Exam 11: Respiratory Conditions
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| Upper Respiratory Tract | consists of the oronasopharynx, the pharynx, the larynx and the upper part of the trachea.
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| Lower Respiratory Tract | consists of the lower trachea, main stem bronchi, segmental bronchi, subsegmental bronchioles, terminal bronchioles, and the alveoli.
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| Respiratory infection: Etiology | b. Infectious Agents include viruses such as the respiratory syncytial virus (RSV), non-polio enteroviruses (coxsackieviruses A and B), adenoviruses, parainfluenza viruses, and human metapneumoviruses
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| Respiratory Infection: Clinical Manifestations | Fever
Poor feeding and anorexia
Vomiting
Diarrhea
Abdominal pain
Nasal blockage
Nasal discharge
Cough
Respiratory sounds
Sore Throat
Meningismus
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| The lower respiratory tract includes? | The lower trachea, main stem bronchi, segmental bronchi, subsegmental bronchioles, terminal bronchioles and the alveoli.
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| Nasopharyngitis | the common cold. It is the most common infection of the respiratory tract.
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| Nasopharyngitis: Pathophysiology | Rhinovirus
RSV
Adenovirus
Influenza virus
Parainfluenza virus.
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| What 3 factors can cause respiratory infection? | Diameter of airways.
Distance between structures.
Short and open eustachian tubes.
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| Acute Pharyngitis | Inflammation of the pharynx.
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| Acute Pharyngitis Pathophysiology | Throat culture should be performed to rule out GABHS (strep throat) 2 years old or older, complaining of sore throat, with or without exudate.
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| GABHS infection: Clinical Manifestations | Subclinical (no symptoms)
Abrupt onset
Pharyngitis (sore throat)
Headache
High fever (usually > = 102For higher)
ABD pain
Red, inflamed tongue (strawberry tongue)
Erythematous, fine sandpaper rash (characteristic)
Enlarged cervical lymph nodes
Ma
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| Non-GABHS infection: Clinical Manifestations | Gradual onset
Pharyngitis
Fever
Headache
Malaise
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| GABHS infection: Therapeutic Management | Oral penicillin for at least 10 days. PCN produces a prompt response within 24 hours.
Intramuscular penicillin G, painful, use ice to freeze site first, not the first line of choice
Oral erythromycin if PCN allergy
Antipyretics for fever, discomfort
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| Non-GABHS: Therapeutic Management | No specific treatment for non-strep sore throat
Antipyretics for fever, discomfort
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| What is another name for nasopharyngitis? | The common cold.
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| Why aren't antibiotics given for nasopharyngitis? | Antibiotics are for bacteria and the common cold is caused by a virus.
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| Tonsillitis/ Adenoiditis: Pathophysiology | Causative agent may be viral or bacterial
Due to the abundant lymphoid tissue and the frequency of URIs tonsillitis is a common cause of illness in young children
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| Tonsillitis/ Adenoiditis: Clinical Manifestations | Caused by inflammation of tonsils
Obstruction of passage of air or food with "kissing tonsils”
Difficulty swallowing
Difficulty breathing
Mouth-breathing
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| What postoperative complication requires immediate medical attention, above all others? | Hemorrhage.
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| Croup | generalized term applied to a symptom complex characterized by;
Hoarseness
Resonant “barking” or “brassy” cough
Varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx
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| Croup syndromes | can affect the larynx, trachea, bronchi
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| Acute Epiglottitis | a serious obstructive inflammatory process that occurs predominately in children 2 to 8 years of age.
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| Acute Laryngitis | acute infectious laryngitis is common illness in older children and adolescents. Viruses is usually the causative agents.
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| Acute Laryngotracheobronchitis | LTB is the most common croup syndrome, primarily affected children younger than 5 years of age. a. Causative organisms are parainfluenza virus types 2 and 3, human metapneumovirus, RSV, influenza A and B, and M. pneumoniae.
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| Acute Spasmodic Laryngitis | “midnight croup” or “twilight croup”.
a. Characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night. Usually affects children 1-3 years of age.
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| Bacterial Tracheitis | an infection of the mucosa of the upper trachea, is a distinct entity with features of both croup and Epiglottitis
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| Bacterial Tracheitis: Etiology | Occurs in children under 3 years of age.
May be a serious cause of airway obstruction that is severe enough to cause respiratory arrest.
Stridor affected by position. Absence of drooling.
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| Which form of croup can develop into a respiratory emergency? | Acute croup (laryngotracheobronchitis).
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| Respiratory Syncytial Virus (RSV) | virus that causes respiratory tract infections. It is a major cause of lower respiratory tract infections and hospital visits during infancy and childhood.
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| Bronchiolitis | an acute viral infection with maximum effect at the bronchiolar level. Infection occurs primarily in winter and early spring.
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| palivizumab (Synagis) | Prevention of RSV, a monoclonal antibody given monthly in an IM injection; there are specific guidelines for use of this.
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| How long can the RSV survive on countertops, tissues and soap bars? | More than 6 hours.
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| Pneumonia | inflammation of the pulmonary parenchyma, is common in childhood but occurs more frequently in infancy and early childhood.
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| Types of pneumonia | Lobar.
Bronchopneumonia.
Interstitial.
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| Lobar Pneumonia | all or a large segment of one or more pulmonary lobes is involved
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| Bronchopneumonia | this begins in the terminal bronchioles, which become clogged with mucopurulent exudate to form consolidated patches in nearby lobules (also called lobular pneumonia)
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| Interstitial Pneumonia | the inflammatory process is more of less confined within the alveolar walls (interstitium) and the peribronchial and interlobular tissues
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| Viral pneumonia: Therapeutic Management | Occurs more frequently, seen in children of all ages
ii. Symptomatic and includes measures to promote oxygenation and comfort
iii. Cool mist
iv. Chest physiotherapy and postural drainage
v. Antipyretics for fever management
vi. Fluid intake
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| Bacterial pneumonia: Therapeutic Management | i. Antibiotic therapy (oral, IM, IV)
ii. Bedrest
iii. Liberal oral fluid intake or IV fluids (hospitalized)
iv. Antipyretics for fever
v. Oxygen (hospitalized)
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| Bacterial pneumonia: Hospitalization | 1. Pleural effusion
2. Empyema
3. Compliance with therapy is estimate to be poor
4. Infants less than 1 month old
5. Chronic illnesses present
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| Aspiration pneumonia: Therapeutic Management | i. May be life-threatening
ii. Emergency treatment of the choking infant/ child
iii. Usually aspirated foreign body (FB) rarely coughed up and must be removed instrumentally by endoscopy
iv. Sedation is required
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| How is pneumonia classified? | Morphologic, but most useful is based on the etiologic agent.
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| Asthma | a. Chronic inflammatory disorder of the airways
b. Inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough
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| Asthma Etiology | complex disorder involving biochemical, genetic, immunologic, environmental, infectious, endocrine, and Psychologic factors.
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| Asthma Pathophysiology | results from complex interactions among inflammatory cells, mediators, and the cells and tissues present in the airways.
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| Mechanisms responsible for the obstructive symptoms in asthma include: | i. Inflammatory response to stimuli
ii. Airway edema and accumulation and secretion of mucus
iii. Spasm of the smooth muscle of the bronchi and bronchioles, which decrease the caliber of the bronchioles
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| Asthma: Diagnostic Tests | Pulmonary Function Tests (PFTs).
Peak Expiratory Flow Rate (PEFR).
Bronchoprovocation Testing.
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| Long-term control medications, Asthma | a. Inhaled corticosteroids
b. Cromolyn sodium, nedocromil
c. Long-acting beta-2 agonists
d. Methylxanthines
e. Leukotriene modifiers
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| Quick Relief, Asthma | a. Short-acting beta-2 agonists
b. Anticholinergics
c. Systemic corticosteroids
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| What are the classic manifestations of asthma? | Dyspnea, wheezing, coughing
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| Question: What are the goals of asthma therapy? | Maintain normal activity levels, maintain normal pulmonary function, prevent chronic symptoms and recurrent exacerbations, provide optimum drug therapy with minimum or no adverse effects and assist the child in living as normal and happy life.
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| Cystic Fibrosis | inherited disease that affects the lungs, digestive system, sweat glands, and male fertility. Its name derives from the fibrous scar tissue that develops in the pancreas, one of the principal organs affected by the disease.
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| Cystic Fibrosis: Clinical Features | i. Increased viscosity of mucous gland secretions
ii. Striking elevation of sweat electrolytes
iii. Increase in several organic and enzymatic constituents of saliva
iv. Abnormalities in autonomic nervous system function
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| Cystic Fibrosis: Clinical Manifestations | Meconium (about 10% of cases in newborns).
Gastrointestinal.
Pulmonary.
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| Cystic Fibrosis: Meconium Manifestations | i. Abdominal distention
ii. Vomiting
iii. Failure to pass stools
iv. Rapid development of dehydration
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| Cystic Fibrosis: GI Manifestations | i. Large, foul-smelling stools
ii. Voracious appetite (early)
iii. Loss of appetite (later)
iv. Weight loss
v. Marked tissue wasting
vi. Failure to grow
vii. Distended ABD
viii. Thin extremities
ix. deficiency of fat-soluble A, D,E, K
xi. Anemi
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| Cystic Fibrosis: Pulmonary Manifestations (Initial) |
1. Wheezy respirations
2. Dry, non-productive cough
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| Cystic Fibrosis: Pulmonary Manifestations (Eventually) | 1. Increased Dyspnea
2. Paroxysmal cough
3. Evidence of obstructive emphysema and patchy areas of atelectasis
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| Cystic Fibrosis: Pulmonary Manifestations (Progressive Involvement) | 1. Overinflated, barrel-shaped chest
2. Cyanosis
3. Clubbing of fingers and toes
4. Repeated episodes of bronchitis and bronchopneumonia
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| Cystic Fibrosis: Complications | a. Prolapse of the rectum.
b. Intestinal obstruction .
c. Pulmonary complications (i. Bronchiectasis
ii. Atelectasis
iii. Hyperinflation
iv. Pneumonia)
d. Reproductive systems
e. Growth and development
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| Cystic Fibrosis Related Diabetes (CFRD) | a combination of insulin resistance and insulin deficiency with unstable glucose homeostasis in the presence of acute lung infection and treatment
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| What are the two main problems related to the GI system as seen in Cystic Fibrosis? | Intestinal obstruction and prolapsed rectum from bulky stools.
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| What exercises can the parents be taught to do at home to help move secretions up and out? | Postural drainage and chest physical therapy.
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