Flashcards in Pediatric Pulmonary Deck (68):
What are characteristics of airway cartilage in infants?
Soft and compressible
How do infants breath and why can this be problematic?
Through their nose and their nares are small
Why can infection spread quicker in infants anatomically?
Everything is smaller and closer together.
An infant's metabolism is faster so they require....
What is the diaphragm made out of in infants?
Since infants have a lower number of alveoli, they need to...
breathe faster to get the oxygen.
What do you observe during a respiratory assessment?
Affect, color, respiratory rate, accessory muscle use, retractions.
Where are the different retraction sites?
Suprasternal, Substernal, Clavicular, Intercostal, Subcostal
What kind of accessory muscles do infants use?
What change should you look for during feeding and sleeping?
What do you note upon auscultating lungs?
Quality of air movement, any adventitious breath sounds, may breath shallow at night.
What are the common kinds of adventitious breath sounds?
Wheezing, Course crackles (rhonci), fine crackles (rales), stridor (audible wheeze)
What is sinusitis?
Infection and inflammation of the sinus cavaties, usually from a staph, strep, or H. flu infection.
How do you treat sinusitis?
Antipyretics, analgesics, antibiotics, nasal spray, (advil, tylenol)
What are some complications of sinusitis?
osteomylitus of facial bones.
Does sinusitis affect upper or lower airway?
What is Laryngitis?
Usually caused by a virus that causes hoarseness and URI symptoms.
How do you treat laryngitis?
Treat symptoms- fluids, pain and fever relievers.
Which part of the airway does laryngitis affect?
What is acute laryngotracheobronchitis?
Croup- swelling or obstruction of the larynx, trachea, and bronchi caused by parainfluenza virus, flu type A and B, adenovirus, RSV, and mycoplasm pneumoniae.
What are symptoms of croup?
Hoarseness, barking, brassy, croupy cough, inspiratory stridor, low grade fever, wheezing, retractions.
Does croup affect the upper or lower airway?
What is spasmodic croup, or midnight croup?
Paroxysmal attacks of laryngeal obstruction that occurs mainly at night, mild/no inflammation, lasts 2-5 days.
What are symptoms of midnight croup?
No fever, no inflammation, lasts 2-5 days, awaken by barking cough, hoarseness, noisy respiration, well during the day besides hoarseness.
How do you manage croup at home?
Mist, either warm or cool- whichever works. Humidity, possibly exposure to cold air.
How do you manage croup in the hospital?
Maintain airway, high humidity, cool mist, fluids, nebulized epinephrine, corticosteroids.
What is acute epiglottitis?
Supraglottic obstruction that results in severe respiratory distress and requires immediate attention.
What are symptoms of acute epiglottitis?
Fever, tripoding, drooling, irritable, thick and muffled voice, retractions
How do you diagnose acute epiglottitis?
Portable lateral neck X-ray
How do you treat acute epiglottitis?
Bring down swelling with IV antibiotics and corticosteroids
How do you prevent acute epiglottitis?
H. Influenza type B Vaccine.
What is bronchiolitis?
An acute viral infection at bronchiolar level, usually caused by RSV, can develop into pneumonia very quickly.
Is bronchiolitis a lower or upper airway problem?
What is RSV infection?
The bronchiolar mucosa swells and lumina are filled with mucous and exudate, then are obstructed and lead to hyperinflation, obstruction, and atelectasis- mimics emphysema.
What does RSV mimic?
How is RSV diagnosed?
With a nasopharyngeal washing.
What kind of precautions is an RSV patient placed on?
Contact and droplet isolation.
How is RSV transmitted?
Through direct contact of respiratory secretions, can survive on countertops, gloves, tissues for hours
What are clinical manifestations of RSV?
Begins as URI- runny nose, low fever, cough, pink eye, poor feeding, then progresses to a lower respiratory infection with coughing, wheezing, tachypnea, retractions, cyanosis.
What is the pharmalogical treatment of RSV?
What is Ribavirin?
An aerosolized antiviral that is given in a mist tent for 12-18 hours/day for 3-5 days. Pregnant women should avoid this med.
What is some prophylactics for RSV?
Respigam- IV for high risk infants
Synagis- IM to high risk infants.
What is management of bronchiolitis?
Managed at home unless in distress or dehydrated, maintain airway, mist therapy, adequate fluid intake, contact precautions.
What is pneumonia?
Lower respiratory inflammation of the alveoli and bronchioles involving a lobe or large segment of the lung- viral or bacterial.
What is viral pneumonia?
Associated with viral URI, more common, treat symptoms.
What is bacterial pneumonia?
Very ill appearance with high fever, difficulty breathing, cough, chest pain.
What kind of patients are at risk for pneumonia?
High risk infants, premature infants, RSV patients.
What are complications of pneumonia?
Tension pneumothorax, pleural effusion
Treatment of pneumonia
Antibiotics, antipyretics, fluids, calories, rest, oxygen prn, chest tube care if needed, activity as tolderated
What is otitis media?
Inflammation of the middle ear
What infants are at risk?
Formula fed, smoking, households with many members, and history.
What is acute otitis media?
Rapid onset of an ear infection lasting 3 weeks.
What is otitis media with effusion?
Fluid in the middle ear.
What is chronic otitis with effusion?
Persistent ear infection with fluid lasting longer than 3 weeks.
What is the pathophysiology/cause of otitis media?
Results from dysfunctioning eustachian tube
What does the eustachian tube do?
Protects middle ear from secretions, drains secretion from middle ear to nasopharyngeal section, ventilates middle ear to equalize air pressure.
What are clinical manifestations of otitis media?
Pain, fever, runny nose, vomitting, diarrhea, loss of appetite, full feeling
How do you diagnose an ear infection?
Assess tympanic membrane
Upon assessing tympanic membrane, what does it look life if there is an ear infection?
intact membrane that is bright red, building, with obscure landmarks.
What does an ear infection with effusion look like upon assessment?
dull, grey membrane with visible fluid.
How do you treat otitis media?
Careful use of antibiotics- amoxicillin, augmentin, azithromycin, cephalosporins, tylenol for pain
What are the tonsils and what do they do?
Masses of lymphoid tissue in pharyngeal cavity that filter and protect respiratory and alimentary tracts from organisms
What is tonsillitis?
Inflammation of palatine tonsils, may be viral or bacterial, obstructs passage of air and food
How do you treat viral tonsillitis?
self limiting- treat symptoms.
How do you treat bacterial tonsillitis?
Antibiotics, and treat symptoms.
Indications for tonsillectomy
recurrent, frequent strep infections, massive hypertrophy that causes difficulty eating and breathing.
When is a tonsillectomy contraindicated?
Cleft palate, acute infection