Respiratory

Question 1

upper respiratory

Answer 1

nose
pharynx
larynx
upper trachea

Question 2

lower respiratory

Answer 2

bronchi
alveoli
lower trachea

Question 3

croup syndromes

Answer 3

infections of epiglottis or larynx

Question 4

viral infection rate increases at…

Answer 4

3-6 mo of age, as maternal antibodies are no longer present

Question 5

why are toddlers and preschoolers at increased risk for illness?

Answer 5

shorter ear canals
shorter tracheas
larger tonsils

Question 6

upper respiratory infections (URI)

Answer 6

nasopharyngitis
pharyngitis
tonsilitis
influenza
otitis media
infectious mononucleosis

Question 7

lower respiratory infections (LRI)

Answer 7

bronchiolitis and RSV
asthma
cystic fibrosis

Question 8

croup syndromes/middle resp infections

Answer 8

acute epiglottitis
laryngotracheobronchitis (LTB)
acute spasmodic laryngitis
bacterial tracheitis

Question 9

nasopharyngitis

Answer 9

common cold
fever and runny nose!

Question 10

pharyngitis

Answer 10

“strep throat”
caused by GABHS or virus
dx: throat culture/rapid stress test
CM: sore throat, exudate, fever, lymphadenopathy, HA, muscle soreness, lethargy
treat: abx
RN interv: isolation until on abx for 24hrs (droplet/droplet contact), new toothbrush, gargle salt water, drink warm/cold liquids, warm/cold neck compress
complication: AKI or rheumatic fever

Question 11

tonsilittis

Answer 11

inflammation of tonsils
viral or bacterial
CM: enlarged tonsils, “frog in throat”, difficulty swallowing, snoring, mouth breathing
treat: tonsillectomy if more than 3 yrs or severe snoring and apnea
monitor for: bleeding and dehydration.
postop= soft foods for 2 weeks, pain meds, avoid activities that increase pressure

Question 12

influenza

Answer 12

C is milder than A and B
transmission: contact and droplets
vaccine: IM inactivated for 6mo+, nasal live for 2yr+
manage w antipyretics and hydration
antiviral (oseltamivir) within 48hrs of symptoms or exposure

Question 13

otitis media

Answer 13

malfunctioning eustachian tubes
usually viral
dx: otoscope (purulent, red and bulging membrane)
CM: tugging at ear, earache, irritable, fever
risk factors: down syndrome, cleft palate, day care, smoking at home
treat: abx for bacterial, surgically placed tubes for recurrent.
for 6mo+ wait 72hrs before intervening
prevent by no bottle propping

Question 14

infectious mononucleosis

Answer 14

epstein barr virus
transmitted via saliva
common in adolescents
dx: blood test (+ if blood clumps)
CM: fever, fatigue, lymphadenopathy, exudative pharyngitis
manage: hydration, tylenol, ibuprofen, rest
complication: splenomegaly (rupture- medical emergency, severe abd pain)

Question 15

acute epiglottitis

Answer 15

medical emergency
severe obstructive inflammation
CM: absence of spontaneous cough, drooling, agitation, inspiratory stridor, sore throat, tripod positioning, retractions, pain
treat: abx, steroids, oxygen
do NOT exam airway
prevent: Hib vaccine

Question 16

acute laryngotracheobronchitis (LTB)

Answer 16

most common croupe
common in under 5yrs
viral
CM: seal like cough, hoarseness, low grade fever
manage: maintain airway, cool humidified air, steroids

Question 17

acute spasmodic laryngitis

Answer 17

“midnight croup”
recurrent paraoxysmal attack
kids 1-3 at night
viral

Question 18

bacterial trachitis

Answer 18

infection of mucosa of upper trachea
5-7yrs
CM: thick, purulent secretions, respiratory distress
manage: fluids, sleep sitting up, abx

Question 19

bronchiolitis and RSV

Answer 19

common in infants
CM: fever, cough, wheeze, coarse lung sounds, tachypnea, lethargy, poor feeding
dx: nasopharyngeal swab
manage: NP suctioning, O2, hydration

Question 20

most common reason for hospitalization w RSV

Answer 20

dehydration
low O2 sat

Question 21

asthma

Answer 21

chronic inflammatory disorder
dx: pulm function tests
cause: genetics, 2nd hand smoke, being black, premature birth
risk factors for exacerbation: URI, allergies, exercise
CM: wheezing, diminished lung sounds, cough at night, breathlessness, chest tightness, feel better after rescue inhaler

Question 22

severity classification in kids 5yrs+

Answer 22

step 1- intermittent asthma, less than 2x/week
step 2- mild, persistent asthma, 2+x/week
step 3- moderate, persistent asthma, symptoms daily
step 4- severe, persistent asthma, continual symptoms

Question 23

status asthmaticus

Answer 23

medical emergency
epinephrine
continuous albuterol nebulizers
mag sulfate
steroids

Question 24

uncontrolled asthma can lead to

Answer 24

COPD

Question 25

long term controller meds

Answer 25

preventative
inhaled steroid (QVAR)
theophylline (has narrow TI, monitor serum level)
leukotriene modifiers (for allergies, Montelukast)
anticholinergics (Atrovent)

Question 26

quick release meds

Answer 26

rescue
beta adrenergic antagonist (albuterol, Xopenex, terbutaline)
oral corticosteroid (fluticasone)

Question 27

asthma goal

Answer 27

less than 2 symptomatic days per week
monitor function w peak flow meter (blow out hard and fast, do 3 attempts, zero out before each use, stand upright)

Question 28

cystic fibrosis

Answer 28

exocrine glands produce thick mucus that obstruct respiratory passages
lethal, progressive genetic illness (autosomal recessive. need CTFR gene from both parents)
dx: newborn screening, sweat chloride test (elevated Cl and Na)
CM: meconium ileus, steatorrhea, weight loss, increased appetite, progressive COPD, repeated bouts of URIs, gradual resp deterioration, electrolyte deficiency
manage: vigorous daily resp routine (chest physiotherapy, bronchodilator nebs), aggressive infection treatment, replace pancreatic enzymes w meals, high protein/high calorie diet, treat constipation, salt supplementation
prognosis- 37.4 yrs
can do lung, heart, liver, pancreas transplants

Question 29

peak flow results

Answer 29

good= green, 80%+
caution= yellow, 50-79%
emergent= red, less than 50%