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Flashcards in T3-Blueprint: Respiratory Deck (100):
1

Respiratory: What is the focus for pediatrics-airway or cardio?

Airway

2

When do children have alveoli?

Not till age 8 or 9

3

What type of airways do children have?

Short, more narrow airways from trachea to bronchioles

4 mm (child) vs 20 mm (adult)

4

Describe the trachea of children.

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

5

Child or adult:
Small nasopharynx

Child

6

Child or adult:
Lymph tissue grows rapidly

Child

Lymph tissue grows rapidly till age 12, then atrophies

7

Child or adult:
Smaller nares

Child

8

Child or adult:
Smaller oral cavity

Child

9

Child or adult:
Large tongue

Child

*risk for obstruction since they have a large tongue but small oral cavity

10

What kind of epiglottis does the child have?

Long, floppy epiglottis which is vulnerable to swelling

11

What is higher in the neck for a child..what does this mean?

Larynx and glottis is higher in the neck--risk of aspiration

12

What cartilage is immature in the child and can collapse?

Thyroid, cricoid, tracheal cartilage

13

Do children have few or lots of functional muscles in airway

Few

14

Children have ____ amounts of soft tissues and loosely anchored mucus--risk of edema and obstruction

Large

15

Respiratory: What is the focus for adults-airway or cardio?

Cardio

16

T/F: Chest wall is inflexible in infants and children

FALSE--it is flexible--their chest muscles are immature and ribs are cartilaginous---this is why you see their retractions so well

17

Location of retractions for mild distress?

Intercostal (between ribs)

18

Location of retractions for worsening distress?

Substernal & subcostal

*below the sternum and ribs

19

Locations of retractions for severe distress?

Supraclavicular
Suprasternal

*Use of accessory muscles: sternocleidomastoid and trapezius

20

What is laryngotracheobronchitis (LTB)? And what age?

Aka croup; Moderate to severe airway obstruction caused by inflammation of larynx, trachea, and large bronchi

Ages 1-3

21

What is the classic sign of laryngotracheobronchitis (LTB)/Croup?

Inspiratory stridor

22

How does LTB begin?

With simple URI for 1-2 days and infection descends

23

Since LBT causes problems to larynx, trachea, and large bronchi...what symptoms will occur first: laryngeal, tracheal, bronchial? Describe.

Laryngeal

-Stridor, brassy, barking, or seal like cough

24

LBT: Laryngeal symptoms occur first..Then what?

Inflammation of the trachea and bronchi

-Resp obstruction (secretions, swelling of mucosa, muscle spasms)

25

What are some other s/s of LBT?

Hoarseness
Mild fever
Restlessness
Nasal flaring
Retractions
Hypoxia
Respiratory fatigue

26

What is treatment for mild croup?

Can manage at home if no strider at rest

Oral fluids encouraged if RR is under 60

Cool mist humidifier, steam from shower, go outside in cool night air

Fever control: Acetaminophen

27

What is treatment for severe croup?

If stridor is constant--GO TO HOSPITAL

Oxygen is needed

Nebulized racemic epi or nebulized corticosteroids

Pulse ox needed

28

Severe croup: What is nebulized racemic epinephrine?

Alpha adrenergic causing vasodilation of mucosa

29

General term applied to a complex of symptoms characterized by a barking cough (swelling of larynx)

Croup

30

Mild or severe croup: croup cough, hoarseness, no stridor at rest

Mild

31

Mild or severe croup: continuous stridor, retractions, use of accessory muscles

Severe

32

A potentially life threatening condition that occurs when the epiglottis swells, blocking the flow of air into your lungs

Epiglottitis

33

What is the epiglottis?

A small cartilage lid that covers your windpipe

34

What are 3 ways to get epiglottis?

Bacterial (comes from H flu if not immunized)

Staph

Strep

35

Is inflammation of the epiglottis a medical emergency?

YES

36

What is the hallmark sign for Epiglottitis?

Drooling

37

Epiglottitis: Describe the S/S?

*Hallmark: Drooling

Others:
-Very sore throat
-Refuse to swallorw
-*Prefers UPRIGHT TRIPOD POSITION with chin out and mouth open
-Muffled voice
-Reluctant to cry/speak
-Retractions
-Anxiety, fever
-*Epiglottis is SWOLLEN AND CHERRY RED

38

How is epiglottitis diagnosed?

"Thumb sign" in lateral X-ray verse the normal little finger shape of the trachea

*must take lateral X-ray of neck

39

Epiglottitis: Is intubation necessary?

May be depending on how closed the airway is due to inflammation

40

Epiglottitis: What antibiotic?

Methyprednisolone

41

Epiglottitis: Why would we give IV steroids?

To help with inflammation

42

Is epiglottis seen much still today?

No seen as much because of the Hib vaccine

43

Sudden onset of symptoms of obstruction of airway of varying degrees due to inhalation of object

Foreign body aspiration

44

If a FB is taken in through nose, where can it move to?

Into lower structures

45

FB aspiration is common in what ages?

Toddlers, 1-3

46

What do the symptoms of FB inhalation depend on?

-Size of object
-Where object lands in resp. tree
-If it was witnessed or unwitnessed

47

FB: If it was unwitnessed, what may be the first indication that event has occurred?

Infection

48

FB: If there is partial obstruction and the patient is moving air what do we do?

Go to ED

49

FB: Partial obstruction signs?

Coughing and wheezing but continues to move air with decreased breath sounds or absence of breath sounds in lung segment

50

FB: What are signs of total obstruction?

Cyanosis
Cant speak
Collapse
*can cause death!!

51

FB: What do we do for total obstruction for a child under 1 year?

Back blows, chest thrusts

52

FB: What do we do for total obstruction for an older child?

Abdominal child

53

What are choking hazard foods?

-Hot dog
-Nuts
-Grapes
-Veggie pieces (carrots, peas, beans, corn)
-Popcorn
-PB
-Gum
-Hard candy
-Small parts of balloons
-Coins
-Beads
-Buttons
-Pins

54

What are management for FB?

Xray: object is visible on chest xray

Surgery: Laryngoscopy and bronchoscopy

55

Signs of a foreign body in the nose:
-What kind of discharge?
-What kind of obstruction?

Unilateral nasal discharge that is foul smelling

Local obstruction with sneezing and mild discomfort

56

Foreign body in the nose: Discomfort may ____ in time, especially as objects may grow bigger as it absorbs moisture. Local _____

Increase in time

Local mucosal swelling

57

Foreign body in the nose: Can infection occur?

Yes, followed by foul breath and purulent or bloody discharge from one nostril

58

What is a lower respiratory tract (RSV) problem?

Bronchiolitis

59

What are the initial signs and symptoms of bronchiolitis?

URI with fever, sneezing, rhinorrhea, coughing, and anorexia

60

What are the signs after a few days of having bronchiolitis?

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

61

What are some treatments for bronchiolitis?

-Home rest
-Chest x ray
-RSV culture
-Possible hospitalization

62

What are meds for bronchiolitis?

Bronchodilators
Corticosteroids
Humidified O2

63

Bronchiolitis (LRT-RSV) is very common. When is the higher incidence?

95% of kids have by age 3; winter and early spring usually

64

What is an upper respiratory infection?

Strep pharyngitis

65

Strep pharyngitis: majority or bacterial or viral?

Viral

66

Strep pharyngitis: What do we do if it is bacterial or suspect it to be bacterial?

Throat culture

67

S/S of strep pharyngitis?

-Sudden onset of sore throat/fever
-Headache
-Abdominal pain
-Vomiting
-Poss rash
-Lyphadenopathy (neck)
-Neck pain

68

Poss rash is a s/s of strep pharyngitis. What is this?

Fine, sandpaper like rash

69

What is the treatment for pharyngitis?

Oral penicillin G for 10 days

70

Oral penicillin G is given for treatment of strep pharyngitis. What is given to penicillin sensitive patients?

Erythromycin

71

Strep pharyngitis: What can we put on the neck? What can help soothe the throat?

Neck: warm or cool compress

Mouth: Gargle with warm saline

72

Tonsillitis have a ___ throat and difficulty ____

Sore throat and difficulty swallowing

*have a fever

73

Tonsillitis patients have a history of what?

Otitis media and hearing difficulities

74

Tonsillitis: Nose or mouth breathers?

Mouth breathing and snoring; have mouth odor

75

Tonsillitis: What kind of qualities are heard in the voice

Nasal

76

Tonsillitis: What kind of inflammation?

Tonsil inflammation with redness and edema

*small patches of yellowish pus also may become visible

77

What is a tonsillectomy?

Removal of the palatine tonsiles

78

Tonsillectomy is removal of the palatine tonsils. Where are these palatine tonsils located?

Both sides of oropharynx

79

What is an adenoidectomy?

Removal of the pharyngeal tonsils

80

What is another name for pharyngeal tonsils?

Adenoids

81

What is the normal color for TM?

Translucent
Slightly pink of grey

82

When we shine the light in an ear of a patient with a normal TM, what should we see?

Well defined light reflex, and the cone shaped reflection (points away from face)

83

Inflammation of middle ear without reference to etiology or pathogenesis

Otitis media

84

Infection of the structures of the middle ear with rapid clinical symptoms of infection

Acute otitis media

85

S/S of acute otitis media?

-Pain and irritable
-Fever and rhinorrhea
-Decreased appetite
-Ruptured TM (will be non transparent grayish color)

86

Treatment for acute otitis media?

Antibiotics for at least 10 days

87

How do we look in ear of a child less than 3?

Pull pinna down and back

88

T/F: Many acute otitis media infections can clear up spontaneously in a few days

True

89

What if a child has recurrent otitis media?

1. Tympanostomy tube placement
2. Adenidetomy

90

What does a tympanovstomy tube placement do for a child with recurrent otitis media?

They are pressure equalizer tubes and spontaneously fall out in ~6 months

91

Otits media problems are mostly related to eustachian tube malfunction. How are these tubes in children?

Short and more horizontal

92

Otitis media: What age is this common in?

First 24 months of life and again during school (5-6)

*infrequently after age 7

93

What months and homes are otitis media cases common in?

-Winter months
-Homes with second hand smoke

94

What other illnesses/disorders increase risk of otitis media?

Down Syndrome
Cleft lip/palate

95

Lower or higher risk of otitis media in those who are breastfed?

Lower

96

Collection of fluid in the middle ear but not infection

Otitis media effusion

97

"Swimmers ear"--infection of outer ear canal.

Otitis externa

*inflammation of skin of ear canal

98

FB: How do we remove soft objects (paper, insects)?

With foreceps

99

FB: How do we remove small, hard objects (like pebbles)?

Suction tip
Hook
Irrigation

100

FB: When is irrigation contraindicated?

If subject is a vegetative matter (beans, pasta) because it will swell with fluid

Decks in Pediatrics-MJ Class (61):