The Child With Respiratory Dysfunction Flashcards
what are signs and symptoms associated with respiratory tract infections
fever poor feeding/anorexia V/D abdominal pain HA/neck stiffness nasal blockage nasal discharge cough respiratory sounds sore throat
what are early signs of respiratory complications
earache RR > 50-60/min fever> 101 persistent cough for 2 days or more wheezing crying
what does the tripod position do
makes it easier to suck in air and its using the strap muscles in the neck
what are clinical manifestations of acute pharyngitis
abrupt onset HA Fever Abd pain mild to severe throat pain
if child tests positive for strep how long will they be on antibiotics and when is the child NOT considered infectious
10 days and is NOT contagious after 24 hrs of them being on abx (change toothbrush at this time)
what are s/s of tonsillitis
sore throat dysphagia mouth odor mouth breathing snoring nasal qualities in voice fever inflamed tonsils
if the tonsillitis is bacterial how will it be treated
with antibiotics
why is it best to wait until age 3-4to have sx for tonsillitis
if the pharyngeal and palentine tonsils are removed before this age then the other 2 tonsils will try to grow and get larger to over compensate for the others that were taken out. there is also a risk of blood loss because it is a very vascular procedure
after tonsillectomy is it normal to see white membrane covering operative site?
yes
post op of a tonsillectomy what should you check
airway and bleeding
position them semi or high fowlers to drain well
what diet should the tonsillectomy pt be on post op
clear liquids after return of gag reflex, advance to soft diet
NO spicy foods
avoid red colored liquids, citrus juice, and milk based foods initially
what is the risk for hemorrhage in tonsillectomy
up to 10 days after sx (can resume normal activities in 1-2 weeks)
fluid and inflammation of the middle ear (bacteria gets trapped in the ear)
otitis media
what typically causes otitis media
RSV and influenza
s/s of acute OM
recent URI/cold fever earache discharge crying, fussy rub or pull ear rolling head side side loss of appetite V/D
feeling of fullness in ear
popping sensation when swallowing
hearing loss
difficulty communicating
Otitis media with effusion
what are croup syndrome characteristics
hoarseness
“barking” or “brassy” cough
inspiratory stridor
resp distress
what is acute epiglottitis
serious obstructive, inflammatory process that is a medical emergency
“was just fine when he went to bed”
presence of drooling
absence of spontaneous cough
acute epiglottitis
what will you see on an acute epiglottitis x ray
thumb sign
what is important when managing acute epiglottitis
protection of airway
NO tongue blade
droplet isolation for at least 24hrs after abx
most common croup syndrome and is preceded by URI
laryngotracheobronchitis
“seal like” cough in the middle of the night
and symptoms always worse at night
laryngotracheobronchitis
is croup contagious
yes lasts about 2-3 days
what is the therapeutic mngmt of laryngotracheobronchitis
cool mist vapor, ride in car with windows down, hydrate, corticosteroids, pulse oximeter
what is different about spasmodic laryngitis compared to laryngotracheobronchitis
not fever involved
usually subsides and feels better in the morning
reoccur through out year
infection of the mucosa of the upper trachea
bacterial tracheitis
what causes respiratory distress in bacterial tracheitis
thick, PURULENT secretions
the CM of bacterial tracheitis are similar to _____ except ________ to ____ therapy
LTB; unresponsive; LTB
what is considered the “reactive” portion of the respiratory tract
lower airway
chronic inflammatory disorder of the airways
asthma
what are the classic signs of asthma
dyspnea
wheezing
cough
what is the most accurate way to dx asthma
pulmonary function testing
what would a child with asthmas HR and RR be
high and increased
long term asthma meds ….
prevent asthma exacerbations
rescue asthma meds….
are quick acting and help treat symptoms in any asthma exacerbation
what are first line therapy for kids who have asthma
corticosteroids (kids older than 5)
use spacer with INHALED corticosteroid to prevent thrush
what long term asthma med can NOT be given by itself it has to be given with corticosteroid
LABAs
what happens if a child with asthma is not responding to other types of maximum therapy?
they are put on methylxanthines
narrow therapeutic range so watch theo levels
what is important to know about quick relief asthma med- systemic corticosteroid
that the dose needs to be tapered down
long term use of corticosteroids can cause
immune system to be lowered
what are signs of SEVERE respiratory distress
refuses to lie down and remains sitting upright
sudden agitation
agitated then suddenly becomes quiet
sweating
for exercise induced bronchospasm what tx should be given
prophylactic with cromolyn or SABA
what is the first line therapy for status asthmaticus
SABAs
what is a peak flow meter and how is it used
measures how much oxygen they exhale in one second
the child should take a deep breath and forcefully exhale
take highest measurement of the 3 times
peak flow meter green
80-100% (mild)
peak flow meter yellow
50-79% (moderate)
peak flow meter red
<50% (severe)
recue med comes _____ to corticosteroid inhaler
before (15 minutes before)
viral inflammation and edema at the level of the bronchioles
respiratory syncytial virus (RSV)
what isolation will the RSV pt be on
droplet and contact
what is used in high risk infants for prevention of RSV
palivizumab
breath in the organism and implants in the respiratory tract
-rarely contagious in children less than 12
cough may or may not be present
TB
what is the gold standard for TB
sputum culture
an induration of greater than or equal to 15 is ______ for TB in children older than 5
positive
condition characterized by exocrine gland (mucous producing) gland that produces multi system involvemnet
cystic fibrosis (some kids don’t exhibit symptoms until 2 years later)
in CF both parents must carry the….
trait (autosomal recessive)
in CF the chloride, sodium and water stay ______ the cell and the mucous on the outside is ______ because it is not being _____ out by the water
inside; thicker; thinned
in CF what is the biggest thing we will see in the sweat
chloride
what are predominantly affected by CF
respiratory tract and pancreas because the thick, sticky mucous accumulates, dilates and clogs glands and ducts
what are CM of CF
frothy, greasy stool thin arms and legs distended abd chronic cough barrel shaped chest skin has salty taste dehydration
what test rules out CF
sweat test (60 mEq/L in children older than 3 months)
what is the tx for CF
pancreatic enzymes
vit ADEK
well balanced, high protein and cal diet
lax or stool softeners
when should pancreatic enzymes be admin
within 30 min of meals and can be swallowed or sprinkled
what is the prognosis of CF
progressive and INCURABLE
