Acute Upper Resp. Infections

Acute Upper Resp. Infections

• Sinusitis

• Er infections

• Pharyngitis

• Tonsillitis

• Laryngomalacia

• Laryngotracheobronchitis

  • Croup

• Epiglottitis

Sinusitis

• Bacterial infection of the paranasal sinuses

• Can be acute or chronic

Sinusitis (Sx)

• Similar to a cold

• Bad breath

• Facial pain

• Eyelid edema

• Sx last longer than 10 days

Sinusitis Tx

• 14-day course antibiotics

• Normal saline wash or spray

• Suctioning helps w/ congestion

Ear Infections

• Acute Otitis Media

• Otitis Media w/ Effusion

Acute Otitis Media (AOM)

• Viral or bacterial

• Potential for the eardrum to rupture

  • Drainage is an indication of a rupture

Acute Otitis Media (AOM) Patho.

• URI w/ congestion→ fluid & pathogens from nasopharynx → middle ear

Acute Otitis Media (AOM) Sx

• Ear pain

  • Tugging on the ear is a classic sign at all ages

• Fever

• Poor feeding

  • Not going to feel like eating

• Fussiness

• Night awakening

• Tympanic perforation

  • Drainage (Indication of a rupture)

  • Decreased pain

Acute Otitis Media (AOM) Diagnosis

• Otoscopic examination

• Complaint of ear pain or intense erythema of the tympanic membrane

• Signs of fluid in the middle ear w/ moderate to severe bulging of the tympanic membrane

• Mild illness:

  • Mild pain & T< 102.2 for < 48 hrs

• Severe illness:

  • T> 102.2 or SEVERE pain for over 48 hrs

• If bilateral

  • Will require antibiotics

Acute Otitis Media (AOM) Managment

• Antibiotics

• Analgesics/ antipyretics

• Comfort measures

  • Numbing ear drops

  • Heating pad or ice pack to affected ear

Otitis Media w/ Effusion (OME)

• Fluid is present w/o signs of infection or pain

• May take several months to resolve

• Primary concern is the effect on hearing & language development

Otitis Media w/ Effusion (OME) Management

• In severe cases:

  • Pressure-Equalizing tubes (PE Tubes)

Pressure-Equalizing Tubes (PE Tubes)

• Allows fluid behind the ear to drain

  • Allowing for tympanic membrane movement & adequate hearing

• Outpatient surgery

• PE tubes stay in for several months

  • Falls out on their own

• Antibiotic ear drops may be prescribed

• Education:

  • Earplugs when swimming

  • Fluid may drain from ear w/ future infections

Pharyngitis/ Tonsilitis “Sore Throats”

• Bacterial

  • Group A Strep

• Viral

Pharyngitis/ Tonsilitis “Sore Throats” (Bacteria)

• Sore throat w/o nasal congestion

• Supportive care & antibiotics

• 20-30% caused by Group A Strep (GABHS)

• Tonsillar exudate

  • NOT diagnostic for bacterial infection

  • Good indicator

• White or gray, furry tongue

Pharyngitis/ Tonsilitis “Sore Throats” (Viral)

• Sore throat associated w/ nasal congestion

• Supportive care ONLY

  • Saline gargles

  • Pain relief

  • Hard candy

  • Cool mist humidity

  • Cool liquid/ popsicles

Pharyngitis/ Tonsilitis “Sore Throats” (Diagnostics)

• Rapid test &/or throat culture required

  • Definitive is throat culture

Pharyngitis/ Tonsilitis “Sore Throats” (Bacterial Tx)

• Supportive care

• Antibiotics

  • Penicillin

  • Take the full amount

• Child NOT contagious after 24 hrs on antibiotics

• New toothbrush after on antibiotics for 24 hrs to prevent reinfection

Streptococcal Pharyngitis “Sore Throat” Complications

• Rheumatic fever

  • Jones criteria

  • Valvular damage

• Post-streptococcal glomerulonephritis

  • Gross hematuria w/ proteinuria

  • Facial & peripheral swelling

  • Decreased urine output w/ dark brown urine (Cola-colored)

Tonsilitis/ Tonsillectomy (Pre-Op)

• Check labs

• Check for family Hx for bleeding disorders

• Their tonsils are usually larger

Tonsilitis/ Tonsillectomy (Post-Op)

• Side lying/ HOB up immediately after surgery

• Assess for excessive swallowing (bleeding)

• Blood-tinged mucous expected

• Frank blood

  • Bleeding from surgical site

  • NOT expected

  • May hemorrhage up to 10 days after surgery

  • Medical Emergency

• No red drink, red foods, spicy foods, straws (sutures), avoid coughing, or blowing nose

• Pain mngmnt.

• Maintain fluid volume

Laryngotrachealmalacia

• Congenital flaccidity of the epiglottis & weakness of the airways walls

• Most common cause of inspiratory stridor in neonates

• May have feedings issues

• Educate families on signs of resp. distress, address feeding issues

Laryngotrachealmalacia (Sx)

• Noisy loud, crowing inspiratory sounds

  • W/ or w/o retractions

• Sx increase when supine or crying

  • Hyperextension of the neck improves the stridor

• Sx typically resolve by 18-24 months

  • Usually grows out of it

Laryngotrachealmalacia (Diagnosis)

• Based on history & direct laryngoscopy

Laryngotracheobronchitis “Croups”

• Viral infection of the larynx, trachea, & bronchi

• Lasts 3-5 days

• Sx worse at night

• Affects children 3 months - 3 years

Laryngotracheobronchitis “Croups” (Sx)

• Barky or seal-like cough

• Noisy breathing

• Hoarse voice

Laryngotracheobronchitis “Croups” (Tx)

• Corticosteroid (Dexamethasone)

  • Reduces inflammation

  • Single dose as a shot or oral syrup

• Racemic epinephrine via nebulizer

  • Reduces edema

  • For serious cases

• Home remedies

  • Cool or humidified air helps Tx Sx

  • Open freezer door (Cool)

  • Hot shower (Humidified)

Epiglottitis

• Inflammation of epiglottitis leads to upper airway obstruction

  • Medical emergency

• Caused by:

  • Haemophilus Influenza Type B (Hib)

• Hib vaccine reduces incidence

• NOT viral, it is a BACTERIA

Epiglottitis (Clin. Manifest.)

• Tripod position

  • Supported by arms

  • Chin thrust out

  • Mouth open

• Child drools

• Strident cough

• Irritability or lethargy present

Epiglottitis (Patho.)

• Bacterial infection (haemophilus influenzae B)

• Epiglottis becomes edematous & cherry red

  • High fever

• Edema severe & painful

  • Obstructs airway & trachea

• Complete airway obstruction

• Hypoxia

• Acidosis

• Death

Epiglottitis (Diagnosis)

• Lateral neck X-ray

Epiglottitis (Nursing Interventions)

• Keep child calm & comfortable

• Support tripod positioning

  • NOT flat

• Keep NPO

• IV fluids

• Antibiotics

• Antipyretics

• Corticosteroids

• Humidified oxygen

• Do NOT exam the throat or insert anything into the mouth

  • NO throat cultures

  • NO tongue blades

  • NO oral temp.

• Have intubation tray & trach equipment at bedside

• Prevent w/ Hib vaccine