Health alterations class 18: URTIs

Tonsillitis

Inflammation of the tonsils

Adenoiditis

Inflammation of the adenoids

Children’s tonsil size

Typically have larger tonsils, this is normal

What does tonsillitis occur with

Pharyngitis, may be bacterial or viral

When tonsils become so inflamed and swollen that they are touching

Kissing tonsils

What issues can kissing tonsils/tonsillitis cause

1. Breathing issues

2. Hard to swallow

3. Pain

What issues can swollen adenoids cause

Hard to breath through nose, child breathes through mouth which dries out the mucous membrane and increases infection risk

Why should we do a tonsil swab if we’re suspecting tonsillitis

Tonsils may be swollen from something else such as strep

Therapeutic management of tonsillitis

Self limiting, may need antibiotics if bacterial (viral just treat symptoms)

Surgery

Can help with pain (cold food and drink, soft food)

What can help with tonsillitis pain

Cold, soft foods (no ice cream because dairy thickens saliva)

Tylenol

Ice

Popsicles

Cough drops

Viral:stay home

When is surgery done for tonsillitis

When it’s recurring

Pre op assessment for tonsillitis

1. Recent URTIs

2. Elevated temp

3. Allergies

4. History of bleeding tendencies

5. Uncontrolled illness (such as diabetes)

6. Family history of reaction to anesthetic or history of bleeding

7. Loose teeth (will have to remove, aspiration risk)

Post op care for tonsillitis

1. Side lying or prone position (want secretions to fall out of mouth, risk for aspiration if not)

2. Moniter vital signs

3. Moniter for bleeding

4. Small amounts of fluid when fully awake (avoid red, brown or straws)

5. Relieve throat pain

6. Home management instructions

Complications of influenza

Pneumonia, secondary infections, encephalitis

Therapeutic management of influenza

Treat symptoms (acetaminophen, ibuprofen, rest, fluids, tamiflu)

Prevention of influenza

Vaccine (2 doses for first time, one a year after)

Otitis media

Inflammation of middle ear with or without effusion

Causes of otitis media

strep pneumonia or H.influenza

Peak incidence of otitis media

6 months-2years, 5-6 years

Types of otitis media

Acute, chronic, or acute with effusion

Why are children more prone to ear infections

Their Eustachian tubes are horizontal, short and wide so fluid goes back easier

Risk factors for OM

1. Second hand smoke

2. Daycare,preschool, kindergarten.,,

3. Supine position when eating or drinking (open up Eustachian tubes)

Possible complications of OM

Temporary or permanent hearing loss, mastoiditis or meningitis

Management of OM

Antibiotics, antipyretics, analgesics

What does a blading tympanic membrane indicate

Fluid is built up (will be red/green and painful)

Nursing considerations for OM

1. Relive pain (Tylenol or Advil)

2. Facilitating damage (lie on side with fluid)

3. Prevent complications or recurrence (take all ABs)

4. Support and educate family (may need tube to drain fluid if recurrent)

Considerations for a tympanic tube

Keep ears dry until certain it’s out!

Signs of OM in infants

Crying, irritable, touching or pulling at ears or trying to pop their ears, febrile

Pneumonia

Inflammation of pulmonary parenchyma, may be primary or secondary disease (after influenza etc)

Pneumonia is most frequent in

Early infancy/ childhood and young adulthood

Bacterial pneumonia

Appear I’ll

Fever, shallow resps,

Treatment if bacterial pneumonia

AB, bed rests fluids, antipyretics

How to help pain from pneumonia

Lie on the side that hurts, if both sides hurt then splint with a pillow while coughing

Viral pneumonia

Occurs frequently (from RSV or influenza)

Treatment if viral pneumonia

Treat symptoms, promote oxygenation (breathe cold air, from mister or outdoors, Fridge), comfort (antipyretics), fluids

Will run its course

General symptoms of pneumonia

1. Fever and chills

2. Resps signs- cough (may vomit from excess coughing), tachypnea (aspirations risk), chest pain, retractions

3. Irritable, restless

4. Anorexia, vomiting (from excessive coughing)

Therapeutic management of pneumonia

Antibiotics (if bacterial) and oxygen

Close monitoring (especially of resp status)

Bed rest, hydration, antipyretics

Pneumonia potential complications

Prognosis is usually good

Pneumothorax

Otitis media

Pleural effusion

Who is at risk for aspiration pneumonia

Children with feeding difficulties (use techniques such as sitting up to eat, hand on chin etc)

What to avoid with aspiration pneumonia

Talcum powder and oily nose drops

When are bronchiolotis and RSV most prevalent

Winter-spring (November to march)

Bronchiolotis and RSV

Spreads by direct contact

Bronchiolar muscosa swell, lumina fill with exudate causing interstitial pneumonitis, hyper inflammation and air trapping

Initial clinical manifestation of RSV

Rhinnorhea (can loosen by keeping hydrated)

Pharyngitis

Coughing

Intermittent fever

Progressive clinical manifestation of RSV

Increased coughing

tachypnea

Retractions

Wheezing

Severe RSV clinical manifestations

Listlessness

Increased tachypnea

Apneic spells

Deteriorating breath sounds

Therapeutic management of RSV

Cool, humidified oxygen (Moniter pulse ox)

Fluids (thin secretions and prevent dehydration)

Airway maintenance (chin up)

Isolation

Bronchodilators

When might a pt become NPO

If they are tachypnic

Prevention of RSV

Vaccine (every month of RSV season)

Nursing care of RSV

Separate rooms

Droplet or contact precautions

NS nose drops and bulb syringe if not NPO

Educate parents on bulb syringe for nasal secretions

Croup main characteristics

Barking/brassy cough and varying degrees of respiratory distress from, the swelling or obstruction in larynx, hoarseness

Infant and children airway

Small diameter

What are most croup cases caused by

Viruses due to Immunization

What does croup affect

Larynx, trachea, bronchi

Types of croup

Epiglottis

Laryngitis

LTB

Tracheitis

Acute epiglottis

Medical emergency!

Usually in children 2-5

Abrupt onset

Clinical manifestations of acute epiglottitis

Drooling (main difference), difficulty swallowing

Tripod positioning

Sore throat

Inspiratory strider, mild hypoxia

Fever, irritable, restless (can’t breathe)

Frog like croaking (not hoarse)

Therapeutic management of acute epiglottitis

Prevent progressive respiratory obstruction (hypoxia, acidosis, obstruction, death)

Intubation or tracheostomy (looking in mouth can make swelling worse so intubate immediately)

Acute LTB

Most common croup syndrome

Affects children under 5, often preceded by URTISs

LTB manifestations

Low grade ever, inspiratory stridor

Suprasternal contractions

Barky seal like cough and hoarseness

Increasing respiratory distress and hypoxia

Can progress to respiratory acidosis, failure and death

Therapeutic management of LTB

Airway management (cool mist)

Hydration (oral or IV)

High humidity with cool mist (outside, fridge, freezer)

Nebulizer treatments (epinephrine, budoneside)

Oral steroids for 3-5 days (IM dexamethasone)

Observation and assessment

Acute spasmodic laryngitis

Spasmodic croup

Paryoxomal attacks of laryngeal obstruction, occurs mainly at night and child feels better in the morning

Bacterial tracheitis

Infection of mucous on URT

Different from croup but similar symptoms

Bacterial tracheitis clinical manifestations

Similar to LTB but doesn’t respond to same tx

Previous URTI with croup cough, strider and no drooling or Dysphagia, high fever

Thick perulent secretions and elevated WBC (respiratory distress)

Therapeutic management of bacterial tracheitis

Antipyretics

Antibiotics

May need intubation