T3 - Blueprint 1 (Josh) Flashcards
Parent education for Asthmatic child?
Remove animals (at least from bedroom)
Remove bedroom carpets
Avoid upholstery
Wash bedding in hot water (>130 degrees)
Reduce humidity (
When should the ED be visited w/ Asthma?
if condition hasn’t gotten better in 30 mins
Foods to avoid w/ peds b/c they can get lodged in airways.
Hot dogs
Nuts
Grapes
Veggie pieces
Popcorn
Peanut Butter
Gum
Hard Candy
S/S of Strep Pharyngitis
most are viral
sudden onset of sore throat/fever
headache
ABDOMINAL PAIN
vomiting
POSS RASH (sandpaper)
Lymphandenopathy (neck)
Neck Pain
In Peds, the focus is on —
In Adults, the focus is on —
airways
cardio
How do peds airways differ from adults?
NO alveoli until 8 or 9 years old
Short, more narrow airways from trachea to bronchioles (4 vs. 20 mm)
Trachea is shorter, angle of the right bronchus at bifurcation is more acute
Smaller nasopharynx
Lymph tissue grows rapidly until age 12, then atrophies
Smaller nares
Smaller oral cavity and large tongue–risk for obstructino
Long, floppy epiglottis vulnerable to swelling
Larynx and glottis higher in neck; risk of aspiration
Thyroid/cricoid/tracheal cartilage are immature and can collapse
Few muscles functional in airway
Large amounts of soft tissues and loosely anchored mucus–risk of edema and obstruction
How should the tympanic membrane appear?
tansluscent
slightly pink or gray
light reflex (cone-shaped) that points away from face
S/S of acute LTB
Slow onset
‘Crowing sounds’
Occurs at night
Slight fever
URI’s precede it
Inspiratory stridor
Retractions
Restlessness
If severe, Epiglottitis may require — to open the airway.
intubation
Early S/S of Bronchiolitis.
URI w/ fever
Sneezing
Rhinorrhea
Coughing
Anorexia
When are oral fluids encouraged w/ LTB (croup)?
if RR is under 60
What characteristic sign will be seen in the X-ray for Epiglottitis?
‘Thumb sign’
- must take lateral xray to see
What is miconeum ileus?
GI symptom of CF
- thick, puttylike mucilaginous meconium blocks the lumen of the small intestine
- gives rise to intestinal obstruction
- causes dehydration and electrolyte imbalances
GI system S/S of Cystic Fibrosis
Early:
- Meconium ileus
Late:
- large, bulky frothy, foul-smelling stools,
- increased appetite early in disease (w/ no weight gain),
- decreased appetite–later,
- failure to grow and anemia,
- fat soluble vitamin deficiency,
- thin extremities and tissue wasting
What kind of diet does CF client need?
high protein, high calorie (150% of normal daily value)
LTB starts out as —
simple URI for 1-2 days
- then infection descends
Respiratory system S/S of Cystic Fibrosis
Early:
- wheezing
- dry/nonproductive cough
Late:
- dyspnea
- paroxysmal cough
- obstructive emphysema
- patchy areas of atelactasis
- frequent pulmonary infections
- overinflated, barrel chest
- cyanosis
- digital clubbing
Swimmer’s ear is — and is an inflammation of skin of ear canal
Otitis Externa
Why is tachycardia a sign of Asthma?
heart is speeding up to try to get the O2 to the tissues that have been deprived due to decreased ventilation
Meds for Asthma that inhibit release of Leukotrienes.
Montelukast
Zafirlukast
T/F: Epiglottitis is a true medical emergency.
True
Which antibiotic is often used w/ Epiglottitis?
Methyprednisone
corticosteroid to help w/ inflammation
Croup is AKA —
Laryngotracheobronchitis (LTB)
- inflammation of larynx, trachea, and large bronchi
— are the first line of asthma therapy for children under 5.
Corticosteroids
The greater the distress, the — the retractions.
higher in the body
- ex: substernal less serious than supraclavicular
Treatment for Strep Pharyngitis
Oral Penicillin G for 10 days
Erythromycin (if allergic to -cillin)
Warm or Cool compress to neck
Warm saline gargles
– are rescue meds for asthma
– are prevention meds for asthma
SABA
LABA
SABA examples:
Albuterol
Levalbuterol
Terbutaline
Instructions for Metered Dose Inhaler
Shake inhaler
Attach spacer
Tilt head back slightly and breathe out slowly
Insert the mouthpiece
At end of normal expiration, depress inhaler firmly and breathe slowly (3-5 secs)
Hold breath 5-10 secs
Remove inhaler and breathe out slowly THRU NOSE
Wait 1 MIN b/t puffs
Treatment for Acute Otitis Media
Antibiotics for 10 days
- pull the pinna down and back
- as you grow UP, you pull UP
GI meds for CF
Pancreatic enzymes (pancrelipase)
Vitamens
GoLYTELY
Motility meds for GERD
— is a chronic inflammatory disorder of the airways.
Asthma
LABA examples:
Salmeterol
- twice a day for long-term prevention
- not for kids
How common is RSV?
95% of kids have had it by age 3
- winter and early spring happens most
Strep Pharyngitis is a —
URI
How is celiac’s disease confirmed?
biopsy of small intestine
Corticosteroids for Asthma
Budesonide
Fluticasone
Methylprednisolone
Prednisone
Which controller med requires you to check the blood annually?
Theophylline
What is the NSAID drug for Asthma?
Cromolyn Sodium
- given via nebulizer of MDI
- minimal S/E
- Inhibits release of inflammatory mediators
Which position is preferred w/ Epiglottitis?
upright tripod position (chin out and mouth open)
What should we remember about Asthmatics?
beware the silent asthmatic
A history of otitis media and hearing difficulties can cause —
tonsilitis
What ages is LTB most common?
3 mths - 3 yrs
What are the fat soluble vitamins?
KADE
- not absorbed w/ CF
Education for Controller meds for Asthma
Same time everyday
Take even if no symptoms (don’t stop taking if feeling better)
Examples of Controller meds for Asthma
Fluticasone
Budesonide
Theophylline (for night symptoms)
Treatments for tonsilitis
Tonsilectomy (palatine tonsils)
Adenoidectomy (pharygeal tonsils)
— is the hallmark sign of Epiglottitis.
Drooling
In – –, exocrine gland dysfunction leads to increased mucous production.
cystic fibrosis
Early symptoms of LTB
brassy, barking cough
stridor
What physiological trait leads to kids having ear infections?
eustachian tube is shorter and more horizontal
When is irrigation of ear to clean out foreign body contraindicated?
if a vegetable or pasta b/c they’ll swell w/ water
– results from sensitivity to gluten, a protein found in grains.
Celiac Disease
Epiglottiis is caused by —
H flu B
What is status asthmaticus?
severe condition when asthma attacks follow one after another
- emergency
— is a lower respiratory tract infection.
Bronchiolitis (RSV)
Which diagnostic tests for CF?
Sweat Chloride Test
- Normal = 40
- CF in infants = > 60
- CF in other ages = > 40
Later S/S of Bronchiolitis (ie: after a few days, what will you see)
Rapid respirations and retractions
CHOKING COUGH
FROTHY MUCOUS
Nasal flaring
Rales, Rhonchi
Prolonged expiratory wheeze
Decreased intake in infants
— is a potentially life-threatening condition that occurs when the small cartilidge ‘lid’ that cover the windpipe swells, blocking air flow into lungs
Epiglottitis
- not seen as much b/c of Hib vaccine
What is the classic sign of LTB?
inspiratory stridor
Clinical manifestations of Asthma
Wheezing (sometimes rhonchi)
Coughing (hacking, nonproductive cough that progresses to frothy, gelatinous sputum)
Dyspnea
Prolonged expiration
CF Stools:
4 F’s
- Fat containing
- Frothy
- Float (due to fat content)
- Foul smelling
Respiratory meds for CF.
SABA (albuterol)
Anticholinergics (ipratropium)
Combo (fluticasone/salmaterol)
Human Deoxyribonuclease (breaks down mucous)
Penacillin antibiotics
Genatmycin and Tobramycin
Risk factors for Otitis Media
Common in first 24 months of life and then again during school (5-6 years old)–infrequently after age 7
Common in winter months and homes with second-hand smoke
Common in: down syndrome, cleft lip/palate
Lower risk in infants who are breastfed
– – is an IV drug for Asthma that is used in ED as muscle relaxer to decrease inflammation.
Magnesium Sulfate
— are given during acute asthma episodes to block bronchospasm.
Anticholinergics
- Atropine
- Ipratroprium (dry mouth!!)
T/F: In mild croup, there is slight stridor at rest.
False
- no stridor at rest in mild croup
— is a collection of fluid in the middle ear, but NO infection.
Otitis Media Effusion
