Laryngotracheobronchitis (LTB) - inflammation of larynx, trachea, and large bronchi

T3 - Blueprint 1 (Josh) Flashcards by Josh Miller

Parent education for Asthmatic child?

Remove animals (at least from bedroom)

Remove bedroom carpets

Avoid upholstery

Wash bedding in hot water (>130 degrees)

Reduce humidity (

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When should the ED be visited w/ Asthma?

if condition hasn’t gotten better in 30 mins

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Foods to avoid w/ peds b/c they can get lodged in airways.

Hot dogs

Nuts

Grapes

Veggie pieces

Popcorn

Peanut Butter

Gum

Hard Candy

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S/S of Strep Pharyngitis

most are viral

sudden onset of sore throat/fever

headache

ABDOMINAL PAIN

vomiting

POSS RASH (sandpaper)

Lymphandenopathy (neck)

Neck Pain

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In Peds, the focus is on —

In Adults, the focus is on —

airways

cardio

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How do peds airways differ from adults?

NO alveoli until 8 or 9 years old

Short, more narrow airways from trachea to bronchioles (4 vs. 20 mm)

Trachea is shorter, angle of the right bronchus at bifurcation is more acute

Smaller nasopharynx

Lymph tissue grows rapidly until age 12, then atrophies

Smaller nares

Smaller oral cavity and large tongue–risk for obstructino

Long, floppy epiglottis vulnerable to swelling

Larynx and glottis higher in neck; risk of aspiration

Thyroid/cricoid/tracheal cartilage are immature and can collapse

Few muscles functional in airway

Large amounts of soft tissues and loosely anchored mucus–risk of edema and obstruction

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How should the tympanic membrane appear?

tansluscent

slightly pink or gray

light reflex (cone-shaped) that points away from face

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S/S of acute LTB

Slow onset

‘Crowing sounds’

Occurs at night

Slight fever

URI’s precede it

Inspiratory stridor

Retractions

Restlessness

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If severe, Epiglottitis may require — to open the airway.

intubation

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Early S/S of Bronchiolitis.

URI w/ fever

Sneezing

Rhinorrhea

Coughing

Anorexia

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When are oral fluids encouraged w/ LTB (croup)?

if RR is under 60

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What characteristic sign will be seen in the X-ray for Epiglottitis?

‘Thumb sign’

must take lateral xray to see

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What is miconeum ileus?

GI symptom of CF

thick, puttylike mucilaginous meconium blocks the lumen of the small intestine
gives rise to intestinal obstruction
causes dehydration and electrolyte imbalances

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GI system S/S of Cystic Fibrosis

Early:
- Meconium ileus

Late:
- large, bulky frothy, foul-smelling stools,

increased appetite early in disease (w/ no weight gain),
decreased appetite–later,
failure to grow and anemia,
fat soluble vitamin deficiency,
thin extremities and tissue wasting

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What kind of diet does CF client need?

high protein, high calorie (150% of normal daily value)

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LTB starts out as —

simple URI for 1-2 days

then infection descends

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Respiratory system S/S of Cystic Fibrosis

Early:

wheezing
dry/nonproductive cough

Late:

dyspnea
paroxysmal cough
obstructive emphysema
patchy areas of atelactasis
frequent pulmonary infections
overinflated, barrel chest
cyanosis
digital clubbing

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Swimmer’s ear is — and is an inflammation of skin of ear canal

Otitis Externa

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Why is tachycardia a sign of Asthma?

heart is speeding up to try to get the O2 to the tissues that have been deprived due to decreased ventilation

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Meds for Asthma that inhibit release of Leukotrienes.

Montelukast

Zafirlukast

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T/F: Epiglottitis is a true medical emergency.

True

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Which antibiotic is often used w/ Epiglottitis?

Methyprednisone

corticosteroid to help w/ inflammation

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Croup is AKA —

Laryngotracheobronchitis (LTB)

inflammation of larynx, trachea, and large bronchi

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— are the first line of asthma therapy for children under 5.

Corticosteroids

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The greater the distress, the --- the retractions.

higher in the body - ex: substernal less serious than supraclavicular

Treatment for Strep Pharyngitis

Oral Penicillin G for 10 days Erythromycin (if allergic to -cillin) Warm or Cool compress to neck Warm saline gargles

-- are rescue meds for asthma -- are prevention meds for asthma

SABA LABA

SABA examples:

Albuterol Levalbuterol Terbutaline

Instructions for Metered Dose Inhaler

Shake inhaler Attach spacer Tilt head back slightly and breathe out slowly Insert the mouthpiece At end of normal expiration, depress inhaler firmly and breathe slowly (3-5 secs) Hold breath 5-10 secs Remove inhaler and breathe out slowly THRU NOSE Wait 1 MIN b/t puffs

Treatment for Acute Otitis Media

Antibiotics for 10 days - pull the pinna down and back - as you grow UP, you pull UP

GI meds for CF

Pancreatic enzymes (pancrelipase) Vitamens GoLYTELY Motility meds for GERD

--- is a chronic inflammatory disorder of the airways.

Asthma

LABA examples:

Salmeterol - twice a day for long-term prevention - not for kids

How common is RSV?

95% of kids have had it by age 3 - winter and early spring happens most

Strep Pharyngitis is a ---

URI

How is celiac's disease confirmed?

biopsy of small intestine

Corticosteroids for Asthma

Budesonide Fluticasone Methylprednisolone Prednisone

Which controller med requires you to check the blood annually?

Theophylline

What is the NSAID drug for Asthma?

Cromolyn Sodium - given via nebulizer of MDI - minimal S/E - Inhibits release of inflammatory mediators

Which position is preferred w/ Epiglottitis?

upright tripod position (chin out and mouth open)

What should we remember about Asthmatics?

beware the silent asthmatic

A history of otitis media and hearing difficulties can cause ---

tonsilitis

What ages is LTB most common?

3 mths - 3 yrs

What are the fat soluble vitamins?

KADE - not absorbed w/ CF

Education for Controller meds for Asthma

Same time everyday Take even if no symptoms (don't stop taking if feeling better)

Examples of Controller meds for Asthma

Fluticasone Budesonide Theophylline (for night symptoms)

Treatments for tonsilitis

Tonsilectomy (palatine tonsils) Adenoidectomy (pharygeal tonsils)

--- is the hallmark sign of Epiglottitis.

Drooling

In -- --, exocrine gland dysfunction leads to increased mucous production.

cystic fibrosis

Early symptoms of LTB

brassy, barking cough stridor

What physiological trait leads to kids having ear infections?

eustachian tube is shorter and more horizontal

When is irrigation of ear to clean out foreign body contraindicated?

if a vegetable or pasta b/c they'll swell w/ water

-- results from sensitivity to gluten, a protein found in grains.

Celiac Disease

Epiglottiis is caused by ---

H flu B

What is status asthmaticus?

severe condition when asthma attacks follow one after another - emergency

--- is a lower respiratory tract infection.

Bronchiolitis (RSV)

Which diagnostic tests for CF?

Sweat Chloride Test - Normal = 40 - CF in infants = > 60 - CF in other ages = > 40

Later S/S of Bronchiolitis (ie: after a few days, what will you see)

Rapid respirations and retractions CHOKING COUGH FROTHY MUCOUS Nasal flaring Rales, Rhonchi Prolonged expiratory wheeze Decreased intake in infants

--- is a potentially life-threatening condition that occurs when the small cartilidge 'lid' that cover the windpipe swells, blocking air flow into lungs

Epiglottitis - not seen as much b/c of Hib vaccine

What is the classic sign of LTB?

inspiratory stridor

Clinical manifestations of Asthma

Wheezing (sometimes rhonchi) Coughing (hacking, nonproductive cough that progresses to frothy, gelatinous sputum) Dyspnea Prolonged expiration

CF Stools:

4 F's - Fat containing - Frothy - Float (due to fat content) - Foul smelling

Respiratory meds for CF.

SABA (albuterol) Anticholinergics (ipratropium) Combo (fluticasone/salmaterol) Human Deoxyribonuclease (breaks down mucous) Penacillin antibiotics Genatmycin and Tobramycin

Risk factors for Otitis Media

Common in first 24 months of life and then again during school (5-6 years old)--infrequently after age 7 Common in winter months and homes with second-hand smoke Common in: down syndrome, cleft lip/palate Lower risk in infants who are breastfed

-- -- is an IV drug for Asthma that is used in ED as muscle relaxer to decrease inflammation.

Magnesium Sulfate

--- are given during acute asthma episodes to block bronchospasm.

Anticholinergics - Atropine - Ipratroprium (dry mouth!!)

T/F: In mild croup, there is slight stridor at rest.

False - no stridor at rest in mild croup

--- is a collection of fluid in the middle ear, but NO infection.

Otitis Media Effusion