CH. 41, 45, 42, 48, 40, 43, 44, 49
what are innate nonspecific immune responses?
first line of defense
skin and mucous membranes
smooth muscle contraction and ciliary actions (bladder and bowel emptying; sneezing and coughing)
physical and chemical membrane
what are adaptive specific immune responses?
recognizes and imprints on the pathogens (specific)
cell mediated and hormonal
phagocytosis: the process by which phagocytes digest and thereby destroys foreign mechanisms
what is the first stage of infection?
incubation: exposure
what is the second stage of infection?
prodrome: feeling a little sick, but not having all the symptoms
what is the third stage of infection?
illness: full blown illness (all symptoms)
what is the fourth stage of infection?
convalescent: severe illness or further complications
this can also be where you evaluate if the infection is healing or not
why should you document lesions?
to see if it’s gotten worse or better
use a marker on the lesion
what is the first vital sign change we notice first with infections?
change in temperature
what is rubeola (measles)?
infectious period: 4 days before the rash appears and 4 days after
source: respiratory tract, urine, or blood of infected person
what are the s/s of rubeola?
fever, malaise, rash, koplik’s spots, photophobia
3 C’s: coryza, cough, conjunctivitis
the spots can be on the buccal mucosa
what is the treatment for rubeola?
dim the lights for photophobia
antipyretics
vitamin A supplements
vaporizer
what is roseola (exanthem subitum)?
agent: human herpesvirus type 6
infectious period: may be from time febrile symptoms occur to when the rash appears
what are the s/s of roseola?
sudden high fever 3-5 days; febrile seizures can occur
rash; rose-pink macules that blanch with pressure
rash appears 1-2 days after the fever subsides
what is the treatment of roseola?
symptomatic
fever control
what is varicella (chicken pox)?
infectious period: 1-2 days before the onset of rash to 6 days after the first crop vesicles (when the lesions are crusted over)
precautions: contact and airborne
can be spread through lesions
what are the s/s of varicella?
slight fever, malaise, anorexia
rash appears on the trunk and scalp then moves to face and extremities
lesions becomes pustules and then crusts over; becomes very itchy
what are children more susceptible to with varicella?
infections
scratching their lesions; open wounds
what is the treatment of varicella?
acyclovir for children who are immunocompromised
VCZ immune globulin or IVIG is recommended for immunocompromised children
what is scarlet fever?
infectious period: until 24 hr antimicrobial therapy has begun
source: nasopharyngeal secretions of infected persons or ingestion of contaminated milk (breast feeding)
what are the s/s of scarlet fever?
abrupt high fever, flushes cheeks, vomiting, headache, enlarged lymph nodes
red fine sandpaper-like rash develops in the armpits, groin, and neck
skin can start sloughing off like a sheet
strawberry tongue
white to red
what is the treatment for scarlet fever?
antibiotics such as penicillin for 10 days
supportive care
what is rocky mountain spotted fever?
agent: gram negative bacteria (Rickettsia rickettsia)
source: wild rodents, dogs
vector: ticks (wood, dog, lone star)
what are the s/s of rocky mountain spotted fever?
nonspecific
headache, fever, anorexia, restlessness
third day
maculopapular or petechial rash appears
on wrists, palms, ankles, and soles
hemorrhagic and necrotic lesions can appear as the rash progresses
what is the treatment for rocky mountain spotted fever?
early detection and treatment within 5 days of the beginning of illness
doxycycline (5-7 days) until the child is afebrile for 3 days
avoiding ticks is the most effective way to prevent
what two STDs go hand in hand?
chlamydia and gonorrhea- treat both!
what vaccine prevents whooping coughing?
pertussis vaccine given with DTaP
at the age of 11-12 years Tdap is recommended for children who have complete DTaP
how long is a period of apnea?
cessation of breathing for 20 secs or longer
how should a nurse plan their care throughout the day for a infant with whooping cough?
clustered care if possible to allow the child and parents’ to rest
can a child with whooping cough receive a bottle?
no, small, frequent feedings may benefit the baby more such as gavage or parenteral
what is whooping cough?
occurs in children who are not immunized
agent: Bordetella pertussis
highly contagious; airborne precautions
incubation period: usually 10 days
what is a common complication seen with pertussis?
pneumonia
what are the stages of pertussis?
incubation
catarrhal
paroxysmal
convalescent
what is the catarrhal phase of pertussis?
last 1-2 weeks
low grade fever
cough
nasal congestion
VERY contagious in this phase!
also best time to diagnose and kill bacteria
what is the paroxysmal stage of pertussis?
lasts 1-6 weeks
uninterrupted series of coughing(increased severity)
whooping noise- older children may not manifest this
cough may induce vomiting
cyanosis
protrusion of tongue
salivation
distention of neck veins
anorexia
how might infants be affected by whooping cough during the paroxysmal phase?
apnea, a.l.t.e (apparent life-threatening event), decreased O2 levels, cyanosis, or death
what is the convalescent phase of pertussis?
lasts greater than 2 weeks
cough slowly improves
airway heals
what are the respiratory differences in children?
they code more from respiratory than cardiac
smaller airways and undeveloped cartilage
increase work of breathing
infants have smaller nares and narrow nasal passages
brief apneic periods are common in newborns
what may be some clinical manifestations of respiratory infections in children?
fever
under age of 3, at risk for febrile seizures
decreased appetite, N/V/D, and abdominal pain
at risk for dehydration
breathing impairment
increased respirations
respiratory sounds
increased work of breathing
retractions
oxygen desaturation
cough. sore throat, nasal blockage, or discharge
ABCs!
what diagnostic tests are used for respiratory infections?
ABGs
vomiting-metabolic alkalosis
diarrhea- metabolic acidosis
test for RVP (respiratory viral panel) to know what precautions to be on
always use droplet precautions before testing
how can you decrease a child’s work of breathing?
oxygen administration
how can you promote hydration?
IV fluids; Pedialyte; monitor I&O
what do you do when an infant is tachypneic >60 BPM?
NPO order; prevent aspiration
what can hyperextending a child’s neck do?
can occlude a child’s airway
what is sinusitis?
often follows other infections such as allergic rhinitis or otitis media
s/s of cold, but no improvement after 10 days
TX: surgery
what is nasopharyngitis?
common cold
TX: supportive care- decrease respiratory effort
very contagious- prevent the spread!
what are croup syndromes?
refers to a group of conditions characterized by inspiratory stridor, a harsh (brassy or croupy) cough, hoarseness, and varying degrees of respiratory distress
“barking” or seal-like” cough
affects the larynx, trachea, and bronchi
acute laryngotracheobronchitis (LTB) and acute epiglottis
what does stridor indicate?
emergency
wheezing heard without a stethoscope
INDICATES upper airway occlusion
what is acute epiglottitis?
medical emergency- life threatening
intubate immediately before trach
do NOT irritate the airway- will cause more inflammation
what are the common s/s of acute epiglottitis?
drooling indicates airway is closed and they can’t swallow
tripod position helps the pt. breathe better
why should the parents stay calm for the child during respiratory distress?
to reduce distress and relax the airway
crying can aggravate laryngospasms and increases hypoxia
how can you treat a “barking” cough at home?
keep the child in a bathroom with a steaming shower or use a cool-mist vaporizer
what is acute laryngotracheobronchitis (LTB)?
most common croup syndrome
can progress to respiratory acidosis and respiratory failure
usually affects infants and toddlers; age 6 months to 6 years
what is the TX of acute laryngotracheobronchitis?
keep calm and relax airway- steam
maintain hydration
may give nebulizer of epinephrine or steroids, but may not always work
possibility of further closing of airway
what is bacterial tracheitis?
bacteria causative
thick purulent secretions that result in respiratory distress
similar s/s of of LTB
can be a complication of LTB
what is the treatment of bacterial tracheitis?
humidified oxygen. antipyretics, antibiotics, possible need for intubation
what is strep throat?
cause: group A B- hemolytic streptococcal infection
risk for rheumatic fever and acute glomerulonephritis
contagious- not contagious after 24 hours of antibiotic therapy
what are the s/s of strep throat?
pharyngitis
headache
fever
abdominal pain
tonsils and pharynx may be inflamed and covered in exudate
what is the treatment for strep throat?
oral penicillin such as amoxicillin for at least 10 days to control symptoms
cephalosporins may be used in case of allergy to penicillins
what is tonsillitis?
usually occurs with pharyngitis
can be bacterial or viral
inflammation causing kissing tonsils- closes up airway and causes difficulty breathing
what are the s/s of tonsillitis?
sore throat, ear pain, cough ,fever, odynophagia (pain in swallowing), headache, swollen or tender lymph nodes, and bad breath
what is the TX for tonsillitis?
locate the origin and treat the causative agent
tonsillectomy and adenoidectomy (for more severe/recurrent cases)
what is the most obvious sign of bleeding in tonsillectomy?
continuous excessive swallowing
what education should be provided to parents after a tonsillectomy?
avoid red liquids, which can be confused with blood
add full liquids (cream soups, gelatin, puddings, and other soups) on the 2nd day and soft foods as they tolerate it
encourage your child to chew and swallow
encourage abundant fluid intake (no citrus juices)
discourage child to cough ,clear throat, or gargle
when can children receive the flu vaccine?
at 6 months of age
what is otitis media?
inflammation of the middle ear
assessment: check tympanic membrane motility
what are the s/s of otitis media?
irritability, rub or pull at ears, ear pain, and fever
child may also have a ear infection with pulling of ears and fever
what is the TX of otitis media?
relieve pain, antibiotics, clear the way for drainage, myringotomy or tympanostomy tube placement
what are some preventative measures you can take for otitis media?
immunization- pneumococcal vaccine
reduce the risks of ear infection
avoid bottle propping
decrease or discontinue pacifier use at 6 months
prevent exposure to tobacco smoke
what is bronchitis?
aka tracheobronchitis
frequently associated with URI
inflammation of large airways (trachea and bronchi)
what are the s/s of bronchitis?
dry, hacking non-productive cough(worsens at night)
cough becomes productive within 2-3 days
what is the TX for bronchitis?
humidity, analgesics, antipyretics
what is RSV and bronchiolitis?
commonly seen with each other
respiratory syncytial virus- common cause of bronchiolitis
bronchiolitis: inflammation of the bronchioles that causes production of thick mucus
what is the most frequent cause of hospitalization in children?
RSV and bronchiolitis
what are the s/s of RSV and bronchiolitis?
rhinorrhea, pharyngitis, coughing, wheezing, fever, increased WOB
what is the TX for RSV and bronchiolitis?
supportive care
suctioning, humidified oxygen, order for IV with fluids
what is the prevention of RSV and bronchiolitis?
monoclonal antibody IM infection
what is pneumonia?
can be primary disease or a complication from another infection
causative agents: inhaled organisms or bloodstream infection
what are the s/s of pneumonia?
cough, tachypnea, breath sound (rhonchi or fine crackles), chest pain, retractions, nasal flaring
breath sounds sound normal after breaking up mucus
what is foreign body aspiration?
swallowing and aspiration of foreign body into air passages
most common offenders are round in shape
hot dogs, candy, popcorn, peanuts, or grapes
what are the signs of foreign body aspiration?
initial choking, gagging, coughing and retractions
cyanosis may occur if condition worsens
what is aspiration pneumonia?
aspiration of fluid or food substance in a child who has difficulty swallowing
fluid enters lung and bacteria grows
how can you prevent aspiration pneumonia?
do NOT feed child while crying or breathing rapidly (>60 BPM)
what is the TX of acute respiratory distress syndrome?
maintain adequate oxygen, treat the cause, and maintenance of adequate cardiac output
is apnea during pooping a concern?
no, this is normal
what should be noted during an episode of apnea?
time and duration of the episode
color changes
bradycardia
O2 saturation
action that stimulated breathing
what is asthma?
chronic inflammatory disorder that causes episodic airway obstruction
can be worse at night for children
what are the s/s of an asthma exacerbation?
nonproductive cough, chest tightness, SOB, wheezing, reduced expiratory flow, increased sputum (which causes more respiratory distress)
if wheezing becomes audible by ear, administer albuterol
what are some indicators of respiratory distress in asthma attacks?
tachypnea, tachycardia, retractions, inspiratory and expiratory wheeze
what is silent chest?
no wheezing because of decreased air movement; decreased wheezing in a child who is not improving clinically can signal an inability to move air
what medication should be administered immediately for asthma exacerbation?
bronchodilator such as albuterol
tachycardia can be a normal response after an atatck
anticholinergics and corticosteroids may also be used
how can you determine if a bronchodilator has been effective?
wheezing may actually signal that the child’s condition is improving
using a spirometry
tell patient to blow bubbles to help use
what education can be given for asthma?
how to avoid triggers
daily use of peak flowmeter to monitor pulmonary status and response to treatment
how to recognize early warning signs of an attack
measures that can be taken to prevent severe attacks
medication administration
what is cystic fibrosis?
chronic, autosomal-recessive, inherited disorder of the exocrine glands
affects multiple organ systems
abnormal thick secretions usually by those of the bronchioles, small intestine, and pancreatic and bile ducts
at risk for pneumonia
should a child with CF be given a cough suppressant?
no!
the child should be encouraged to cough up mucus to clear airways
usually do this with ACTs (airway clearance techniques)
what nursing interventions may be done for CF?
individualized for each child and is aimed at preventing and treating pulmonary infections, maintaining optimal nutritional status, facilitating airway clearance and gas exchange, and promoting psychological adjustment
what indicates improvement in a hospitalized CF patient?
improved breath sounds, oxygen saturation greater than 95%, and stable respiratory status, normal WBC and body temperature
how does CF affect the respiratory system?
chronic respiratory tract infection and impaired oxygen and carbon dioxide exchange cause varying degrees of hypoxia, hypercapnia, and acidosis
may result in cor pulmonale, HF, and other complications
death in individuals with CF is almost always from respiratory failure
how does CF affect the digestive system?
blocked by thick mucus, the pancreatic ducts are unable to secrete trypsin, amylase, and lipase into the small intestine.
without these digestive enzymes, proteins, carbohydrates, and fats are poorly absorbed
malnutrition and growth failure may be evident
need a high protein, high calorie diet!
why are patients with CF at increased risk of respiratory infections?
stasis of secretions from bronchial obstruction provides a medium for bacterial growth
chronic infection causes the release of toxic chemicals that damage lung tissues and alter host defenses within the airways, thus exacerbating the infection and inflammation
what is one of the first signs of cystic fibrosis in neonates?
abnormal stool