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MAAM JULIE
MATERNAL AND PEDIATRICS
| Question | Answer |
|---|---|
| Two Divisions in Respiratory System | Upper and Lower |
| What are the parts in the upper? | Nose, Paranasal sinuses (frontal, sphenoid, ethmoid, maxillary sinus), pharynx, larynx and epiglottis. |
| What are the parts in the lower respiratory tract? | Bronchi, bronchioles, and alveoli. |
| Pathophysiology of respiration | Through inspiration it delivers warmed and moistened air to the alveoli, transport o2 across the alveolar membrane to hemoglobin-laden blood cells back into alveoli. Through expiration it releases CO2 |
| Choanal Atresia | Congenital condition where there's a bone blocking the airway. |
| Causes of Choanal Atresia | Congenital Abnormality involving either membrane or bony tissue growth obstructing the nasal passage. |
| S/Sx of Choanal Atresia | Respiratory distress- Up to 3 months age babies, they are a nose breathers. =struggling to breathe when mouth is closed, with cyanosis indicating oxygen deprivation -DOB, Color improvement when crying (mouth breathing) |
| Problems with Choanal Atresia | Difficulty feeding, leading to episode of air hunger or cyanosis |
| Testing the patient with Choanal Atresia | Confirmed by an ability to pass soft #8 or #10 French catheter through the post nares/nostrils. |
| Management of Choanal Atresia | Surgical Treatment/ Local piercing Supportive care: IV fluids to maintain glucose and hydration levels. |
| Common colds/ Acute Nasopharyngitis aka SIP-ON. | Most common frequent infectious disease in children, toddlers may experience 10-12 colds per year while school-age children and adolescents may have 8-10 yearly |
| Causes of common colds/Acute Nasopharyngitis aka SIP=ON | RSV (Rhinovirus, Respiratory Syncytial Virus, Adenovirus, parainfluenza, and influenza. Children with compromised immune system or pre existing health issues at higher risk. |
| S/SX Causes of common colds/Acute Nasopharyngitis aka SIP=ON | -Nasal Congestion and watery rhinitis. -Low grade fever (lasting for few days) -Edematous and inflamed nasal mucous-membranes causing breathing difficulty -Cough from draining upper airway secretions -Swollen cervical lymph nodes |
| How many weeks does a Nasopharyngitis aka SIP=ON last? | Symptoms typically last about a week through a previous cold colds may to predispose young children to secondary bacterial infection. |
| Management of Nasopharyngitis aka SIP=ON. | -Antipyretics for fever. -Avoid aspirin in children under 18 -Saline nose drops or nasal spray to liquify secretions -Bulb syringe suctioning for infants to aid -Breathing during feedings -Cool Mist |
| Treatment for Nasopharyngitis aka SIP=ON. | Antibiotics Cough and colds medication for children parents should be educated |
| Pharyngitis | Pharyngitis is an infection and inflammation of the throat, it can be viral or bacterial in origin and occurs most commonly between 5-15 years of age. |
| In what weather is Pharyngitis more active? | In winter and spring with an incubation of 2-5 days chronic allergies with postnasal discharge can also cause nasal nasal irrigation. |
| What is the causes of viral Pharyngitis? | Usually caused by viruses |
| S/SX of a Viral Pharyngitis? | Sore throat, fever rhinorrhea, cough, and malaise. -Erythema of the pharynx and palatine arch, tonsillar exudate may or may not be present. |
| Management of Viral Pharyngitis | Oral analgesic (e.g. Acetaminophen) Ibuprofen for pain relief. Warm water gargles for school age children. Focus on adequate hydration. |
| What is Streptococcal Pharyngitis? | Causes: Group A beta Hemolytic streptococcus is the organism most frequently involved in bacterial pharyngitis in children, particularly those between ages of 5-15 years. |
| S/SX of Streptococcal Pharyngitis? | Sudden onset with more severe symptoms than viral pharyngitis Enlarged tonsils with Redness and inflammation, Petechiae. |
| Management for Streptopharyngitis? | Antibiotics used such as penicillin or cephalosporin Supportive care similar to viral pharyngitis. Antibiotics help prevent complications like acute rheumatic fever and glomerulonephritis, and they reduce symptom duration. |
| Retropharyngeal Abscess | Is a collection of abscess in the retropharyngeal space, which is located at the back of the throat, behind the pharynx. Although rare, it is a medical emergency due to the risk of airway obstruction |
| S/SX OF Retropharyngeal Abscess. | High fever= Refusal to eat or drooling due to difficulty SWALLOWING. Snoring Respiration as the pharynx becomes occupied . Swelling on one side of the neck requiring medical evaluation to determine its cause. |
| What position will you the head into? | Hyperextension of the head in infants for improved breathing |
| Management of Retropharyngeal Abscess. | Hospitalization IV antibiotics Surgical drainage if cant be healed with antibiotics. |
| Tonsillectomy | Surgical removal of the palatine tonsils. An adenoidectomy is an operation to remove enlarged adenoids. Adenoids are small lumps of tissue at the back of the throat behind the nose. They're part of the immune system and help fight infection. |
| Indications for surgery on Tonsillectomy | Frequent throat infections, Tonsillar hypertrophy causing breathing different infection. Adenoids causing obstruction or sleep apnea |
| Procedure of Tonsillectomy | Tonsillar tissue is removed by ligation or laser surgery, sutures are not typically used |
| Risk on Tonsillectomy | Aspiration of blood surgery complication related to general anesthesia due to frequency bleeding. |
| Epistaxis | Caused by nasal trauma or dryness |
| Common Causes of Epistaxis | Nose picking, nasal trauma or dry air leading to cracked mucous membranes |
| Other Causes Epistaxis | Strenuous exercise, Hemolytic disorder, Associated condition such as nasal polyps, sinusitis or allergic rhinitis. Famillial predisposition in some cases. |
| Management of Epistaxis | Immediate care- Upright position then forward the head to prevent blood from flowing into the nasopharynx. Apply pressure to the sides of the nasal cartilage with fingers for about 10 minutes. Calm and reassure the child to minimize crying. |
| Why do we need to minimize the crying of the child? | Because crying increase blood vessel and prolong bleeding. |
| What are the things to avoid when the patient has EPISTAXIS? | Avoid inserting tissue or blowing the nose to prevent clot disruption. |
| For further intervention incase EPISTAXIS don't stop | Prolonged or severe bleeding may require emergency care, including nasal packing. Chronic or recurrent nosebleeds should be investigated for potential systemic diseases or blood disorders. |
| Sinusitis | It's the infection and inflammation of the sinus cavities. It is uncommon in children under 6 years old because the frontal sinuses are not fully developed. |
| Primary Common causes of Sinusitis. | Viral Infections – Common cold, flu. Bacterial Infections – Persistent sinus blockage. Fungal Infections – More common in immunocompromised individuals. |
| Secondary Common causes of Sinusitis. | Arising from a viral upper respiratory illness. Allergies – Triggers nasal inflammation. Nasal Polyps & Deviated Septum – Blocks sinus drainage. Environmental Irritants – Smoke, pollution, strong odors. Dental Infections – Spread from upper teeth. |
| S/SX of SINUSITIS. | Persistent or worsening symptoms following a viral upper respiratory infection (URI) (e.g., common cold) lasting >10 days or worsening after initial improvement |
| Laryngitis | is the inflammation of the larynx HUSKY=brassy or hoarse voice. It's a complication of pharyngitis excessive use of voice. |
| S/SX of Laryngitis. | Hoarse, Inability to produce sounds, Annoying tickling in the throat. |
| Management of Laryngitis | Sips of fluids (warm or cold.) to alleviate throat discomfort. Rest voice |
| Congenital Laryngomalacia (Tracheomalacia) | is weaker than normal , causing it to collapse, high pitched sound. |
| S/SX of Tracheomalacia | Laryngeal Stridor intense when supine, while sucking retractions of the sternum, Frequent pauses during feeding to maintaining ventilation and recover from respiratory effort. |
| Management of Tracheomalacia. | Slow feeding with adequate resting periods Parental reassurance that the condition typically resolves by 1 years of age ages as the cartilage strengthens. |
| What to teach to the parents if patient had Tracheomalacia. | Teach parents to monitor for upper respiratory infections, as these cam worsen laryngeal collapse and risk tracheal obstruction. Encourage immediate medical care if there are signs respiratory distress. |
| Croup (Laryngotracheobronchitis.) | Croup-inflammatory condition affecting the larynx, trachea, and major bronchi, typically caused by a viral infection. most commonly by the parainfluenza virus. It primarily affects children between 6 months and 3 years of age. |
| Causes of viral infection of Laryngotracheobronchitis. | Viral infection, especially from parainfluenza virus. Other viruses that can cause croup include respiratory syncytial virus, adenovirus, and influenza. |
| S/SX OF LARYNGOTRACHEOBRONCHITIS/CROUP. | Barking cough, inspiratory stridor, marked retractions due to inflammations mildly elevated temp. or normal fever, symptoms typically worsen at night with minimal signs during the day. |
| MANAGEMENT OF LARYNGOTRACHEOBRONCHITIS. | Cool, moist air to soothe the airway and ease breathing, Corticosteroids like dexamethasone to reduce inflammation. Racemic epinephrine (administered via nebulizer) For bronchodilation and airway opening which is generally provided in health care setting |
| HOME MANAGEMENT OF LARYNGOTRACHEOBRONCHITIS. | MAY INCLUDE= Dexamethasone while racemic epinephrine requires professional supervision. |
| Epiglottitis | Potentially life threatening inflammation of the epiglottis, a cartilage flap that prevents food and fluid from entering the airway during swallowing. |
| Causes of Epiglottitis | It commonly affects children aged 2-8 years and can be bacterial. e.g haemophilus influenzae type B) or Viral (e.g RSV) |
| S/SX of Epiglottitis | Difficulty swallowing, drooling and tongue protrusion, -Cherry red, swollen epiglottitis visible during gag reflex , visualization should only be attempted in emergency setting, |
| When does it begin (Epiglottitis) and what are the other S/SX? | Begins as a child , Mild upper respiratory infection progresses rapidly to severe inspiratory stridor, high fever, hoarseness, and severe throat pain. |
| Precautions of Epiglottitis? | Never attempt direct visualization of the throat culture in symptomatic children unless airway support (e.g tracheostomy or intubation) is immediately avaible. |
| Immediate Interventions | Provide O2 if cyanosis or respi distress is present Administer IV antibiotic to treat infection Ensure hydration with IV fluids Establish an endotracheal airway to maintain breathing IF MATUKAN HEMLIK MANEUVER. |
| Aspiration | Is the inhalation of a foreign object into the airway commonly seen in infants and toddlers |
| Causes in Aspiration | Inhalation of small objects like coins, peanuts or other small items. |
| Assessment in Aspiration=IMMEDIATE REACTION | Choking, forceful coughing (in most cases, this dislodge the object). Severe Obstruction. Inability to cough or speak, indicating a blocked airway. |
| Therapeutic Management Aspiration | Initial prevention Perform back blows or sub diaphragmatic abdominal thrust (based on childs age and size) to dislodge the object. |
| Emergency care for Aspiration | If interventions are unsuccessful, seek emergency- medical assistance immediately to prevent respiratory distress or failure. |
| Influenza | It involves inflammation and infection of the major airways |
| Cause of Influenza | Orthomyxovirus influenza type A, B, or C. |
| Symptoms of Influenza | Cough, Fever, Fatigue, Body chest, sore throat, GI symptoms (e.g, vomiting, diarrhea) |
| Transmission of influenza | Highly contagious, spreads easily in house holds and classrooms. Children are infectious 1 day before symptoms appear up to 5 days after symptoms begin. |
| Complication of Influenza | Young children especially those with chronic conditions (e.g, cardiac or respi disease) are at higher risk of complications. |
| Management of Influenza | Oseltamivir for young children or children w/ risk factor such as cardiac or respi disease. |
| Prevention for Influenza | Children over 6 months of age should receive either the inactivated vaccine given by injection) or the given activated vaccine (given by nasal spray). |
| Bronchitis | inflammation of the bronchi in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. |
| Causes of bronchitis | Viral agents, Influenzae viruses, Adenovirus. |
| Bacterial Agent of Bronchitis | Mycoplasma pneumoniae. |
| S/SX of Bronchitis | Initial mild upper respi tract infection 1-2 days Progression to Fever, Dry, hacking cough, hoarse and mildly productive), Nasal Congestion, cough severe enough to wake the child from sleep |
| Symptoms duration of Bronchitis | Typically 1 week Full recovery way to take up to 2 weeks. |
| Assessment Findings in Bronchitis | Auscultation: Rhonchi, Coarse Crackles, Chest X ray, Diffuse alveolar hyperinflation. Markings at the lungs hilum |
| Management of Bronchitis | Antibiotics (only if bacterial) Bronchodilators (e.g., albuterol for airway opening) Corticosteroids (for severe inflammation) Expectorants (e.g., guaifenesin to loosen mucus) Antitussives (for persistent cough) |
| Non-pharmacological intervention of BRONCHITIS | Rest & Hydration (supports recovery, thins mucus) Steam Inhalation & Humidifiers (ease breathing) Warm Compress (chest relief) Avoid Irritants (smoke, dust) Proper Nutrition (boosts immunity) |
| Bronchiolitis | Bronchiolitis is a sickness that happens when tiny airways in the lungs get swollen and blocked after a cold. It usually affects little kids, especially toddlers and preschoolers. |
| What age is bronchiolitis be real hard? | for babies under 6 months old, it can be really serious and make it hard for them to breathe, sometimes needing a hospital stay. |
| Causes of broncholitis | RSV is the leading cause of bronchiolitis. Other causes exist, however, including viruses, bacteria, and myco-plasmal organisms. |
| Who's at higher risk of Bronchiolitis? | Premature infants and those with bronchopulmonary dysplasia, immunodeficiency, or congenital heart disease are at especially high risk. |
| How did BRONCHOLITIS OCCUR? | Bronchiolitis occurs when viruses or other infectious agents invade the mucosal cells lining the bronchi and bronchioles, causing the cells to die. |
| Symptoms of BRONCHIOLITIS | Coughing Wheezing Fast or troubled breathing Runny nose Fever Poor feeding Irritability or tiredness |
| Management of bronchiolitis | MILD CASES MANAGED AT HOME- ANTIPYRETICS (4FEVER) adequate hydration nasal suctioning and saline drops. Hospitalization for severe cases. APNEA, HYPOXIA, DEHYDRATION DUE TO FEEDING DIFFICULTIES. |
| INFECTION CONTROL FOR BRONCHIOLITIS? |
Created by:
Jon Anderson
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