1229 Exam 8: Bronchitis and Bronchiolitis Flashcards
What is Bronchitis?
- Inflammation of the large airways
- Affects children in first 4 years of life
- Usually viral and associated with URI
- Mycoplasma pneumoniae (common in kids >6)
- Mild/self-limiting
- Symptomatic treatment
- Most recover in 5-10 days (uneventfully)
What does Bronchitis look like?
- Dry hacking cough
- non-productive (productive in 2-3 days)
- Worse at night
- Recover in 5-10 days
How is Bronchitis diagnosed?
Physical Exam -Lung sounds -Associated URI --Usually viral --M. pneumoniae in kids >6 --Bacteria, fungi, allergic disorders, airborne irritants Symptoms
How is Bronchitis treated?
Treat symptoms
- Analgesics
- Antipyretics
- Humidity
- Cough suppressants
- -Helpful for rest
- -Careful not to interfere with secretion clearance
What do I teach my pt about Bronchitis?
Promote rest and comfort
Infection control
Promote hydration
Prevention
What is Bronchiolitis?
- Acute viral infection of the bronchiolar level
- Rare in children older than 2
- Bronchiole mucosa swell
- Lumina are filled with mucus and exudate
- Bronchioles infiltrated with inflammatory cells
- 80% RSV
- -Most important pathogen in infancy/toddlers
- -RSV infections seen in late fall, peak in winter, and decrease in spring
- -Spread from hand to eye, nose, or other mucous membranes
What does Bronchiolitis look like?
Begins as URI -Along with rhinorrhea/low grade fever -Otitis media and conjunctivitis may be present Cough develops Respiratory tract infection Apnea Severe disease -Increased arterial carbon dioxide (PaCO2) -Hypercapnia (>70 bpm) -Respiratory acidosis/hypoxemia
How is Bronchiolitis diagnosed?
Identify RSV by (Really Small Victims)
Nasal secretions/washings
-enzyme-linked immunosorbent assay (ELISA)
-Or direct fluorescent antibody (DFA)
How is Bronchiolitis treated?
Oxygen mist Ribovirin for high risk patients -Ribovirin aerosol (controversial) Prevention in high risk pts -Palivizumab IM (Synagis) -Preferred for most (ease of admin, safety, effectiveness) --Monoclonal antibody --Monthly IM during RSV season (Nov-Mar)
What do I teach my pt about Bronchiolitis?
Prevention
Promote hydration
Conserve energy
Isolation
Bronchitis
- Under 4 years
- Large airways
- Virus/bacteria
- Mild/self-limiting
- Dry/hacking cough
- 5-7 day recovery
- Symptomatic Tx
- Prevention
Bronchi-o-litis
- Birth to 2 years
- Small airways
- RSV/viruses
- More severe
- -wheezing/retract/flaring/labored/tachypnea (70)
- Longer recovery
- -O2, bronchodilators, suction, fluids, Ribovirin
- Prevention
- -Palivizumab (Synagis)
- –Form of IgG
The Big Picture
Mom brings baby in ER -History of URI -Increased SOB Assessment -Wheezing, retractions, crackles, tachypnea, diminished breath sounds Labs -ELISA or DFA --Bronchial washing or suction trap
The Big Picture cont…
Treatment
- At home unless
- -Resp distress, dehydration, lung/heart disease
- -Home environment no adequate
- Cool humidified oxygen
- -Keep O2 sat =,>90
- -CPT not recommended
- -Periodic suctioning
- -Fluids PO may be contraindicated (SOB)
- -IV may be needed for hydration
Big Pic cont…
- Hydration is critical to thin secretion
- Bronchodilators have short term benefits
- -Albuterol, formoterol, aminophylline, theophyllin
- Racemic Epi
- -Most improvement
- Steroids, antihistamines not effective
- Antiboitics not used for RSV
- -May see it used if they have OM also
- Ribovirin only real Tx
- -Use in infants controversial
- -Cost and toxic effects to staff (Teratogen)
Prevention
Palivizumab given monthly IM November-March
-High risk infants and children < 2 years
