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94 Cards in this Set

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List the structures of the upper respiratory tract.
1. nose
2. pharynx
3. trachea (epiglottis, larynx)
List the structures of the lower respiratory tract.
1. bronchi
2. bronchioles
3. alveoli
After contracting an URI, what can children get more quickly?
LRI
What are anatomical differences in a child's lower respiratory tract that make them more likely to develop a LTI?
1. diameter of airway is smaller
2. bifurcation of trachea is higher
3. the distance between respiratory structures is shorter (so organisms have to travel a shorter amount)
What breath sounds do we want to listen for when ascultating the lungs? Give examples.
adventitious sounds

1.crackles
2. rhonchi
3. wheezing
What are crackles?
make the sound of running hair between your fingers
What are rhonchi?
low-pitched snoring sound
What are wheezes?
high-pitched snoring sound
What are signs of respiratory distress?
1. nasal flaring
2. retractions
3. using accessory muscles
4. grunting
tachypnea
What is usually the first sign of respiratory distress?
tachypnea
Why are retractions significant?
they can give you an idea of wehre the problem is
Which retractions indicate a URI?
1. suprasternal
2. supraclavicular
What retractions indicate a LRI?
1. subcostal
2. substernal
3. intercostal
What is the most prevalent disease of early childhood?
acute otitis media (AOM)
AOM
AOM
Describe the incidence pattern of AOM.
at its height in ages 6 mo - 2 yrs

it gradually decreases after 2, but then it slightly increases upon entering school
What life event increases the risk of getting AOM?
being exposed to other children and getting sick
What features of the child's eustachian tube makes them more likely to get sick?
1. more horizontal than vertical
2. shorter
What are 3 functions of the eustachian tube?
1. protect the middle ear (from nasopharyngeal secretions)
2. helps drain the middle ear secretions (to the nasopharynx)
3. equalize pressure
What are 2 mechanisms that one could contract AOM?
1. intrinsic
2. extrinsic
What are intrinsic factors that can cause AOM?
obstruction of the eustachian tube (ie from edema/swelling). Caused by:

1. tobacco smoke (causes inflammation)
2. allergies
3. infections (viral/bacterial)
What are extrinsic factors that can cause AOM?
1. tumor
2. adenoid/tonsil swelling

**they can cause an obstruction outside the eustachian tube so that secretions sit in the middle ear
List the etiologies of AOM.
1. infectious
2. noninfectious
3. passive smoke
4. feeding techniques
5. dysfunctioning eustachian tube
Which infectious agents are causative for AOM?
1. Streptococcus pneumonia
2. H. influenzae
3. M. catarrhalis
4. Pneumococcus pneumonia
Give 2 examples of noninfectious AOM etiologies.
1. allergies
2. passive smoking
Which feeding method of a baby is more effective in reducing AOM?
breast feeding babies have a lower incidence than bottle fed babies in developing AOM. Bottle fed babies are fed in the supine position, which facilitates secretions to go into the middle ear-->AOM
List the clinical manifestations for AOM.
1. irritability (tug at ears)
2. lymphadenopathy
3. fever (as high as 104)
4. rinorrhea/corhyza
5. loss of appetite (sucking/swallowing is painful)
6. V/D
What are signs that the tympanic membrane has ruptured?
1. if you find green discharge on a pillow
2. reduced fever
3. reduced pain (from relief of pressure)

**may cause scarring if more than 1 rupture has occurred
How do you repair a ruptured tympanic membrane?
they usually heal without surgery
What are 2 methods used to dx AOM?
1. otoscopy
2. auditory test
How can you identify AOM in otoscopy?
1. membrane: intact, bright, red, bulging
2. no landmarks
3. no cone of light
What does a normal tympanic membrane look under otoscopy?
1. grayish in color
2. bony prominences
3. cone of light
When should you assess for mobility of the tympanic membrane?
1. if the TM looks normal
2. if you suspect that the TM is scarred

*DON’T check for mobility during an active infection--it'll hurt!
What otoscopy evidence would lead you to believe that the TM is scarred?
Push air into the ear w/ the otoscope--the TM should move. If it doesn't, this indicates immobility (scarring)
Are the majority of AOM viral or bacterial?
viral, usually improves within 48 hrs
What is a major tx problem with AOM?
drug resistance is becoming a huge problem:
1. given Abs for viral infections
2. parents not combleting Ab course when needed
How should you treat a child who is 6 mo or younger if you suspect AOM?
ALWAYS administer an antibiotic, even if you're just suspicious that the causitive agent is bacterial
When are 2 cases in which you should administer antibacterial therapy to a child 6 mo - 2 yr?
1. if you're certain that the causitive AOM agent is bacterial
2. if you're uncertain of the causitive agent, but the infection is severe within the past 24h:
-fever (102.2F/39C+)
-moderate-severe otalgia
When is observation considered a reasonable tx for a patient (6mo-2y) with undifferentiated AOM?
dx is not certain AND illness is not severe
If your 6mo-2y patient is improving 48-72hrs later, what should you do?
nothing
If your 6mo-2y patient is worsening 48-72hrs later, what should you do?
begin antibacterial therapy
For children older than 2y, when should you administer antibacterial therapy?
with severe illness
For children older than 2y, when is it appropriate to just observe?
if the dx is not certain AND if the illness is not severe
Is observation in mild cases always appropriate?
No, it should only be done if:
1. follow-up can be assured
2. antibiotic therapy can be initiated if symptoms worsen
When should you prescribe antibiotics if the patient initally presented with an uncertain dx/mild symptoms?
if no improvement is seen in 48-72 hrs
What is the cause for 99% of AOM?
a COLD in which secretions sit in the middle ear, don't drain, and causes an infection
What are 2 pharmaological actions to tx AOM?
1. antibiotics
2. analgesics/antipyretics
What is the first line antibiotic for AOM tx? What is its route?
amoxicillin- PO
What is a second line Ab tx for AOM? What is its route?
rocephin (a cephalosporin) - IM (sometimes need a second dose)
Why would you prescribe a pt w/ rocephin over amoxicillin?
1. concerned about compliance
2. concerned about absorption (ie in the event of V,D)
Why administer an analgesic/antipyretic in the case of AOM?
to relieve pain/fever
What are non-pharmalogical methods that are effective in tx AOM?
1. soak a warm washcloth and place over ear
2. drop warm oil into the ear
Which vaccines can be used to prevent AOM?
1. Prevnar
2. Hib

*both protect against BACTERIA only
Which agents does Prevnar protect against?
pneumococcal bacteria
Which agents does Hib protect against?
H. influenzae
CHRONIC OTITIS MEDIA W/EFFUSION
CHRONIC OTITIS MEDIA W/EFFUSION
What is the cause of COM w/ effusion?
AFTER infection from AOM has cleared, the fluid remains in the middle ear for weeks or months
Is there pain or fever associated with OME?
no
What are the symptoms associated with OME?
1. fullness/popping of ear when swallowing
2. mild-moderate hearing loss (hears muffled sounds)
3. speech difficult to understand (may be a sign of a recurrent effusion)
What is the 1 pharmological tx for OME that is not recommended for children under 2?
antihistamine
What is a surgical option for tx OME?
myringotomy
What is myringotomy?
a surgery in which ventilation tubes (tympanostomy tubes) are insterted into the TM to allow fluid to drain
When would an OME call for a myringotomy surgeyr?
1. if in bilateral OME, fluid persists for more than 3 mo (despite non-surgical intervention) + there is associated hearing loss AND
2. 3+ episodes of OME in a 6 mo perior OR
3. 4 episodes in a 1 year period
How do you remove the tympanostomy tubes?
they fall out with wax in 6 mo-1 yr
How can you visually identify chronic otitis media w/efflusion via otoscope?
1. not red
2. can see fluid (bubbles)
3. bony prominence
4. cone of light
CROUP SYNDROMES
CROUP SYNDROMES
What are the characteristics of croup?
1. hoarseness
2. cough
3. varying degrees of stridor
4. respiratory distress (from swelling/obstruction in larynx)
What is a stridor?
An obstruction of the in the upper airway that you don't need a stethoscope to hear
At what point in respirations can you hear a stridor?
inspiration
What are the 4 types of croup syndromes?
1. acute epiglottitis
2. acute laryngeotracheobronchitis
3. acute spasmotic laryngitis
4. acute tracheitis
Which croup syndrome is a bacterial emergency?
acute epiglottitis
Which croup syndrome is most common?
acute laryngotracheobronchitis
What are the causes of croup syndromes? Which is most common (*)?
1. viral:*
-parainfluenza
-RSV
-influenza A & B

2. bacterial:
-mycoplasma pneumoniae (atypical)
Why do we hear a stridor and have retractions in croup?
EDEMAmatous swelling: trying to pull air against the narrowed passageway
What are other typical characteristics of croup?
1. frightened expression
2. barking cough
3. hoarseness
4. respiratory distress
5. inspiratory stridor & retractions
In which gender is croup more common?
boys
What is the typical age of onset for croup?
6 mo - 3 years, peak at 2 years
What is the seasonality of croup?
Late autumn - early winter (esp LTB)
LARYNGOTRACHEOBRONCHITIS (LTB)
LARYNGOTRACHEOBRONCHITIS (LTB)
What is the etiological agent of LTB?
virus
What is the typical affected age of LTB?
3 mo - 8 yrs (toddler years most common)
Describe the onset of LTB.
Gradual: begins with a URI (runny nose) and wakes up with a seal-like cough
In addition to a seal-like cough, which other clinical manifestations are present in LTB?
1. inspiratory stridor
2. supracostal retractions
3. tachpnea
4. distressed & frightened
5. hypoxia may develop
Which is often the first sign of LTB?
tachypnea (increasedRR)
Describe the effects of tachypnea lasting for a long period of time.
They get tired, so they go into respiratory failure, in which the RR eventually starts to decrease. They then become acidotic because they can't blow off the excess CO2. If acidosis becomes too severe, they may need to be intubated in the ICU
What is mild LTB?
No stridor at rest
How do you manage mild LTB?
At home:
1. keep comfortable
2. antipyretics
3. high humidity w/ COOl mist (to decrease swelling/barking)-humidifier/outside
4 . be in room w/ steamy shower (to break up secretions)
5. encourage fluids (helps break up secretions)
6. elevate the head of the crib
What is it important to teach parents of children w/ mild LTB?
S&S of respiratory distress & making sure they stay hydrated
Why does severe LTB require hospitalization?
1. stridor
2. can't take in fluids
3. signs of respiratory distress
How do you tx severe LTB?
1. nebulizers of NS every few hours
2. IV fluid
3. meds
4. O2 when necessary
It is important to monitor RR with severe LTB. At which RR should you stop PO fluids and administer via strict IV? Why?
If RR>60.

don’t want child to aspirate (difficult to suck and breathe at the same time)
In severe LTB, which meds to you administer to decrease subglottal edema?
1. IV corticosteroids
2. racemic epinephrine via nebulizer
How often can you administer those meds?
repeat every 2 hrs if signs reoccur
Why is it extremely important to keep an eye on kids with respiratory illness?
the #1 cause of cardiac arrest is respiratory arrest!