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50 Cards in this Set

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Define bronchiolitis?
an acute viral infection with maximum effect at the bronchiolar level
What age is bronchiolitis rare in?
older than 2yo
RSV is responsible for what percentage or more of the cases during epidemic periods?
80%
RSV is considered the SINGLE most important respiratory pathogen in what age group?
infancy and early childhood...<one of the most common causes of hospitalization in infants>...<poses one of the greatest threats to the respiratory system of infants and small children>
What season does RSV begin in?
<late fall, reaches a peak in winter, and decreases in spring>
<RSV is easily spread from?>
hand to eye
nose
other mucous membranes

<(transmitted through direct or close contact with respiratory secretions of infected individuals)>
What is the pathophysiology of RSV?

they're infiltrated with inflammatory cells...and what kind of pneumonitis is normally present?

hyperinflation and
obstructive emphysema
resulting from partial
obstruction and
patchy areas of atelectasis

dilation of bronchhial passages on inspiration allows sufficient space for intake of air, but what keeps air from leaving the lungs on expiration?

EMPHYSEMA
mucosa swell...lumina are filled with mucus and exudate...what happens to the walls of the bronchi and bronchioles?

peribronchiolar interstitial pneumonitis...there are varying degrees of obstruction in small air passages which lead to?

narrowed passages...thus air is trapped distal to the obstruction and causes progressive overinflation which is termed?
What does bronchiolitis begin as?

rhinorrhea and low-grade
fever
otitis media and conjunctivi-
tis may also be present...
in time what might happen?

respiratory tract infection with typical symptoms
upper respiratory infection...and what are the symmptoms?

cough develops and if disease progresses it becomes?
What might a chest radiograph show?
hyperaeration and areas of
consolidation that are difficult to differentiate from bacterial pneumonia
What might be the first symptom recognizable in very young infants?

arterial carbon dioxide tension (PaCO2) (hypercapnia)...which can lease to what kind of acidosis?
apnea...severe disease might be followed by a rise in?

respiratory acidosis...as well as hypoxemia
How is positive i.d. made of RSV?
using either enzyme-linked immunosorbent assay (ELISA) or rapid immunofluorescent antibody (IFA) from direct
aspiration of nasal secretions or nasopharyngeal washings
How is bronchiolitis treated?
symptomatically with high humidity, adequate fluid intake, and rest
Most children can be managed?
at home
When should children be hospitalized?
with underlying lung or heart disease, associated debilitated states, or an inadequate caregiver

also child that is tachypneic, has marked retractions, seems listless, or has a history of poor fluid intake
Hospitalized treatment involves?
mist therapy combined with oxygen administered by hood or tent in concentrations sufficient to alleviate dyspnea and hypoxia, after which mist alone is continued for mild dyspnea
Why might fluids by mouth be contraindicated?
because of tachypnea
weakness
fatigue....

so go with IV fluids until acute crisis of disease has passed
What guides therapy?
clinical assessments
noninvasive oxygen monitoring
blood gas values
Routine use of the following drugs is controversial.
bronchodilators
corticosteroids (for inflam-
mation and edema)
cough suppressants
antibiotics
Initial symptoms of RSV?
<rhinorrhea
pharyngitis
coughing/sneezing
wheezing
possible ear or eye drainage
intermittent fever>
Initial signs or symptoms with progression of illness?
<increased coughing and
wheezing
air hunger
tachypnea and retractions
cyanosis>
Initial signs or symptoms with severe illness?
<tachypnea, greater than
70 breaths/min
listlessness
apneic spells
poor air exchange; poor
breath sounds>
How is RSV infection prevented?
RSV immune globulin
palivizumab
What provides neutralizing antibodies against RSV?
RSV immune globulin (RSV-IGIV)...this is an IV preparation of immunoglobulin G that neutralizes antibodies against RSV...given in a monthly IV infusion just prior to RSV season
What is palivizumab?
a monoclonal antibody given monthly in an IM injection...preferred for high risk children because of its ease of administration, safety, and effectiveness
RSV-IGIV is given to infants and children younger than?

chronic lung disease and who have required medical therapy for CLD within 6 months before RSV season start
24 months of age and who have?
What preterm gestation age can benefit from RSV prophylaxis?
29 to 32 weeks until 6 months old
What are risk factors that might make it beneficial for a child to receive RSV prophylaxis (palivizumabe injections for example)?
two or more of the following:
school-age siblings
crowding in the home
day care attendance
children who are 24 months
of age or younger with
cyanotic and acyanotic
congenital heart disease
Children admitted to the hospital with suspected RSV infection should be assigned?
in separate rooms or grouped with other RSV-infected children
When caring for isolated RSV children, what precautionary measures should nurse take?
consistent handwashing
gloves
gowns
masks
goggles
What is ribavirin?
an antiviral drug used to treat RSV and hepatitis C...
aerosolized and delivered via a small-particle aerosol
generator (SPAG) through an
oxygen hood, tent, mask, or ventilator...take care to decrease the escape of aerosolized ribavirin into the air...pregnant hcp's should not care for a child receiving ribavirin due to toxicity
Children receiving RSV-IVIG should be monitored for symptoms of?
fluid volume overload during IV administration
Antibodies in RSV-IVIG may interfere with immune response to?
live virus vaccines
ex: mumps
rubella
measles
chickenpox
these vaccines should be deferred for 9 months after the last dose of RSV-IVIG infusion...this doesn't apply to palivizumab
The hcp who administers palivizumab must arrange to administer it within how many hours?
six hours after opening the vial
To relieve the pain of IV infusions of RSV-IVIG and IM injections of palivizumab, what should be applied to the insertion site or IM site before the procedure?
EMLA cream
<What 3 organisms can cause bronchiolitis?>
viral pneumoniae
mycoplasma pneumoniae
RSV...most common cause
<Nearly all children have been infected with RSV by?
2 years of age and reinfection is common
<RSV is the most common cause of lower respiratory tract infections in?
infants and children
<Respiratory and cardiac problems makes a child more susceptible to RSV.
okay
<Define RSV?>
viruses invade mucosal cells that line the small bronchi and bronchioles...
invaded cells die when the virus bursts from inside the cell to invade adjacent cells...
resulting cell debris clogs and obstructs the bronchioles and irritates the airway...
in response, the airway lining swells and produces excessive mucus...
results in partial airway obstruction and bronchospasms
<RSV begins with?
<upper respiratory infection:
rhinorrhea
low grade fever
otitis media
conjunctivitis
coughing
wheezing
<An 18-mo infant who was brought to the ER by her parents because she was wheezing and SOB...
Her mother stated she has had a cold for the past 2 days with a temp as high as 101.4 that was treated with acetaminophen...she had a runny nose and sounded hoarse when she cried...
the nursing assessment included T101.8, P150, R65; expiratory wheezing audible without stethoscope; air hunger with marked retractions; and frequent coughing spasms...

What did physician order?
<stat CXR
enzyme-linked immunosorbent
assay test (ELISA) on
nasal secretions
croup tent
admission to the pediatric
unit with a preliminary
diagnosis of RSV
ribavirin was ordered to be
started on admission
<The ONLY ANTIVIRAL drug that's available for treatment of RSV is?
<Ribavirin
<What clinical manifestations of RSV does this client exhibit?
<runny nose
queasy
temperature (low grade)
retraction
air hunger
rapid respirations
coughing spasms and started
with upper respiratory
tract infection
<Why was the croup tent ordered?
>provides humidified air
<If most children with RSV can be treated at home, why was child admitted to hospital?
having marked retraction

and if adequacy of care giver is questionable, then admit to hospital
<What are the other elements of therapeutic management of RSV?
rest
nutrition
hydration
cardiopulmonary functioning
make sure saturated oxygen
levels are good

Liquids by mouth are contraindicated if respirations are up too high or they're just too weak.
<Who should especially stay away from Croup tent?
pregnant woman
<Around croup tent, health care workers should wear?
masks to prevent absorption of particles less than one micron in diameter.
<The ventilator that's applying the ribivirin should be turned off
5-10 minutes prior to health care worker handling client
<What drug is very controversial and hasn't been confirmed and is used only for life-threatening cases of RSV?
ribavirin