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Pediatrics > Acute Respiratory pt. 2 (Exam 2) > Flashcards

Acute Respiratory pt. 2 (Exam 2) Flashcards

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1
Q

Disorders of the ear

A

Otitis Externa (OE - Swimmers Ear)

Otitis Media (OM)

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2
Q

Otitis Externa

A

Inflammation / Infection of outer ear

Auricle / Canal

Water gets trapped by ear wax which mediates growth

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3
Q

External Otitis: Etiology

A

Bacteria

Dermatitis

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4
Q

Otitis Externa: Clinical Manifestations

A

Very painful
-increase with movement

Drainage
-serosanguineous / purulent

Can smell bad

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5
Q

Otitis Externa: Therapy

A

Antibiotic / Steroid Drops

Tylenol

Prevention

NO ORAL ANTIBIOTICS

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6
Q

How to prevent otitis externa

A

Keep ear dry and drain ear

One drop white vinegar / one drop rubbing alcohol (not with tubes)

Do not sumberg head in water 10 days after diagnosis

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7
Q

Otitis Media

A

Infection of the middle ear (behind the tympanic membrane)

Fluid accumulates and becomes growth medium

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8
Q

Otitis Media: Risk Factors

A

-Exposure to smoke and many people

-Bottles in bed

-Non immunized

-Winter

-Non BF infant

-Pacifier use beyond infancy

-Fam hx

-Immune deficiency

-Allergic rhinitis

-Males

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9
Q

what is preventive for otitis media?

A

Breast fed

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10
Q

If past 6 months of age and still getting recurrent ear infection what do we try?

A

Zyrtec to reduces allergies / fluid accumilaiton

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11
Q

Otitis Media: Clinical Manifestations

A

Infants get irritable

Holds / pulls at ear

Fever up to 104

May roll head from side to side

Ruptured tympanic membrane

Hearing loss if chronic

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12
Q

Otitis Media: Therapeutic Management

A

80% of infections will go away on their own but pain can cause problems

Antibiotics

Tylenol / ibuprofen

Warm compress

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13
Q

Antibiotic Therapy: Otitis Media Criteria

A

Less than 6 months

6-23 months if bilateral AOM

> 6 months w/ drainage - fever - ear pain > 48 hours

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14
Q

Drug of choice of middle ear infections?

A

Amoxicillin

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15
Q

Chronic Otitis Media Treatment

A

Myringotomy with PE tympanostomy tubes tubes

Allow fluid to escape inside of ear into outside of ear

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16
Q

PE Tubes: Teaching

A

-No diving - Jumping (in water) - prolonged submersion

-No swimming in lakes / rivers

-Avoid pressure postoperatively

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17
Q

Croup Syndromes

A

Swelling / Obstruction in region of the larynx

Hoarseness - Barky cough

Inspiratory stridor

Varying degrees of respiratory distress

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18
Q

Acute Laryngotracheobronchitis (LTB)

A

Viral Croup

Inflammation of lining of larynx - trachea - bronchi causing narrowing of the airway

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19
Q

Viral Croup Name

A

Acute laryngotracheobronchitis

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20
Q

Viral Croup is common in

A

Infants and children < 5 yrs old

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21
Q

LTB: Clinical Manifestations

A

Epiglottic becomes edematous

Trachea swells resulting restriction of airway

Barky cough - Inspiratory stridor

Respiratory distress

Restractions

Agitations

Cyanosis

Increased HR - Extreme restlessness - listlessness

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22
Q

T/F: Most kids do okay with viral croup?

A

True

They sound worse than they look

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23
Q

LTB: Hospital Management

A

Respiratory assessment

Pulse ox management

High humidity with cool mist

Humidified oxygen

Racemic epinephrine

Corticosteroids

Keep calm: Parents at bedside

Bronchodilators / antibiotics not helpful

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24
Q

LTB: Home managment

A

High Humidity

High fluid intake

Tylenol

Avoid cough syrups and cold medicines

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25
Signs of Increasing LTB
Increasing RR > 60 per min --- start NPO Decrease RR w/ Decrease LOC Increase agitation, restlessness, anxiety, decreased LOC Cyanosis Stridor at rest Moderate to severe retractions Not drinking fluids
26
Epiglottitis
Bacterial croup SERIOUS - Life threatening obstructive inflammatory process
27
When does epiglottitis tend to appear?
Between 2-5 years old
28
What is the difference between epiglottis and LTB
BACTERIAL = Absence of cough Drooling High degree agitations
29
LTB Kids sounds _______ than they look Epiglottis kids look _______ than they sound
Worse Worse
30
Epiglottitis: Clinical manifestations
Abrupt onset with sore throat High fever, mouth open, tongue protruding Agiations Drooling Tripod sitting Sore red inflamed throat Difficulty swallowing Stridor No cough
31
Epiglottis: Intervnetion
NO tongue blade and NO looking in throat STAY CALM AND KEEP PARENTS CALM Avoid x-ray and transport Prepare for sedation and intubation
32
Cardinal Signs of Epiglottitis
Four D's Drooling Dysphagia Dysphonia Distressed inspiratory efforts
33
What vaccine protects against epiglottis and is the reason it is rare now?
Hib vaccine Leading cause of epiglottis = H-influenza
34
What precautions is epiglottis?
Droplet precautions until 24 hours after antibiotics have been started
35
Bronchiolitis (RSV)
RSV Acute viral infection resulting in inflammation of the smaller bronchioles
36
Bronchiolitis (RSV) is characterized by
thick mucus
37
What is the most common cause of children under 2 being hospitalized?
Bronchiolitis (RSV)
38
Peak age for RSV?
2-5 months
39
Do we test for RSV?
No we go based on symptoms All treatment is the same
40
How is bronchiolitis acquired?
Through contact with contaminated surface and hand-to-hand transmission
41
Bronchiolitis: Initial Symptoms Progressive Symptoms Severe Symptoms
Initial: -Rhinorrhea -Pharyngitis -Coughing -Sneezing -Eye / ear infection -Intermittent fever Progressive: -Increased coughing -tachypnea / retractions -fever -feeding problems -increase secretions Severe: -Increase Tachypnea -Apneic spells -Reduce breath sounds -Listlessness -Cyanosis
42
RSV Bronchiolitis: Signs and Symptoms
Apnea may be first sign in infancy Rhinorrhea Pharyngitis Coughing / sneezing Wheezing / crackles Eye / Ear infection Low grade fever Difficulty feeding Irritability
43
RSV Bronchiolitis: S/S can progress to
Tachypnea Air hunger Retractions Cyanosis
44
We do not test for RSV but if we need to figure out what is it, what test do we use?
Qualitative Reverse Transcription Polymerase Chain Reaction (QT-PCR)
45
Primary Goal of RSV Bronchiolitis
Maintain Airway Through suctioning
46
RSV Bronchiolitis: Management
Maintain Airway Symptomatic treatment (can be monitored and managed at home) Medications
47
RSV: Medications
Antiviral - ribavirin (airsol) (inhaled) Bronchodilators Corticosteroids (controversial)
48
Who can not receive ribavirin?
Pregnant Women (they can not even be in the room)
49
We do we give O2 to RSV kids
When their O2 falls below 90%
50
For infants with respiratory issues, what do we do before feeding?
Suctioning Helps child take in air and breath while eating
51
RSV Immunizations
Synagis Only for high risk infants <29 weeks (born prematurely) VERY EXPENSIVE
52
What precautions of RSV Bronchiolitis
Contact / Standard Precautions
53
Pneumonia
Inflammation of the alveoli (lower airway) Can be viral - bacterial
54
Pneumonia: Clinical Manifestations
Fever mild to high Chest pain (may be referred to abdomen) Dullness to percussion Cough - nonproductive early Rhonchi or fine rails, diminished breath sounds Respiratory distress
55
Pneumonia: Complicaitons
Empyema (pus collection) Pyopneumothorax Tension pneumothorax Pleural Effusion
56
Therapeutic Management and Nursing care Pneumonia
Humidified Oxygen Antibiotics (possible bronchodilators) Possible chest tubes May require drainage or CPT Symptomatic rest - hydration Elevate HOB and allow child to assume a position of comfort Close observation for increased signs of respiratory distress
57
What do we do for every respiratory illness
Monitor pulse ox
58
Pertussis
Whooping Cough
59
Pertussis is seen in
Unimmunized children < 4 and > 10 years
60
Pertussis can lead to
Encelapothy, seizures, pneumonia
61
Pertussis Therapeutic Management
Treat with Erythromycin Infants < 6 mos may need ventilator support Humidified oxygen Maintain hydration Watch for and prevent pneumonia
62
TB
Rare but similar to adults Transmission through micro droplet inhalation
63
TB: Risk Factors
Age -Decreased resistance infancy -Decrease resistance in puberty and adolescence Stress states -injury - illness - steroids Nutritional deficits Concurrent infection -HIV -Immunosuppressed -MMR diseases
64
TB: Clinical Manifestations
Asymptomatics with normal C-Xray Malaise Fever Night sweats Slight cough Weight loss Anorexia Lymphadenopahty
65
TB: Once a person test postive
They always will
66
TB: Nursing Care
Rarely need hospitalization Adherence to medication is crucial Isolation: can attend school once on therapy and s/s reduced Adequate nutrition is as necessary as adherence to medication
67
Apnea of Infancy is also know as
Apparent life threatening event (ALTE)
68
Apparent Life Threatening Event (ALTE)
Infant will just stop breathing / turn blue and go limp Come to ER and they recover on own, usually w/o CPR Hook up to monitor and observe + try to figure out course
69
ALTE: Therapeutic Management
Continuous cardiorespiratory monitoring until episode free for 6 months Lots of test and monitoring Teach parents CPR Methylxanthine (caffeine) -gives them some stimulus to breath
70
Discharge Education ALTE
CPR Monitor if they go home with it, interference w electronics No extension cords Emergency # on phone
71
SIDS
Sudden Infant Death Syndrome of infant under 1 year of age that occurs during sleep and remains unexplained after postmortem examination
72
What is the leading cause of death in infants
1-12 months
73
SIDS: Risk factors
Overheating Unsafe sleeping arrangements -co sleeping Super soft bedding Maternal age Prenatal or postnatal smoking parents Substance Abuse parent Poor prenatal care Premature Multiple births (youngest twin) Low apgar score Bottle fed (breath milk is protective)
74
SIDS: Nursing Consideration
Safe sleep / back to sleep Compassionate approach Ask only factual questions Allow family time to say goodbye Provide a keep sake Arrange home visit
75
Do prematures babies have ALTES
If an event occurs in a premature infant we do not consider it an ALTE bc so common

Pediatrics (16 decks)

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