HEENT & Respiratory Disorders in Children

Comprehensive review flashcards covering pediatric HEENT, infectious diseases, immunologic alterations, and respiratory disorders based on lecture notes.

What is the first line of defense in the innate, nonspecific immune response?

Skin integrity (skin and mucous membranes).

What is the definition of epidemiology?

The study of the distribution of health and illness in a population.

In what two ways does active immunity occur?

Either naturally or through vaccine administration.

Why should aspirin never be administered to children presenting with fever or infectious illness?

Due to the risk of Reye's Syndrome.

When should the first dose of the live MMR vaccine (for rubeola and rubella) be given?

After the child's first birthday.

What is the primary risk associated with a pregnant woman contracting Rubella (German measles) during the first trimester?

It causes fetal anomalies.

Which viral infection is known as 'slapped cheek dx' and presents with a bright red rash on the cheeks?

Fifth disease (parvovirus B19).

What mucosal lesions appear during the prodromal phase of Rubeola (measles)?

Koplik spots on the buccal mucosa.

What dietary adjustment is recommended for a child with Rubeola (measles) presenting with Koplik spots?

A soft, bland diet.

Where does the rash of Rubeola (measles) begin, and in which direction does it spread?

It begins behind the ears at the hairline and upper neck, and spreads downward toward the feet.

What is the expected duration of the red, maculopapular rash seen in Rubeola (measles)?

$6\text{ to }7\text{ days}$.

What is Forschheimer's sign, and in which viral disease is it observed?

Reddish pinpoint petechiae on the soft palate, observed in Rubella (German measles).

How does the rash of Rubella (German measles) spread and fade across the body?

It begins on the face, neck, and scalp, spreads downward to the entire body, and fades on the face as it spreads to the trunk.

When does the red rash of Roseola infantum typically appear?

Several hours to $2\text{ days}$ after the fever subsides.

What are the appearance, location, and blanching characteristics of the Roseola infantum rash?

An erythematous, maculopapular, or macular rash (may be surrounded by a whitish ring) that blanches with pressure, located predominantly on the neck and trunk, persisting for $24\text{ to }48\text{ hours}$.

What isolation precautions must be initiated for a hospitalized child with chickenpox (varicella-zoster)?

Strict isolation, including airborne and contact precautions.

Which antiviral medication is prescribed for immunosuppressed children who contract chickenpox?

Acyclovir.

How do the skin lesions of chickenpox progress over time?

They begin as a macular rash, develop into a red papular rash, progress quickly into vesicles with a red base, and then form a crust.

What school accommodation is recommended for a child recovering from Epstein-Barr virus (infectious mononucleosis) who has persistent fatigue?

Attending half-days at school and progressing slowly.

What vaccine prevents pertussis, and what management is required for close contacts of an infected infant?

Preventable with the DTaP vaccine; prophylactic antibiotics should be administered to all individuals in close contact with the infant.

How does the tongue change during the progression of Scarlet fever?

It initially has a white furry coat with red projecting papillae (white strawberry tongue), and by day $4$, the white sloughs off leaving a red swollen tongue (strawberry tongue).

Where does the rash of Scarlet fever initially appear, and when does facial desquamation occur?

It begins in the axillae, groin, and neck within $24\text{ hours}$ of fever, and desquamation begins on the face at the end of the first week.

What are the characteristic signs and symptoms of diphtheria, and what serious complication does it cause?

Fever, foul smell from the throat, and a gray covering over the tonsils; it causes airway obstruction.

What antibiotic, isolation precaution, and topical ointment are used in the management of MRSA?

Vancomycin for treatment, Contact Isolation, and Mupirocin ointment applied to the nares if colonized.

How are pinworms diagnosed, and what common behaviors facilitate their transmission in children?

Diagnosed by the scotch tape test; transmission occurs via playing in sandboxes, not washing hands before eating, putting hands in the mouth, and nail biting.

What preventive measure protects against Borrelia infection (Lyme disease)?

Using insect repellent with DEET.

What are the characteristic clinical findings of bacterial vaginosis?

White vaginal discharge with a fishy smell.

What is the only 100% effective way to prevent sexually transmitted diseases (STDs)?

Abstinence.

Which immune cells are chiefly involved in humoral immunity, and which are involved in cell-mediated immunity?

B cells are chiefly involved in the humoral response, while helper T cells are involved in the cell-mediated response.

At what developmental stage does the thymus peak in size?

At puberty.

When does maternal IgG transferred across the placenta disappear from an infant's circulation?

By $6\text{ to }8\text{ weeks}$ of life.

What skin test finding indicates a positive allergy reaction during diagnostic skin testing?

A positive wheal around the site.

Which specific subset of T lymphocytes is affected by Human Immunodeficiency Virus (HIV)?

$\text{CD4}^+\text{ T cells}$.

What three perinatal interventions are used for HIV-exposed infants to prevent transmission?

IV ADV given to the mother during labor, Cesarean birth at $38\text{ weeks}$, and oral ZDV treatment to the infant after birth.

What is the primary nursing goal for HIV-infected infants and children?

To prevent infection.

How should oral anti-retroviral medications be administered if an HIV-infected child refuses them?

Mix with chocolate syrup, pudding, or applesauce (do not mix with hot, starchy, or acidic foods).

What is the primary nursing concern for a hospitalized child with HIV?

Growth and development.

What rules govern live vaccine administration and discontinuation for pediatric patients receiving corticosteroid therapy?

No live vaccines while on steroids, and do not stop long-term therapy abruptly (taper off gradually).

What skin protection recommendation is critical for a patient diagnosed with systemic lupus erythematosus (SLE)?

Use sunscreen.

How is a blood transfusion reaction from incompatible blood classified among hypersensitivity reactions?

Type II: cytotoxic hypersensitivity.

What are examples of Type I (immediate/anaphylactic) hypersensitivity reactions?

Allergic rhinitis, acute anaphylaxis, hives, eczema, and asthma.

What type of hypersensitivity reaction is contact dermatitis from poison ivy?

Type IV: delayed cell-mediated hypersensitivity.

What initial clinical manifestations indicate impending anaphylaxis?

Sneezing; tightness or tingling of the mouth or face with subsequent swelling of the lips and tongue; severe flushing, urticaria, and itching (especially on head and upper trunk); rapid erythema; and a sense of impending doom.

What is the first and most critical priority in managing anaphylactic shock?

Ensure an adequate airway (possibly by endotracheal intubation).

How should a child experiencing anaphylactic shock be positioned?

Keep the child warm and lying flat or with feet slightly elevated.

What clothing colors and fits should be worn to minimize the risk of insect stings?

Select white or khaki clothing, and wear fitted clothing with long sleeves, pants, and shoes.

What anatomical characteristic makes young infants obligatory nose breathers?

Smaller airways and undeveloped cartilage in the respiratory system.

What physical signs on the face are associated with allergic rhinitis in children?

Allergic salute and allergic shiners.

What environmental modifications to bedding are advised for children with pollen and dust allergies?

Wash sheets weekly in hot water, use no wool or down blankets, and place dust-proof covers on pillows and mattresses.

What indoor humidity level should be maintained to control pollen and dust mite allergens?

$40\text{ to }50\%$.

What target indoor humidity level is recommended to reduce mold exposure?

Humidity below $35\%$ (using a dehumidifier).

What clinical timeframe differentiates sinusitis from an uncomplicated cold?

Signs and symptoms of a cold with no improvement after $10\text{ days}$.

What is otitis media with effusion (OME)?

The presence of fluid behind the tympanic membrane without signs of infection, which often follows an episode of AOM and usually resolves in $1\text{ to }3\text{ months}$.

What behaviors in an infant suggest earache (otalgia) caused by acute otitis media?

Pulling their ears or rolling their heads.

What does yellowish-green, purulent, and foul-smelling ear drainage indicate in otitis media?

Perforation of the tympanic membrane.

What otoscopic findings are characteristic of acute otitis media (AOM)?

Bulging, opaque tympanic membrane that usually looks red, with decreased mobility, diffuse light reflex, and obscured landmarks.

What diagnostic findings and hearing thresholds characterize otitis media with effusion (OME)?

Tinnitus, popping sounds, flattened tracing and negative pressure on tympanogram, and conductive hearing loss below $35\text{ decibels}$.

What clinical features distinguish bacterial pharyngitis from viral pharyngitis?

Bacterial pharyngitis has an abrupt onset, high fever ($39.4\text{ to }40\,^\circ\text{C}$), severe sore throat, and associated abdominal pain, headache, and vomiting.

What is the anatomical difference between tonsillitis and adenoiditis?

Tonsillitis is inflammation and infection of the palatine tonsils, whereas adenoiditis is infection and inflammation of the pharyngeal tonsils (adenoids).

What are the clinical signs of postoperative bleeding following a tonsillectomy?

Excessive swallowing, elevated pulse, decreasing blood pressure, fresh blood in the back of the throat, vomiting bright red blood, and restlessness not associated with pain.

What causes congenital laryngeal stridor in laryngomalacia, and when do symptoms resolve?

Flaccidity of the epiglottis and supraglottic aperture due to immature neuromuscular development of the airway; symptoms resolve by $18\text{ to }24\text{ months}$.

What cluster of symptoms characteristically defines croup?

Sudden onset of a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness (often beginning at night).

What are the four cardinal signs and symptoms of epiglottitis (supraglottitis)?

Drooling, dysphagia (difficulty swallowing), dysphonia (difficulty talking), and distressed respiratory efforts.

Why is oral examination or throat culturing contraindicated when epiglottitis is suspected?

Any stimulation by a tongue depressor or culture swab could trigger complete airway obstruction.

What viral pathogen causes approximately 50% of bronchiolitis cases, and what precautions are needed?

Respiratory syncytial virus (RSV); managed with contact isolation and scrupulous hand hygiene.

In which anatomical location do most aspirated foreign bodies lodge in children?

The right bronchus.

How is clinical apnea defined in pediatric patients?

Cessation of breathing for $20\text{ seconds}$ or longer.

What nursing actions are recommended during an infant apneic episode, and what actions are strictly contraindicated?

Tap the infant's foot, maintain a neutral thermal environment, and have resuscitative equipment ready; do not shake or suction the infant.

When should preventative medication be administered to a child with exercise-induced asthma before participating in sports?

$30\text{ minutes}$ before exercise.

What diagnostic sweat chloride value confirms cystic fibrosis, and what prophylactic medication is given to close contacts of an individual with active TB?

A sweat chloride level $> 60\,\text{meq/L}$ confirms cystic fibrosis; daily isoniazid (INH) is administered to close contacts.