peds respiratory disorders and infectious diseases

when do the sphenoid and maxillary sinuses develop in children?

3-7 years of age

how is the respiratory tract different in children?

have narrowed, funnel shaped airway

their head anatomy leads to greater risk of obstruction

infants have smaller nares and are obligatory nose breathers

oxygenation vs. ventilation

amount of oxygen in the blood

vs.

how well the lungs are moving air

respiratory therapeutics used in children

• humidification

• inhalation devices

• coughing, chest physiotherapy

• airway-clearing devices

• oxygen administration

• incentive spirometer

• pharmacologic therapies

• tracheostomy

nasopharyngitis (common cold)

mostly viral; is an upper respiratory infection

assess for nasal congestion, watery rhinitis, low-grade fever, cough, sore throat, swollen/palpable cervical lymph nodes

risk factors: school/daycare attendance

interventions: supportive care, fever control, no antibiotics, nasal saline, cool mist humidifier

pharyngitis

infection and inflammation of the throat; mostly happens in the winter

mostly viral

assess for throat pain, enlarged cervical lymph nodes, erythema

if bacterial, assess for white exudate, petechiae, headache, stomach ache, rash

interventions: antipyretics (warm water gargle), antibiotics if bacterial, hydration, nutrition

epistaxis (nosebleeds)

can be caused by trauma or irritation

assess for bleeding from nare (rarely bilateral)

risk factors: dry air, untrimmed nails, strenuous exercise, allergic rhinitis

interventions: remain upright, tilt head forward, apply pressure to area, minimize crying and stress, do not blow or insert tissues

when to refer a patient with epistaxis

• cannot stop after 20 minutes with pressure

• interferes with breathing

• leads to vomiting

• high blood pressure

• easy bruising, petechiae

• injury

laryngotracheobronchitis (croup)

inflammation of the larynx, trachea, and major bronchi

usually viral

risk factors: fall/winter, 6m-3y, underlying conditions with narrowed airways

manifestations and interventions of croup

• barking cough, usually at night

• retractions

• inspiratory stridor

use inhaled/nebulized corticosteroids, humidified air, and give fluids

influenza

inflammation of the airways of the lower respiratory tract

risk factors: young, immunocompromised, seasonal - winter, close contact with infected people

assess for: cough, fever, fatigue, body aches

interventions: oseltamivir for children with cardiac and respiratory risk factors; annual vaccine

bronchiolitis

inflammation and edema of the fine bronchioles and small bronchi

most commonly caused by RSV

assess for: cough, wheeze, retractions, low grade fever, respiratory distress; can increase and last 2 weeks

interventions: hydration, nasal suctioning and saline, antipyretics, vaccine

bronchitis

inflammation of the major bronchi

usually viral

risk factors: fall/winter, school-aged children

assess for: fever, hoarse cough that is mildly productive and wakes them from sleep, rhonchi, crackles, rales

do chest X-ray

asthma

chronic inflammation of the respiratory tract

most common chronic illness in children

usually presents before the age of 5

can have viral and/or environmental triggers (tobacco smoke, pollen, mold, pollution)

manifestations: expiratory wheeze, chest tightness, hoarseness, cough

interventions: peak flow rate monitoring, drug therapy, trigger avoidance

quick relief (albuterol) inhalers vs. long-acting control medications for asthma***

used to treat immediate symptoms

vs.

ex. fluticasone; used daily to prevent asthma attacks

proper spacer technique

1. Make sure their lips cover the entire mouthpiece so there are no gaps

2. sit upright and breathe out gently; hold spacer and puffer level so that they do not tilt up or hang down

3. Press the puffer once to release a dose of the medicine into the spacer. Do not remove the puffer.

4. Allow your child to breathe in and out four times. This usually means leaving the spacer in position for about 15–20 seconds. Do not remove the mask in between each breath – there is a two-way valve system that will prevent any of the medication from escaping from the chamber

cystic fibrosis

chromosomal abnormality; screen in newborns and prenates

characterized by the inability to transport small molecules across cell membranes → thick mucous secretions in pancreas and lungs

can have frequent respiratory infections and can be unable to absorb milk fat

manifestations: failure to gain weight, salty sweat, recurrent respiratory infections

interventions: hydration, nutrition, infection control, aerosol/humidity therapy, chest physiotherapy

varicella (chickenpox)

(chickens fly = _____ precautions)

viral illness; vaccine preventable - 2 doses one at 12-15mo and one at 4-6 years

will have a fever and itchy macules, papules, vesicles appearing in crops around trunk and extremities

need airborne and contact precautions = negative pressure room

can be reactivated later in life as shingles

rubella

viral illness contracted thru direct or indirect contact with droplets

vaccine preventable - 2 doses one at 12-15mo and one at 4-6 years

will have discrete pink-red maculopapular rash on face then trunk then extremities

will also have fever and joint pain

seasonal: spring

dangerous for pregnant women (ella nao pode chegar perto) and their fetus

follow droplet precautions 1-7days following onset of rash

erythema infectiosum (fifth disease = 5 fingers slapping the cheek, parou)

parovirus transmitted through respiratory secretions, exposure to blood, or through utero

self-limiting manifestations; “slapped cheek” rash and pallor around mouth

seasonal: winter through spring

dangerous to pregnant women and their fetus

measles

viral illness transmitted through direct contact with droplets or airborne

vaccine preventable - 2 doses one at 12-15mo and one at 4-6 years

4Cs:

• cough

• coryza (clear nasal discharge)

• conjunctivitis

• Koplik spots (bluish white spots on oral/buccal mucosa)

rash that starts behind the ear and fades to brown (will not fade with pressure)

give vaccine education, assess for early signs, infection control, airborne precautions

infectious mononucleosis

viral infection caused by EBV

manifestations: fever, palatal petechiae, abdominal pain, hepatosplenomegaly, cervical adenopathy (enlarged lymph nodes)

risk factors: 15-24 yrs

due to splenic rupture risk, no contact sports should be done for 4-6w

pain and fever management

pertussis (whooping cough)

bacterial illness that is vaccine preventable (DTap: 2m, 4m, 6m, 15-18m, 11-12 yrs) and is transmitted through direct and indirect contact

will have upper respiratory infection symptoms and a paroxysmal cough with inspiration

impetigo

bacterial illness transmitted through direct contact with lesions

characterized by honey-colored crusts around the face

use prescribed ointments and oral antibiotics

do not share towels

pinworms

helminthic infection - small white threadlike worms that live in the cecum and lay eggs in perianal region (visible to the naked eye)

risk factors: preschool/school aged, thumb sucking, nighttime awakening

teach parents to use flashlight and tape to check

interventions: teach to avoid nail biting, thumb sucking, and how to trim nails

pediculosis capitis (head lice)

parasitic infestation - can see small white flecks on hair shaft (nits and eggs) and will have extreme pruritis