Module 3 peds URI and rhinosinusitis Flashcards
URI/common cold s/s
initial low grade fever
ST
progresses to
- rhinorrhea
- cough
- congestion: purulent discharge day 3ish
- sneezing
- hoarseness
- sleep disturbance
s/s should dec. at end of 10 days
Most common viral URI cause
rhinovirus
URI contagious
first 3 days: most contagious
can shed for up to 2 weeks
spread of viral URI
- hand contact of infected surface to nose or eyes
- inhalation of airborne particles
- deposition of large particles that land on eyes or nasal mucosa
viral URI physical exam
mild conjunctival injection
red nasal mucosa with secretions
mild erythema of pharynx
anterior cervical lymphadenopathy
URI managements
self limiting
secondary bacterial infections
- otitis media
- pneumonia
- sinusitis
- wheezing
acute rhinosinusitis
inflamed mucosal lining of the nasal passages and paranasal sinuses
ARS 3 presentations
- onset of severe URI s/s
- onset of URI s/s with persistent s/s
- Double sickening: initial improvement followed by onset of severe disease
chronic rhinosinusitis
s/s > 12 weeks
predisposing factors for CRS
- preceding viral, bacterial, or fungal infection
- environmental irritants
- allergies
- anatomic problems
– septal deviation, nasal polyps, trauma, FB - GERD
- cigarette smoking
- CF
- primary ciliary dyskinesia
- immunodeficiencies
adenoids
reservoir for bacterial infections that lead to nose and nasal sinus infections
-> adenoidectomy
Bacterial sinusitis Major criteria
- facial pain or pressure
- facial congestoin or fullness
- nasal congestoin
- nasal discharge, purulence, discolored PND
- hyposmia or anosmia (dec./loss of smell)
- fever
bacterial sinusitis minor criteria
- HA
- fever
- halitosis
- fatigue
- dental pain
- cough
- ear pain, pressure, fullness
Ethmoiditis
can occur after child is 6 mo. old
frontal rhinosinusitis
first seen around 10 years old
treatment ARS 3 clinical presentations
- URI w/ persistent nasal discharge or daytime cough x 10 days
- URI that worsens or new onset fever, nasal discharge, daytime cough after initial improvement
- fever > 102.2 with purulent nasal discharge for > 3 days, + sinusitis
ARS and antibiotic therapy
severe onset or worsening course requires antibiotics
Management of CRS
referral to otolaryngologist
adenoidectomy: <12 years old
decongestant & antihistamine
intranasal corticosteroids
saline irrigation
analgesics
DIVING contraindicated
rhinosinusitis complications
ethmoid sinusitis -> orbital complications
- preseptal cellulitis
- orbital cellulitis
- subperiosteal and orbital abscess
frontal sinusitis -> intracranial complications
- pott’s puffy tumor
- epidural abscess
- subperiosteal abscess
- brain abscess
- venous thrombosis
- meningitis
orbital cellulitis s/s
swelling and erythema of eyelids
proptosis
dec. extraocular movements
altered vision
orbital abscess can lead to
proptosis
ophthalmoplegia
vision loss
cavernous sinus thrombosis
periorbital edema
chemosis
headaches
-> cranial nerve palsies
pott’s puffy tumor or osteomyelitis presents with
frontal bone tenderness
swelling on the forehead
prevention of ARS
allergy and GERD management
flu vaccine
relief of nasal airway obstruction
