Respiratory EXAM 4

Virus vs. Bacteria

Virus- Must have a host to reproduce and attacks specific cells, tx focuses on alleviating sx

Bacteria - Reproduce on their own, survives in extreme environments and are treated with antibiotics

How does pediatric anatomy increase risk of infection

Diameter of airways is smaller

Distance between structures is shorter, allowing organisms to rapidly move down

Short and open eustachian tubes

How does age factor into ped respiratory illness?

< 3 months maternal antibodies offer protection

3-6 months infection rate increases

Toddlers and preschoolers have a high rate of viral infections

5+ yrs see an increase in strep and mycoplasma pneumoniae infections

Increased immunity develops with age

Risk factors for respiratory infections

Immunocompromised, allergies and asthma, cardiac anomalies, cystic fibrosis, exposure to infections in daycare and second hand smoke

What are some of the seasonal variations

Most common during winter and spring

Mycoplasmal infections are more common in fall and winter

Asthmatic bronchitis is more frequent in cold weather and RSV is typically winter and early spring

Pharyngitis Cause, s/sx

Cause is bacterial or viral (80-90%)

S/SX: No sx to severe toxicity

• Onset often abrupt

• Headache, fever, and abdominal pain

• Pharynx and tonsils may be inflamed w/ exudate

• Tongue may be edematous and red ( strawberry tongue) along with Uvula

• Sandpaper rash on trunk, axillae, elbow, and groin (scarlet fever/ group A strep)

• Anterior cervical lymphadenopathy

Pharyngitis Diagnostic and therapeutic/nursing management

Diagnosed w/ throat culture

Therapeutic - antibiotics if bacterial

Nursing - Cold or warm compresses to the neck, warm saline gargles, cool liquids or ice chips, DISCARD TOOTHBRUSHES

CHILDREN ARE CONSIDERED INFECTIOUS TO OTHERS UP TO 24 HOURS AFTER INITIATION OF ABX

Tonsillitis causes , s/sx, diagnostics

Causes: Bacterial or viral

S/SX: Edema, erythema, diff. swallowing or breathing, snoring. white or yellow patches on tonsils

Diagnosed w/ culture

Tonsillitis therapeutic and nursing management

Therapeutic - ABX if bacterial and tonsillectomy

Nursing - Minimize activities that precipitate bleeding, soft to liquid diet, ice collar,

WATCH FOR CONTINUOUS SWALLOWING WHICH IS AN EARLY SIGN OF BLEEDING

Influenza causes, s/sx, and diagnostic

Causes - A/B epidemic or C milder disease

S/sx: flushed face, myalgia, lack of energy, fever, chills, congestion, N/V

Diagnosed w/ nasal swab

Influenza therapeutic and nursing considerations

Therapeutic - Symptomatic tx, antiviral drugs ( Symmetrel, ramantadine, zanamivir, tamiflu), Vaccine for prevention

Nursing - Handwashing education, alert for secondary infections, hydration, no aspirin (reyes syndrome)

Otitis Media Cause, s/sx, diagnosis

Cause - Growth of pathogen in the middle ear usually proceeded by viral respiratory infection (RSV, influenza)

S/Sx: Crying, fussiness, restlessness, irritability, rolling head from side to side, pulling on ears and loss of appetite

Diagnosis: Acute - Observable inflammation of middle ear ; Effusion - fluid in middle ear space, feeling of fullness in ear

Otitis Media Therapeutic and nursing considerations

Therapeutic - Pharmacologic, surgical (Myringotomy)

Nursing - Pain management, post-operative care, education, prevention of reoccurrence

Infectious Mononucleosis cause, s/sx, diagnosis

Cause - Epstein barr virus

S/SX - Appears after 30-50 day incubation period w/ general infection sx of fever, aches, sore throat, and fatigue

Diagnosed w/ lab tests

Infectious Mononucleosis therapeutic and nursing considerations

Therapeutic - No vaccine or med, treat sx

Nursing - Educate that it is transmitted through saliva, common among adolscents

Acute Epiglottitis cause, s/sx, diagnosis

MEDICAL EMERGENCY

Cause - Viral agents and caustic (Smoke, foreign bodies, agents)

S/SX: Abrupt onset that can progress to severe respiratory distress

• 4 D’s - Dysphagia, dysphonia, drooling and distress

Diagnosis is the clinical presentation - MUST PROTECT AIRWAY, ONLY INSPECT THROAT IF INTUBATION IS POSSIBLE

Acute Epiglottitis therapeutic and nursing considerations

Therapeutic - Abx therapy if bacterial, and manage airway

Nursing - High prob of intubation, never use tongue depressors or take a throat culture, Hib vaccine

Acute Laryngotracheobronchitis (LTB) cause, s/sx, diagnosis

Cause - RSV, Parainfluenza virus, Mycoplasma pneumoniae, influenza A and B

• Most common in children under 5

S/SX - Inspiratory stridor, BARKING OR SEAL LIKE COUGH, suprasternal retractions, resp. Distress and hypoxia

Diagnosis: Clinical presentation and swab

Acute Laryngotracheobronchitis (LTB) therapeutic and nursing considerations

Therapeutic - maintain airway, high humidity and cool mist, inhaled meds steroids and vasoconstrictors

Nursing - Education, observation, hydration

Bronchitis Causes, S/SX, diagnosis

Causes - Predominantly viral, M. Pneumoniae can cause in children greater than 6

S/SX: Cough that worsens at night, starts as non-productive then becomes productive after 2-3 days

Diagnosis: Clinical presentation

Bronchitis therapeutic and nursing management

Therapeutic - sx tx: antipyretics, analgesics, humidity, and cough suppresants

Nursing - May become chronic, cough suppressants can interfere w/ clearance of secretions

should be screened for tobacco or weed use if recurring

Bronchiolitis and RSV Cause, S/SX, diagnostic test

Cause - RSV

S/SX - Begins with uri sx: wheezing, sneezing eye/ear drainage, fever pharyngitis

• Progress w/ increased coughing/wheezing, tachy and cyanosis

• Severe- Tachy, listlessness, apnea, diminished breath sounds

Diagnosis - Nasal wash test for RSV antigen

Bronchiolitis and RSV management and considerations

Management: Humified oxygen, hydration, airway maintenance, nasal suctioning

Considerations: Droplet and contact precautions, Education, severe infection in first year of life increases risk for asthma

Status Asthmaticus

MEDICAL EMERGENCY

characterized by severe asthma exacerbation that doesn't respond to typical treatment and may require hospitalization.

Tx: Humidified oxygen, bronchodilators, anti-inflammatory, muscle relaxants

Considerations: IV initiation for fluids and medications

Cystic Fibrosis

Autosomal recessive trait that increases viscosity of mucous gland secretions resulting in mechanical obstructions

Thick mucoprotein accumulates, dilates, precipitates and forms CONCRETIONS in glands and ducts

CF manifestations

FTT, Respiratory depression, cyanosis, clubbing, Meconium ileus (first sx), CHILD TASTES SALTY

CF diagnosis

Sweat chloride test - Results would be 2-5times greater

Chest X-ray

Stool fat and enzyme analysis

Barium enema

How does CF affect the GI tract'

Thick secretions block ducts and prevents pancreatic enzymes from reaching the duodenum leading to malabsorption of nutrients (Azotorrhea) and steatorrhea.

CF nursing considerations

Respiratory Management:

• CPT, transplantation, and forced expiration abx for infections and bronchodilators

GI Management:

High protein and caloric diet, Salt supplementation, Replacement of pancreatic enzymes, reduction of rectal prolapse

What position should the child lay after a respiratory emergency

Side laying to prevent aspiration