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Respiratory Alter.
Test #2
| Question | Answer |
|---|---|
| Otitis Media | middle ear infection |
| Common cause of otitis media | eustachian tube - straighter in younger children and does not drain properly |
| Peak age for otitis media | 6 months - 2 yrs |
| risk factors | *winter, household w/ smokers, males, formula fed babies |
| Most common etiology | *hemophilus influenzae *streptococcus pneumoniae *moraxella catarrhalis |
| Acute otitis media | rapid onset & short duration (3wks) |
| acute otitis media with effusion | A.O.M with fluid also present in middle ear |
| subacute otitis media with effusion | middle ear infection & effusion lasting 3wks - 3 months (assoc. with a low grade fever) |
| chronic otitis media with effusion | middle ear infection with effusion persisting beyond 3 months (assoc. with low grade fever and fullness in ear) |
| Clinical Manifestations O.M. | *pulling ears *fever *irritable/dizzy *purulent drainage may or may not be present |
| Diagnostic evaluation for O.M | middle ear effusion w/ 1 or more of the following: erythema of tympanic membrane, bulging TM, absent landmarks, poor light reflex w/ otoscope, limited TM mobility, earache |
| Therapeutic Management for O.M | *wait longer to tx w/ abx *abx 10-14 days for non-draining: PE tubes topical ear drops recommended *analgesics *decongestants *Myringotomy- incision in TM |
| Candidates for prophylaxis therapy of O.M. | *3 episodes of O.M. in a 6 month period *2 episodes before 6 months |
| Complications of O.M. | Hearing Impairment, Chronic effusion |
| Treating complications of O.M | Pressure Equalizer tubes |
| Complications of PE Tubes | Meningitis, Subdural empyema, Mastoiditis |
| Removal of PE Tubes | remian in 6 months before spontaneously rejection |
| Parent Education for O.M. | *no bottle propping *no smoking around child *Compliance |
| Tonsillitis | inflammation & infection of the masses of lymphiod tissue that encircle the pharyngeal cavity. Tonsils filter & protect respiratory and alimentary tracts from invasion by pathogenic organisms |
| Size of tonsils in child | > in adults to protect agains URI when especially susceptible |
| Palatine or Faucial Tonsils | Visualized during oral exam |
| Pharyngeal tonsils | AKA adenoids, posterior wall of NP, opposite posterior nares |
| Lingual tonsils | base of tongue |
| Tubal Tonsils | near posterior NP opening of eustachian tubes |
| Clinical manifestations of tonsilitis | *sore throat, fever, dysphagia, anorexia, vomiting *tonsils enlarged w/ yellow exudate *difficulty swallowing |
| Therapeutic management for tonsilitis | bed rest, antipyretics, cool mist vaporizer, liquid diet, warm saline gargle, throat culture to r/o strep, Pen x 10 days for strep, sx tx is controversial |
| Tonsilectomy | removal of palatine tonsils |
| What happens to the lingual and tubal tonsils when palatine tonsils are removed? | they enlarge to compensate and can pharyngeal and eustachian tube obstruction |
| What is the most common surgery performed after the newborn period? | tonsilectomy |
| At what age should tonsils be removed? | after 3-4 yrs of age d/t blood loss and possible regrowth and hypertrophy of lymphoid tissue |
| Adenoidectomy is recommended for... | recurrent O.M. to prevent hearing loss, hypertrophic adenoids that obstruct breathing, *over the age of 3-4 |
| Post-op assessment of adenoidectomy | hearing, smell and taste (expect improvement) |
| Pre-op assessment of tonsilectomy/ adenoidectomy | *bleeding tendencies (site is very vascular) *Baseline vitals *loose teeth (so they arent dislodge and swallowed or aspirated) |
| Post-op care for tonsil/adenoidectomy | *position on abd. or side to facilitate drainage *discourage coughing and clearing of throat *inspect all secretions & emesis for blood *avoid crying, give analgesics, ice collar |
| S/S of hemorrhage in tonsil/adenoidectomy | frequent swallowing, increased pulse |
| Risk period for hemorrhage in tonsil/adenoidectomy | first 24 hrs *7-14 days post-op d/t sloughing |
| Things to avoid with tonsil/adenoidectomy | red/brown fluids, straws (may percipitate bleeding), citrus juice, milk/icecream, |
| Food and fluids for tonsil/adenoidectomy | cool H2O, crushed ice, flavored popsicles, or diluted juice, soft food 1-2 days post-op or as tolerated |
| Mononucleosis | acute self-limiting infectious disease common among young persons up to 25 years of age |
| Mono cause | Epstein Barr Virus or Cytomegalovirus- both are herpes simlex family viruses |
| Mono incubation and infection | *communicable through direct contact with oral secretions *incubation period is 4-6wks |
| Cardinal sign of mono | *general malaise * fever *sore throat *cervical lymphnoid adenopathy |
| Early warning signs of mono | *flu like symptoms *malaise *headache *low grade fever |
| Associated symptoms of mono | *splenomegaly *hepatic involvement *macular eruption (if abx given virus-drug reaction) *exudate *pharyngitis/tonsilitis) |
| Heterophil Antibody Test | used to diagnose mono- determines the extent to which a patients serum will agglutinate sheep RBCs (titer of 1:160 is diagnostic) |
| Rapid Response tests for mono | Monospot slide test- rapid sensitive, inexpensive and easy to perform. *can detect significant agglutination at lower levels which permits earlier diagnosis |
| Therapeutic management for mono | *symptomatic tx (mild analgesics) *bed rest *penicillan of strep + *activity restriction if splenomegaly is present |
| Prognosis of mono | generally good *acute symptoms disappear in 7-10 days *fatigue may subside in 2-4 weeks *mar require restricted activity for 2-3 months |
| Croup Syndrome etiology | usually viral |
| Croup peak age | 3months to 3 years |
| Croup incidence | increased occurrence in the winter months |
| Croup symptoms | *hoarseness *barky/brassy cough *inspiratory stridor * respiratory distress-co2-respiratory acidosis-respiratory failure |
| Acute Laryngotracheobronchitits (LTB) | Most common croup syndrome (AKA viral croup) |
| Incidence of LTB | 3-8 years (usually <5yrs affected) |
| LTB etiology | *para inlfuenza viruses *respiratory syncytial virus (RSV) |
| LTB progression | rapid, edema and inflammation proceeds to vocal chords and lower airway (can go to bed in good condition and wake-up in respiratory stridor) |
| LTB therapeutic management | *high humidity via cool mist tent * oxygen prn *racemic epinephrine (fast acting anti-inflammatory) *corticosteroids *keep infant calm *monitor resp *ET tube or trach set up at bedside *increase fluids |
| Acute Spasmodic Laryngitis (Spasmodic Croup)Etiology | Viral with allergen component |
| Acute Spasmodic Laryngitis incidence | 3 months to 3 years |
| Spasmodic Croup Progression | rapid, usually occurs at night with sudden wakening of symptoms, subsids in a few hours (cold night air sometimes relieves spasms) |
| Therapeutic management of Spasmodic Croup | self-limiting, cool mist tent at night, hospitalized if severe, Racemic Epinephrine/ corticosteriods if severe |
| Acute Epiglottittis | a serious life threatening inflammatory process at the epiglottis. Results in tracheal obstruction |
| Acute Epiglottittis Etiology | Bacterial Croup (commonly hemophilus influenza B) |
| Peak age for Acute Epiglottittis | 2-6 years |
| Clinical manifestations of Acute Epiglottittis | *sudden onset *pale/shocky *respiratory distress *frightened *assumes tripod position *drooling |
| DO NOT attempt to visualize throat with tongue blade with.... | Acute Epiglottittis |
| Therapeutic Management for acute epiglottittis | *notify physician *prepare to assist w/ tracheostomy/ intubation *intubated til swelling subsides (48hrs) *humidified oxygen *IV abx, corticosteriods |
| Prevention of acute epiglottittis | HIB vax *begins at 2 months: administration has greatly decreased incidence |
| Acute bronchiolitis | bronchiole mucosa swells and fills with exudate |
| Incidence of acute bronchiolitis | *fall and winter months * 1st and 2nd year of life (rare after 2yrs) |
| Etiology of actue bronchiolitis | *RSV *Adeno and Para Influenza virus |
| Clinical Manifestations of acute bronchiolitis | *gradual onset of respiratory distress *Barrel chested d/t trapped air & over inflation *usually occurs with URI expect nasal discharge and mild fever |
| Diagnostic eval. for acute bronchiolitis | RSV made by ELISA from N.P secretions *must r/o asthma/RAD *high occurence in cystic fibrosis patients |
| Therapeytic management for acute bronchiolitis | *mist tent to loosen secretions *Bronchodialator/steroids *Ribavirin by hood, tent or mask for 12 hours *wear hepta filter mask-toxic to pregnant women |
| RSV protocol | *coherent clients/nurses *contact/droplet isolation *handwashing *avoid succeptible patients |
| Prophylactic therapy for RSV | Respigam vax (Gamma Globulin) decreases severity of infection but does not prevent it |
| Cystic Fibrosis | a generalized multisystem disorder affecting the exocrine glands. Defect in CFtransmembrane Regulator (CFTR) proteins found in lungs, GI, sweat glands and GU *the substance they secrete are abnormally viscous |
| Cystic Fibrosis etiology | Autosomal recessive trait, males > females |
| Cystic Fibrosis patho | secretions of the exocrine glands are thick and sticky rather than thin and slippery |
| Pulmonary effects of cystic fibrosis | decreased cilliary action & mucous secreting cells have increased production of thick secretions |
| Bronchioles and bronchi effects of cystic fibrosis | become plugged- results in irreversible fibrotic changes of the lungs |
| Clinical manifestations of cystic fibrosis | *pulmonary infections *emphysema *atelactasis *pneumothorax *nasal polyps *chronic sinusitis *hemoptysis *cough *wheezing *increased ap chest diameter *decreased exertional endurance |
| Hepatic signs of cystic fibrosis | intrahepatic biliary tract becomes obstructed and causes biliary cirrhosis (result in portal HTN) |
| Reproductive signs of cystic fibrosis | *fibrosis of epididymis and vasdeferans *obstruction of fallopian tubes *causes infertility |
| GI and pancreatic signs of CF | become obstructed, enzymes do not reach intestines and digestion is impaired-results in loss of foodstuff in stools |
| Earliest signs of CF affecting GI and pancreas | *rectal polyps(3mo-3yr)*intussusception<2yrs *heat prostration *pancreatic fibrosis *glucose intolerance *diabetes *pancreatitis *FTT w/good appetite *frequent smelly stools *pot belly *vomiting *Maldigestion *hyperglycemia |
| Cardiac signs of CF | Cor pulmonale (hypertrophy of right ventricle) *clubbing of fingers in older children |
| Metabolic signs of CF | Have increased permeability to chloride *salty saliva *hypoelectrolytemia *metabolic acidosis *growth retardation |
| CF diagnostic evaluation | *usually done before 6mo *health/family history *sodium levels *meas. trypsin *enzymes in stool *chest X-ray |
| Immunoreactive Trypsinogen Test | shows increased blood levels of IRT an enzyme produced by the pancreas in the newborn (CF testing) |
| BMC (Borehringer-Mannheim Corp) | meconium strip test includes lactose and protein content: present in babies with CF & used for screening |
| Pulmonary function studies for CF | decreases vital capacity/flow rates & increases residual volume or increased total lung capacity or both (after 4yrs) |
| Definitive diagnosis for CF | postive sweat test and one or more criteria (fam hx., absent enzymes, lung changes, steatorrhea) |
| Goal of care in CF | prevent and control pulmonary infection |
| Preventing and controlling pulmonary infection in CF | *bronchodilators *mucolytics *antihistamines *chest physiotherapy & postural drainage *breathing exercises * bronchopulmonary lavage |
| Lobectomy in CF | remove portion of lung *symptomatic treatment that retards progression of pulmonary involvement |
| Lung transplant in CF | *living donors: one lobe from 2 donors *cadaveric donor: transplanted from brain dead donor -50% are alive in 5 years |
| Up and coming treatment for CF | Denufusol- in phase 3 testing. Given fast track status with FDA. Enhances lung hydration and mucociliary mechanisms |
| Apnea of infancy | cessatation of breathing for 20 seconds or more associated with bradycardia, cyanosis or pallor |
| Incidenc of infant apnea | *2wks-6mo *while asleep |
| Etiology of infant apnea | *seizure disorder *GER *significant anemia *sepsis *hypoglycemia *impaired regulation of breathing *maternal cocaine abuse |
| Therapeutic management of infant apnea | *cardiopulmonary monitoring *treat underlying cause *theophylline to decreases apnea swells |
| Interventions for infant apnea | *start with gentle stimulation *turn supine *rub or pat trunk *flick the feet *never shake *proceed with cpr if no brething in response to the above |
| SIDs | sudden death, unexplained by history, which through postmortem exam fails to demonstrate an adequate cause of death |
| SIDs etiology | unkown |
| Theories of SIDs | *brainstem abnormalities *sleep habits *CO2 breathing *smoking |
Created by:
jas067
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