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44 Cards in this Set
- Front
- Back
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To promote respiratory comfort the np suggest
a. hot water humidifer b. cold water humidifer c.draining sinuses d. sleeping on the stomach |
B. Cold
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What breath sounds are associated with infectious croup and LTB
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Stridor
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The common cold.
What is the incidence rate? What is the management? |
6-10 a year
Supportive management-no antibiotic |
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Acute viral pharyngitis or tonsillitis
onset? prominent symptoms type of fever? |
gradual onset
prominent nasal symptoms of rhinorrhea, sore throat, and dysphagia, mild cough Low grade fever. |
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Physical examination of viral pharygnitis?
Epstein-Barr Adenovirus- Enterovirus Herpesvirus |
Epstein-Barr virus-exudate on the tonsils, soft palate petechial, diffuse adenopathy
Adenovirus- virus-exudate on the tonsils and cervical adenopathy Enteroviruses-vesicles or ulcers on the tonsillar pillars and posterior fauces, coryza, vomiting, or diarrhea Herpesvirus-ulcers anteriorly and marked adenopathy |
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Epidemiology of Acute Bacterial Pharyngitis and Tonsillitis
3 different bacteria? p773 |
Common cause-GABHS, Neisseria gonorrhoeae, and Corynebacterium diphtheriae
GABHS accounts for 15% to 30% in children N. Gonorrhoeae mimic GABHS and rare C. Diphtheriae causes diphtheria and rare |
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Hx associated with bacterial phanyngitis
onset age symptoms |
Less common in younger than 2 years old
Abrupt onset without nasal symptoms Moderate to high fever, malaise, prominent sore throat, dysphagia Winter or early spring |
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PE with Acute Bacterial Pharyngitis and Tonsillitis
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Petechiae on soft plate and pharynx
Swollen beefy-red uvula Red enlarged tonsillopharyngeal tissue Tonsillopharyngeal exudate that is yellow, blood-tinged (frequently) Tender and enlarged anterior cervical lymph nodes Stigmata of scarlet fever-scarlatiniform rash, strawberry tongue, circumoral pallor |
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Management of Acute Bacterial Pharyngitis and Tonsillitis
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Benzathine penicillin G intramuscularly (600,000 units if less than 60 lbs; 1.2 million units for larger children and adults)
Pen VK orally for 10 days (40mg/kg divided 3 times children dose/adult dose 500mg two to three times a day x 10 days Amoxicillin suspension 750 mg once daily for children less than 40 kg & 1000mg once daily for children >40 kg |
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What do you do about acute purulent rhinitis?
Likely organisms Management |
pneumococci, H flu, beta-hemolytic strep, staph
WAIT AND SEE |
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When do the frontal sinuses begin to develop
Sinusitis timing Acute vs sub acute vs chronic |
7 years old
Acute-> 10 days but < 30 days Subacute-> 30 days (4 weeks) to 12 weeks Recurrent- Episodes of acute sinusitis (each lasting < 4 weeks) but separated by symptom-free intervals of at least 10 days. Chronic > 12 weeks |
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What are the common bacteria with sinusitis
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Common bacterial organisms
S. pneumoniae Nontypable H. influenzae Moraxella catarrhalis Less often S. aureus |
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Major criteria in sinusitis
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Facial congestion and/or fullness
Fever (acute only) Purulent rhinorrhea and/or discolored nasal discharge or postnasal drip on nasal examination Facial pain and/or pressure Nasal obstruction Hyposmia or anosmia |
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Management of sinusitis
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Amoxicillin 80 to 90mg/kg/day, Amoxicillin-clavulanate (augment), cefpodoxime, proxetil, cefuroxime axetil if the child has not taken antibiotic in past 4 to 6 weeks. AAP recommend 40 to 45mg/kg/day
If allergic to amoxicillin-azithromycin, clarithromycin, erythromycin, or sulfamethoxazole/trimethoprin (SMT) 38% failure rate |
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Laryngotracheobronchitis (Croup)
What are the viral causes What age is it most common? Who is affected more? How long does it last |
Parainfluenza viruses (types 1, 2 & 3)
Respiratory syncytial virus (RSV) Most common between 6 & 36 months old; 60% < 24 months old Most often in cold season of the year Males are more often affected than females Recurrent croup & recurrent laryngitis develop in children until 6 years old Family history Last 5 days |
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LTB Croup
What are the Clinical Findings (History)? |
Prodrome of URI symptoms (rhinorrhea, conjunctivitis or both)
Intermittent stridor-mild to moderate Gradual onset of symptoms (2 to 3 days) Symptoms worse at night May or may not have sore throat Most the time improve in a few days |
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LTB Croup Physical Examination
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Slight dyspnea, tachypnea, and retractions
Mild, brassy, or barking cough (harsh sounding) Stridor-high pitched, harsh sound from turbulent airflow that is generally inspiratory, but may be biphasic Temperature typically low grade (but can be 104 Decrease breath sounds bilaterally with rhonchi Wheezing and rales if there is additional lower airway involvement |
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What is the diagnostic test for and the results? Croup
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Radiography if soft tissues of the neck & chest are displays for this is a classic for subglottic narrowing (“steeple sign”)
Microbiology cultures helpful in selected cases |
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Management of LTB Croup
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Symptomatic relief
Mild croup-steam from hot shower or bath or “cold” humidifier Ride in car at night Cough and cold medication sometimes help if URI symptoms If bronchospasm is also suspected, the use of bronchodilators in the usual doses prescribed for relief of asthma Corticosteroids as part of the management of LTB for decreasing edema (oral Prednisone 1 to 2 mg/kg/day or dexamethasone either oral or IM for outpatients with mild or moderate croup). A one time dose of dexamethasone (0.6mg/kg/dose) as part outpatient management-one time |
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At what point would you hospitalize a patient with croup
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Indication for hospitalization
Respiratory rate 70 to 90 Exhibiting stridor at rest > 102 fever |
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Bronchitis What is the difference between acute and chronic?
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Acute –viral agent resulting inflammation of the tracheal and major bronchial mucosa
Chronic-a productive cough lasting for more than 3 months, is usually a symptom of another chronic disorder (e.g., allergies, asthma, CF, cigarette smoking) Bronchitis involves fully cartilaginized conducting airways |
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What is the epidemiology of bronchitis?
preceded by? What is the cause of bacteria if any? What are the viral implications What are the bacterial agents What kind of bug with CF |
Preceded by viral URI
Weaken tissue succumb to a secondary bacterial infection Viral agents implicated in bronchitis are rhinovirus, RSV, and parinfluenza Also, S. pneumoniae, B. pertussis, and H. influenzae are the most commonly cultured bacterial organisms M. pneumoniae and C. pneumoniae also Pseudomonas aeruginosa is common agent in children with CF |
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What kind of history can you expect with bronchitis
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Dry, hacking unproductive cough
Low substernal discomfort or burning chest pain aggravated by coughing Cough becomes productive after few days, and shortness of breath can occur |
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What is the PE like with bronchitis?
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Low grade or no fever
Signs of nasopharyngeal infection, conjunctivitis, and rhinitis (common) Coarse breath sounds and coarse to fine moist rales Presence of rhonchi, which can be high pitched and resemble wheezes |
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What is the management of bronchitis?
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Supportive
Postural drainage Cough suppressants (not under 2) Antihistamines-should not be used Antibiotics only if bacterial infection or high fever/crackles |
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Cystic Fibrosis
What are the 4 major factors that play a part in the disease/ |
Genetic disorder
COPD GI disturbance Exocrine dysfunction. |
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CF: type of genetic illness
Most common in? Major insult is? |
Autosomal recessive genetic disorder involving mutation of the CF transmenbrane conductance regulator gene on chromosome 7
1 in 2500 White Major insult is inability to clear mucoid secretions Inadequate salt and water secretion on the cellular level; problem with regulating chloride |
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Clinical Findings in CF (790)
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Pulmonary-major cause of severe chronic lung disease
Gastrointestinal tract and nutrition-newborn-meconium ileus syndrome; older child with gastrointestinal obstruction; Failure to thrive; vitamin A,K,E, and D deficiencies Hepatobiliary tract Pancreas-pancreatitis/DM GU-delayed sexual development/absence of the vas deferens Sweat glands-excessive salt loss |
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Bronchiolitis is seen mostly as ?
bug? |
wheezing in a infant.
RSV |
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CF Diagnostics and Treatment
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Sweat Test >60 mEq/L of chloride is diagnostic for CF
40-60 is suspicious -Multidisciplinary team approach and home-based maintenance therapy for pulmonary and nutritional interventions is critical |
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Pneumonia and the pathogens
most common? |
ALL AGES-RSV, influenza, cytomegalovirus, parainfluenza, adenoviruses, human metapneumovirus and rhinovirus
NEONATES-Group B -hemolytic streptococcus, gram-negative organisms, and listeria moncytogenes- 1-3 MONTHS-S. aureus, (a very serious infection) C. trachomatis, S. pneumoniae 4 months to 5 years old-S. pneumoniae, nontyable H. influenzae, and M. pneumoniae- 5 years and older--M. pneumoniae, C. pneumoniae, and S. pneumoniae- 90% S. pneumonia |
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Hyperinflation (depressed diaphragm) with mild interstitial infiltrates.
What is the most likely diagnosis for this infant? |
Bronchiolitis.
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Which of the following pathogens is most commonly responsible for viral croup?
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Parainfluenza virus.
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What would be the most effective way of prevented the disease?
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Proper hand washing and exposure precautions
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What is the immunohistopathologic response in asthma (4) things
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Shedding of airway epithelium and collagen deposition beneath the basement membrane
Edema Mast cell activation Inflammory infiltration by eosinophils (especially in fatal asthma) |
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What is the epidemiology of asthma
Genetic predisposed children or acquired How is it mediated? 5-10% have what induced |
Genetic predisposed children or acquired
IgE-mediated response to common aeroallergens, known as atopy Asthma leading reason for pediatric hospital admissions and accounts for 7 million visits annually to pediatric setting (Centers for Disease Control and prevention [CDC], 2005). 5 to 10% of children with asthma have food induced respiratory symptoms |
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Clinical findings in asthma
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Family history
Conditions associated with asthma (e.g., chronic sinusitis, nasal polyposis, gastroesophageal reflux, and chronic otitis media) C/O chest tightness or dyspnea Cough at night and early morning Cough or short of breath with exercise Seasonal, continuous, or episodic pattern of symptoms |
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What can be found the physical exam in a asthma patient.
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Wheezing (may be absent if severe obstruction)
Prolong expiratory phase, high-pitched rhonchi Diminished breath sounds Signs of respiratory distress i.e. tachycardia, retractions, nasal flaring, using accessory muscle, increasing restlessness, apprehension, agitation, drowsiness to coma Tachycardia hypertension or hypotension, pulsus paradoxus Cyanosis of lips and nail beds if underlying hypoxemia |
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Diagnostics for Asthma Include?
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O2Sat -95% mild 90-95 moderate and 90 or less is severe
CBC, CXR, CT-sinus Allergy workup Sweat test if CF is suspected. PFT-spirometry testing in those >4 years old. |
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PEF reading for asthma?
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Interpretation of PEF reading for use of peak flow meter
Green zone more than 80% to 100% good control Yellow zone between 50% to 80%-cautions Red zone between 0% to 50% personal best signal a obstruction |
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Asthma management.
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Management
Guidelines for the Diagnosis and Management of Asthma (ERP-3) (NHLBI, 2007) Chronic asthma Treatment based on general control Avoid exposure to known allergens or irritants Administer yearly influenza vaccine Control environment Provide allergen immunotherapy Treat rhinitis |
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Pharmacologic asthma management
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-agonist by nebulization
Spacer-help with coordination Dry power inhaler (DPI)-do not need spacers an don't need to be shaken DO NOT USE IN CHILDREN YOUNGER THAN 5. Inhaled corticosteroids (Pulmicort Turbohaler; Fluovent Diskus) Combination inhaled corticosteroid and long-acting -agonist can be used on children 5 years and older |
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Bronchiolitis Clinical Findings
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URI for 3-7 days then gradual respiratory distress marked by noisy, raspy breathing with audible wheezing.
Low grade to moderate fever up to 102. |
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Bronchiolits Physical findings
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paroxysmal weezing, crackles may be heard throughout the breathing cycle.
Respiratory distress varies Palpable liver and spleen because of their being pushed down by hyperinflation of the lungs. |
