! 2. Magement for RSV is for symptom management - IV fluids - Normal saline mist humidifier - DO NOT DO PERCUSSION OR VIBRATION!! - Elevate head of bed - Cool humidified oxygen if necessary - Monitor O2 sat and vital signs (monitor respiratory distress)

Answer 30

Antibiotics only if there is a secondary infection, but generally don’t because it’s a viral infection * Use Riboviran – antiviral agent - -Used if the patient is immunosuppressed (ex: if they are on oncology unit) - -Causes flu symptoms in people administering it - -Causes DNA mutation so pregnant women can’t go near it; It is not used very often, so really is just with immunosuppressed patients *Never give albuterol or corticosteroids

Answer 31

Synagis (pulvizumab) - Monoclonal antibody - Given as IM injection every 4 weeks - Specific guidelines for who is a candidate for it because it is a very expensive drug - Prevent RSV in high risk infants - No need to delay varicella or MMR - 55% reduction in hospitalizations - May still get RSV - Usually only covered during the first year of life and for one season (November-March) - If child has congenital heart defect or is higher risk then they could get more prevention treatment

Answer 32

1. Most common chronic disease in children 2. 80-90% of children get first symptom before 4-5 years old 3. Number of children with asthma has increased over past 10 years due to environmental pollution/air quality 4. Lower respiratory tract disease 5. Reversible!

Answer 33

A Chronic inflammatory disease that causes narrowing of bronchioles due to 1. Mucus in airway 2. Swelling of airway lining 3. Spasm of muscle in wall of airway 4. Inflammation that causes increase bronchiole hyper-responsiveness to various stimuli * *Stimuli are the triggers such as cold air, cockroach dropping, etc. 5. Allergic component * *Not every child has an allergic component but if they do they will receive additional medications * *Know if they have an allergic component because you will see elevated immunoglobulin E (IgE)

Answer 34

Based on clinical symptoms, lung function and frequency and severity of exacerbations 1. Intermittent Asthma - -Ex: may just be using albuterol before exercise 2. Mild Persistent Asthma 3. Moderate Persistent Asthma 4. Severe Persistent Asthma - --Much more aggressive treatment *Helps with management of asthma by knowing what the child’s needs are based on their classification

Answer 35

1. Outdoor – trees, weeds molds, pollens 2. Indoor – dust, mold, cockroach 3. Irritants (Cleaning products, perfume, cockroach droppings, etc.) 4. Exercise 5. Colds & infections 6. Animals (their dandruff) 7. Medications (Should never be on an aspirin based medication or a beta blocker!!) 8. Emotions 9. Foods 10. Cold air 11. Tobacco smoke (or any smoke)

Answer 36

1. No rugs in the house 2. Wet mopping hard wood floors 3. Hypoallergenic materials 4. May use special vacuum cleaner with filter 5. Covering mattresses 6. Minimize number of stuffed animals * *Wash the ones that you do clean and put them in the freezer to kill the dust mites *Avoiding triggers can be as effective as medications

Answer 37

1. Coughing at night with no infection 2. Irritable, 3. headache, 4. tires easily, 5. increase restlessness, 6. chest tightness, 7. barking paroxysmal nonproductive cough which worsens at night, 8. pale with dark circles around eyes 9. Increased respiratory rate with S&S of respiratory distress 10. May use muscles of neck & abdomen 11. Chronic asthma may develop barrel chest

Answer 38

1. Rhonchi may be present 2. Wheezing may be heard only on expiration in mild cases 3. Both inspiratory and expiratory as obstruction becomes more severe. 4. More severe: breath sounds may not be audible

Answer 39

1. Disease of delineation (ruling out other things) 2. Physical exam, lab tests, X-ray to rule out other diseases 3. PFT’s – presence and degree of lung disease and response to therapy (Pulmonary function test) 4. PEFR - peak expiratory flow rate * Do PFT and PEFR then give patient bronchodilator then repeat the test ---> If they have asthma, you see an improvement in PEFR and PFT after giving the alubertol

Answer 40

1st: Stand up 2nd: Take a deep breath, put PEFR in mouth and blow out as quickly as you can 3rd: Perform 3 times and get personal best (highest number) * Need to be at least 4 years old to understand/use it * Personal best should not be done when sick

Answer 41

Anti-inflammatory drugs 1. PO: Prednisone, for quick relief 2. IV: Solumedrol, for quick relief 3. Inhaled: Flovent, for long term relief - -Need to rinse mouth out after inhaled corticosteroid because it can cause thrush **If rescue inhaler (a B-adrenergic bronchodilator) is used 2x/week or more then they should be started on corticosteroid management medication

Answer 42

Cromolyn & nedocromil sodium - Nonsteroidal anti-inflammatory - Only for long term control - Inhaled - Cromolyn (Intal)

Answer 43

- Bronchiodialator - PO, IV or inhaled 1. Quick relief: Albuterol (Proventil) and Levalbuterol (Xopenex) 2. Long term (not rescue): Salmeterol (Serevent) * *Has a BBW on it though so isn’t normally prescribed **If rescue inhaler (a B-adrenergic bronchodilator) is used 2x/week or more then they should be started on corticosteroid management medication

Answer 44

1. Awake and alert (sleeplessness) 2. Restless/jittery 3. Sweating 4. Increased HR ~If possible, try to avoid PO bronchodilators in order to avoid systemic side effects

Answer 45

- Third line agent - Bronchiolar - IV, PO, IM, or rectal Theophylline * Shouldn’t be used unless nothing else works * The side effects are very significant and there is a narrow therapeutic range (either toxic or subtherapeutic)

Answer 46

- Antiinflammatory For Long term use only PO: Montelukast (Singular) *Also helps with inhaled corticosteroids

Answer 47

1. Serevent Diskus 2. Advair Diskus (Fluticasone/Solmeterol); combo of bronchodilater and corticosteroid 3. Foradil Aerolizer * FDA public health advisory regarding these medications: may in increase the risk of severe asthma episode. * Avoid these with kids!!!!!

Answer 48

Xolair; Allergy associated asthma Only for ages over 12 years *Injection every 2 – 4 weeks during allergy season

Answer 49

1. Avoid triggers 2. Peak flow and chart 3. Recognize symptoms 4. Breathing exercises; deep breathing exercises * *Best sport for asthma: swimming 5. Maintain health 6. Drug compliance 7. Promote normal activities 8. All children should have spacers on their inhaler (meter dose inhaler) - --Much easier to use - --Take deep breath in and count to 10 - --Dissipates the medication - ---Can also use a nebulizer