Exam 2 - Respiratory + Asthma Flashcards
Alveoli may be present in lungs at ____ weeks GA, however are not UNIFORMLY present until ______Weeks.
32 weeks
36 weeks.
Lung development completes at ______
8 years
Lung development in ______ mature the alveoli and lead to _____
Toddlers/pre-school
Lower respiratory rate
Which type of wheezing is worse? Inspiratory or expiratory?
Inspiratory - they can’t get air in (upper airway)
Expiratory is issues getting air out (lower airway)
What viruses can cause croup?
Parainfluenza, Enterococus, flu A+B, RSV, rhinovirus, adenovirus and measles (can cause severe)
S/s of croup
URI with low grade fever, Coryza, respiratory distress, worse at night, no wheezing but stridor, nasal flaring, retractions.
Westley Croup Severity Score
LOC, Cyanosis, stridor, air entry, retractions
<= 2 = mild - home treatment, symptomatic care with antipyretics, mist and oral fluid. Single dose of oral Dexamethasone (0.15-0.6mg/kg, max 16mg)
3-7 = moderate - single dose of Dexamethasone, epi neb close monitoring. Hospitalization may not be needed
8-11 = severe - single dose of oral/IM/IV Dexamethasone and repeated doses of Epi nebs. Inpatient admission.
When does the max effect of racemic epi take effect?
In 30 mins and lasts for 2 hours
S/s of epiglottitis
Baby’s cry is not normal (more quiet)
No coughing but gagging
Extend neck, protrude tongue, mouth breathing, muffled voices.
Look SICK
High fever.
“Thumb sign” on lateral neck X-ray
What vaccine helps to prevent epiglottitis?
HIB
Slide 22 from Respiratory disease - differences in H+P in DDx for children with severe respiratory symptoms. REVIEW!!
OTC remedies for cough
Honey (not under 1 year)
Elderberry, agave(“safe syrup”)
Zinc
Probiotic.
Ginger
Arabesque, hyland’s baby, mama’s bliss cough syrup.
Steaming, humidifier.
Vicks
Eucalyptus or peppermint essential oil. Raise HOB.
Adverse effects from unnecessary, inappropriate abx use
Diarrhea, dermatitis, c diff, antibiotic resistance.
NOT recommended abx for AOM, ABRS and pharyngitis
Azithromycin and 3rd gen cephalosporins.
Bronchiolitis results in ______ and ______
Bronchospasm and mucus production
2 best things that help treat Bronchiolitis and what doesn’t work?>
Oxygen and hydration (racemic epi for moderate-severe)
Albuterol, budesonide.
Degree of illness in bronchiolitis:
Mild - RR <60in <2mo, <50 in 2-12mo and <40 in >12mo.
Good air exchange, minimal or no retractions and no signs of dehydration.
Rest on slide 31
RSVpreF (Abrysvo) - who gets this and when to administer?
Pregnant women in their 3rd trimester (32-36weeks of pregnancy). At least 14 days prior to delivery to be effective.
Nirsevimab (bayfortus) vaccine - who gets it and when is it administered?
Administered for newborns and infants born during RSV season in first week of life whose mother did not get Abrysvo at least 14 days prior to delivery.
Infants who are not born during RSV season may get vaccine <8mo old. 50mg for <5kg and 100mg (HARD TO GET!) for >=5kg.
8-19mo get 200mg dose.
Offer before discharge or at 2 day and 2 week visit in case they change their mind
Slide 37 respiratory PPT - microbes that cause pneumonia based on age.
Listen to some videos of lung sounds: crackles, rales, Rhonchi, wheezing.
What are the main distinguishing factors between bacterial/viral pneumonia and aspiration/FB?
Abrupt onset
Absence of fever.
Sudden onset of coughing/choking.
What is Laryngomalacia and how might it present? Prognosis?
Curled or banded supraglottic larynx and epiglottis that interferes with breathing
Stridor, horse cry, cough on and off worse with eating and lying down (infants who start solid foods)
Most resolve with time but 15% need surgical correction.
Review slide 56 for pediatric respiratory emergency slide show pictures.
What sport might be a good option for kids with asthma?
Swimming - it’s humidified air.
What 3 contributing factors make up asthma?
Airway inflammation, hyperresponsiveness and bronchoconstriction.
What are some triggers/irritants that can precipitate or aggravate asthma symptoms
Viral URI (rhinovirus)
dust, pollen, poop, food, dander, meds
Exercise
Rhinitis
Cigarette, VAPE!! and other smoke
Environmental exposures, pollution, fumes
Cold air, weather change
Emotions.
When is wheezing asthma?
Recurrent wheezing
Other conditions excluded
Known triggers
Responds to asthma therapy.
0-5yrs - FTT, wheezing over 10 days
Daily use of inhaled corticosteroids (ICS) can _______ risk of growth suppression.
Lower.
It may suppress growth in first year of use but kids always catch up.
Slide 13 - asthma predictive index.
What are some RED FLAGS of asthma?
Asymmetric breath sounds
Clubbing of nails
Polyps of nares
Poor growth
See any of these? ^ refer!!!
Modifiable risk factors for asthma to address with treatment
Obesity/overweight, second hand smoke exposure
Slide 20 in asthma - how to classify asthma severity
What does a short course of “burst’ of steroids look like?
Prednisone 1-2mg/kg/day max 40-60mg/day given for 3-10 days.
Review step approach for asthma slide 23
What 5 questions do you ask to assess asthma severity?
Daytime symptoms frequency (<=2 days/week, >2 days/week but not daily, daily, throughout the day)
Nighttime awakenings (<=2nights/month, 3-4 nights/month, >1 night/ week, every night)
SABA rescue (not counting pre-exercise) (<=2 days/week, >2 days/week but not daily, daily, several times/day)
Activity limitations (none, minor, some, extreme)
Exacerbations require inf systemic corticosteroids/hospitalizations (0-1/year, >= 2 in 12 months)
Slide 25 review for asthma.
T/F: peak flow can be a quick alternative to spirometry.
FALSE. Peak flow is a good marker and gives information but does NOT replace spirometry.
When can you start doing peak flow?
Usually at age 5 when child can cooperate, however graph calculations doesnt start until age 8, and literature doesn’t support until age 12
What is the “normal” spirometry FEV1/FVC ratio for kids? Same as adults? TEST Q how much must it increase from baseline post bronchodilator?
> 0.85
Adults are 0.70-0.80)
12% increase.
80% = mild
60-80% = moderate
<60% = severe
What 3 situations would you get a PFT?
Initial assessment
Asthma is “not controlled”
Every 1-2 years.
Controllers:
Rescues:
ICS, LABA, ICA+LABA, LTRA’s(BBW!), Theophylline, Cromolyn (MCS), Omalizumab (refer at this point)
SABA, systemic corticosteroids
What other things can you use as spacers?
Water bottle, toilet paper roll
What is proper inhaler use technique?
Remove cap and attach to spacer. Shake canister and spacer. Cleansing breath (big inhale and FULLY exhale), actuate MDI into chamber, slowly deeply inhale, hold breath for 10 seconds or for 6 breaths. Repeat as prescribed.
What should you do after taking ICS?
Rinse mouth/teeth/gargle.
One year of ICS can be equal to just under 3 days of OCS.
T/F: Asthma can be an EFMP condition
True.
Stages of pertussis
Stage 1 = Catarrhal stage - most contagious can last for 2 weeks and act like a common cold
Stage 2 = paroxysmal stage - staccato cough and resolution of fever. Can last days to weeks. Post tussive emesis, syncope or apnea in infants
Stage 3 = convalescent phase - residual cough for weeks or months.
T/F: whooping cough may not have a whoop in kids under 6mo
True.
Abx most effective in the _____ stage of pertussis
Stage 1 caterhalis.
1st line tx for pertussis
Erythromycin but Azithromycin is more palatable.
Isolate pertussis patients through stage 1 and 3 weeks of paroxysmal stage (5 days after abx)
