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women and children > Paediatric respiratory illnesses > Flashcards

Paediatric respiratory illnesses Flashcards

1
Q

What are the signs and symptoms of croup?

A
  • Seal bark cough
  • Stridor – volume does not represent the severity
  • Extra thoracic stridor – no stethoscope needed, in the upper airways. Intrathoracic heard on expiration when auscultating the chest.
  • Hoarse voice/cry
  • Fever, runny nose
  • Respiratory distress – recession: intercostal, tracheal tug, sternal wall recession.
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2
Q

What is the name of the scoring system used to determine croup severity?

A

Taussig score

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3
Q

What is the treatment and management of croup?

A
  • All patients with stridor must be transported
  • Keep child in upright position
  • Avoid upsetting the child: avoid examining nose, ears, throat, doing BM, cannulation, nebulisation unless absolutely necessary
  • Steroids: Oral Dexamethasone. It is PGD drug.
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4
Q

What are the signs of respiratory distress in children?

A
  • Increased RR
  • Accessory muscle use
  • Recessions
  • Nasal flaring
  • Head bobbing
  • Tracheal tugging
  • Cyanosis
  • Abnormal noises
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5
Q

What are the signs and symptoms of bronchiolitis?

A
  • Coryzal symptoms
  • Respiratory distress
  • Dyspnoea
  • Tachypnoea
  • Poor feeding
  • Mild fever <39
  • Apnoea
  • Wheeze/Crackles
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6
Q

What are the signs that bronchiolitis needs to be admitted?

A
  • <3 months
  • Preexisting conditions: cystic fibrosis, downs syndrome, prematurity, congenital heart disease
  • Decreased feeding by 50-75%
  • Spo2 <94%
  • Apnoea
  • Family anxiety
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7
Q

What can you do to treat/manage bronchiolitis?

A
  • Respiratory & feeding/hydration support
  • Oxygen if sats <94
  • IV fluids
  • Nebulisers not seen to have a good effect, but nothing to stop you trying
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8
Q

How does Otitis media (middle ear inflammation) occur?

A
  • Usually caused by viral infection, can be bacterial
  • Child’s eustachian tubes are shorter, more horizontal and narrower. This makes it harder for them to drain.
  • Can lead to perforated ear drums. Otorrhea – leaking of fluid – can indicate this.
  • Retention of fluid in the middle ear can lead to recurrent ear infections
  • Inflammation can spread to surrounding structures. Inflammation of the bone behind the ear – mastoiditis – is very severe and can lead to meningitis.
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9
Q

What are potential signs and symptoms of otitis media?

A
  • Ear ache, fever, nausea and vomiting, lethargy, slight hearing loss
  • Pulling or tugging/rubbing ear, irritable, poor feeding and restless nights, coughing and runny nose, unresponsiveness to quiet sounds, inattentiveness and loss of balance, otorrhea
  • Signs and symptoms can persist for 3-5 days
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10
Q

What are the signs and symptoms of epiglottitis?

A
  • Fever, sore throat, difficulty and pain when swallowing, visible epiglottis, tripoding, stridor, hoarse voice, drooling
  • Protruding tongue, toxaemia
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11
Q

What are the signs and symptoms of whooping cough?

A
  • Violent paroxysmal cough
  • Violent cough can cause vomiting
  • Can lead to hernia
  • Coughing spasms can be followed by apnoea and cyanosis
  • Can lead to rib fractures and straining of intercostal muscles
  • Notifiable disease
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12
Q

What is the management of whooping cough?

A

Arrange hospital admission if:
- <6months of age and acutely unwell
- Significant breathing difficulties: apnoea, cyanosis, spasms
- Significant complications: seizure, pneumonia, dehydration
If hospital admission is not necessary:
- Antibiotics if onset of cough is within previous 21 days
- Macrolide antibiotic is recommended first line
Prophylaxis
- Antibiotics should be offered to close contacts of suspected or confirmed cases of whooping cough within the previous 21 days
- Groups at high risk include <2months old, pregnant women, healthcare workers, people who are regularly in contact with infants.
Patient advice:
- Rest, adequate fluid intake, paracetamol and ibuprofen
- Likely to cause cough that may last 3 months or more

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13
Q

How does cystic fibrosis present?

A
  • Persistent cough/wheeze, excessive sputum, recurrent/severe pneumonia
  • Chronic sinusitis and nasal polyps
  • Digital clubbing
  • Digestive dysfunction as the pancreatic ducts get blocked – require modified, high calorie diet. Have diminished ability to absorb fats, can lead to vitamin deficiency. May be supplemented with exogenous pancreatic enzymes.
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14
Q

What are the routine treatments for cystic fibrosis?

A
  • Chest physical therapy
  • High-frequency chest wall oscillation vest
  • Positive expiration pressure devices
  • Aerosol therapies
  • Antibiotic treatments
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15
Q

What is the pathophysiology of croup?

A
  • Endothelial cells disruption
  • Upregulates histamine sensitivity
  • Paralysis and death of cilia
  • Disruption of phagocytosis
  • Local necrosis
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16
Q

What are the signs and symptoms of tonsilitis?

A
  • Fever, sore throat, difficulty/painful swallowing, tender cervical nodes
  • Can result in airway obstruction, mouth breathing, snoring, breathing pauses, sleep apnoea
  • Muffled voice is a sign of quincy as is inflammation/white spots spreading from tonsils
  • Symptoms usually last for about a week.
17
Q

What are the pathophysiology of tonsilitis?

A
  • Inflammation of tonsils
  • 50% caused by epstien-barr virus
  • Bacterial cause can cause significant symptoms
  • Palatine tonsils become most inflamed. Can also spread to lingual tonsil.
    Acute exudative tonsilitis
  • Serious build-up of inflammation and oedema in palatine tonsils. Build-up of exudate – decomposing white blood cells ect. Basically pus. Swallowing this can cause digestive dysfunction.
  • Particularly with strep A, inflammation can spread to the anterior arch. White spots of exudate form on the tissue. This is a red flag. They can create peritonsillar abscesses, also known as quincy. They then have to go on to further care, and be treated with antibiotics. As inflammation gets more severe, it affects breathing and swallowing.
18
Q

what are the red flag symptoms of upper respiratory tract infections?

A
  • <3 months with fever >38
  • Signs of sepsis
  • Respiratory distress, drooling, stridor, voice changes, trismus, torticollis(neck spasms), neck swelling, dry mouth
  • Severe suppurative complications – severe inflammation
19
Q

What is the management of upper respiratory tract infections?

A
  • Rule out red flag symptoms
  • Recommendations:
  • No over the counter cough medications
  • Rest
  • Extra fluids
  • Analgesic
  • Antipyretics
  • Estimate of likely duration
  • Worsening advice
  • Anti-biotics do not improve symptoms and can have unpleasant side effects
  • Penicillin and Epstein-barr virus interact to cause a rash which looks like an allergic reaction.
    Hospital intake may be indicated when
  • Reduced fluid intake
  • Children with muffled voices
  • Tenderness behind the ear

women and children (8 decks)

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