PedsLungsBloodCancerSkin Flashcards
What’s involved in a respiratory assessment in peds?
Additional considerations for children?
Rate, rhythm, and ease: the work of breathing.
Infection: symptoms, age, size, seasons, decreased resistance
Infants are obligate nose breathers, small airways, large tongues.
Older children have large tonsils and adenoids.
Common peds respiratory testing?
Pulmonary function tests (PFTs), bronchoscopy, nasopharyngeal wash, apnea-bradycardia monitors, pulse ox
7-10 days duration, clear to yellow thin nasal secretions. Hoarseness with sore throat, dry cough.
Nasopharyngitis, the common cold. Fatigue, decreased appetite, +/- fever. Can be complicated by secondary bacterial infections. Symptomatic relief. Care with combination cold remedies.
What should the family be taught for URIs?
Recognize worsening symptoms. Prolonged or new fever, increased throat pain or lymphadenitis, worsening cough or one lasting longer than 10 days, chest pain, dyspnea, earache, headache, sinus pain, irritability.
When is it sinusitis instead of a cold?
Cold symptoms not improving after 7-10 days. New onset fever and/or cough. Halitosis, eyelid edema, facial pain may be present but is a poor indicator.
Inflammation of the pharynx or tonsils (tonsillitis. Abrupt onset, often dysphagia, fever, HA, abdominal pain. Inspect for what?
Pharyngitis, sore throat.
Exudate, petechiae on the palate, strawberry tongue, lymphadenitis, scarlatiniform rash.
Viral vs bacterial pharyngitis? Diagnosis?
Viral occurs with cold s/s. It’s self-limited, only symptomatic care.
Bacterial occurs without nasal symptoms, just the throat itself: Group A strep (strep throat). Needs treatment with penicillin for 10 days.
Diagnosis is made only by throat culture, not inspection.
Viral in nature. Inflammation, edema, mucus obstruct the airway. Hoarseness, barky cough. Occurs suddenly, at night.
Laryngotracheobronchitis. Young child (3 months to 3 years). Treated with humidified air in shower or cold air.
Symptoms for acute otitis media? Past medical history?
Fever, tugging at ears, night awakening, otalgia, fluid draining from the ear, fussiness, poor feeding, crying lying down.
PMH includes young age, dat care attendance, previous AOM or OME, recent URIs
Risk factors for acute otitis media?
Crowded living, daycare attendance, 1st episode of AOM before the age of 3 months, exposure to passive smoking, not having been breastfed, craniofacial abnormalities, possibly allergies
Complications of AOM? Either AOM or OME complications?
AOM: acute mastoiditis, intracranial infections, tympanosclerosis, tympanic membrane perforation.
Either: hearing loss, expressive speech delay
Inflammation of the bronchioles cause by viruses, such as the respiratory syncytial virus (RSV). Clear runny nose gets progressively worse in 1-3 days. Asthma like: coughing, fever, wheezing.
Acute lower tract infection: bronchiolitis.
Low pulse ox due to edema of the bronchioles. Tachypnea.
Diagnosed with a nasopharyngeal wash, chest XR that shows atelectasis, collapsed alveoli.
Treatment of bronchiolitis?
Symptomatic based, doesn’t need antibiotics. Suctioning, antipyretics, asthmatic medications (bronchodilators). Home care: fluid, suctioning. Hospitalization.
Prevention of bronchiolitis?
Strict hand washing in day care and homes, droplet and contact precautions.
Certain populations: palivizumab vaccine (Synagis),
Risks for bronchiolitis?
Crowded living, children under 2, older siblings in school, heart and respiratory disease, not being breastfed, reasons of RSV, premature.
Viral vs bacterial pneumonia?
Viral they may look okay, be active.
Bacterial they look sick. Abrupt onset often after a URI. When they appear ill: feel, tachypnea, cough, chest pain, malaise. Often present with fever and ab pain.
Risk factors for foreign post aspiration? S/s?
Small airways and kids, Ages 6 months to 4 years old, especially ages 1-3. Boys. Being mobile and exploration, developmental delay, uneducated parents.
S/s can be sudden, cough at first with cyanosis later. Wheezing, stridor (could go into lungs and then have no symptoms, leads to aspiration pneumonia and swelling). Fever.
Associated with atopic dermatitis, asthma, recurrent sinusitis, AOM.
Allergic rhinitis (runny nose caused by allergies). Perennial is year round and indoor environments. Pets, dust mites, cockroach antigens, molds. Seasonal is different seasons and outdoor elements, pollens, trees, weeds, fungi, molds.
Chronic, reversible inflammatory airway disorder. Airway is hyper-reactive to triggers, causing obstruction and bronchoconstriction. Mild intermittent and mild persistent?
Asthma.
Mild intermittent: Symptoms < twice/week. Nocturnal < twice/month. Pulmonary function > 80% normal
Mild persistent. Symptoms > twice/week, not daily. Nocturnal > twice/month. Pulmonary function > 80% normal
Moderate persistent and severe persistent asthma?
Moderate persistent: Symptoms daily. Nocturnal > 1/week. Pulmonary function 60-80% normal
Severe persistent: Symptoms continuous, frequently at night, activity limitations. Pulmonary function < 60% normal
How does one use a peak flow meter?
Set the arrow on the meter to zero. Stand up straight. Deep breath with lips tightly around the meter. Blow out hard and fast. Repeat 3 times and record the highest.
Green is >80% of expected peak flow, yellow is 50-80, red is <50% of expected.
What does the peak flow reading mean?
Objective measurement of lung function. Child can learn to perform the test to help determine status of asthma. Can provide early identification of subtle symptoms. Early treatment can help to decrease risk of permanent lung changes (remodeling).
Rescue medications for asthma?
Prevention meds?
Rescue to treat acute symptoms and exacerbations. Short-acting beta 2 agonists such as Albuterol and Xopenex.
Prevention are long-term controller meds. Achieve and maintain control of the inflammation. Inhaled corticosteroids. Oral leukotriene modifiers.
Asthma med that dilates the smooth muscle, decreasing spasms. Side effects?
Short-acting beta 2 agonists for rescue in acute exacerbations. Side effects include increased heart rate, trouble sleeping, increased RR. All of these result in decreased adherence. Albuterol and levbuterol (has less cardiac effects than albuterol)
Decrease inflammation to treat reversible airflow obstruction. Control symptoms and reduce bronchial hyper- responsiveness. Lowest dose to avoid side effects.
Corticosteroids in acute exacerbations.
Prednisolone given orally. Solumedrol given IV for hospitalized patients.
Autosomal recessive disorder. Deletion of chromosome 7 is responsible gene mutation, causes dysfunction of the exocrine glands. Chloride transport across cells is interrupted so water transport abnormalities occur. Difficult for the body to clear secretions.
Cystic fibrosis. Recommended testing for women presenting for preconception or prenatal care, DNA testing done prenatally or on newborns.
Results in drier, thicker secretions in sweat glands, GI test, pancreas, repository, other exocrine tissues. High levels of chloride in sweat cause salty taste.
Further explain cystic fibrosis?
Pancreatic enzyme inactivity causes malabsorption, poor growth, fatty stools. Thick mucus plugs the small airways. Secondary bacterial infections with usual bugs. Leads to obstruction and inflammation leading to chronic infection, tissue damage, respiratory failure. S. aureus, p. auriginosa.
