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1 NR 602 Quiz 3 Study Guide: Respiratory Infections
1 NR 602 Quiz 3 Study Guide: Respiratory Infections
Respiratory Infections
Sinusitis/Rhinosinusitis
Pneumonia
- Bacterial or Viral
o Bacterial:
less common in childhood
S. pneumo.
Most common cause
Lobar pneumonia
Methicillin resistant Staph aureus(MRSA)
Community acquired
Empyema
Necrosis
o Viral:
More common in children < 2 yrs
Gradual onset
- Typical or Atypical
o Typical: lobar, infection of alveolar space resulting in consolidation
o Atypical: non-localized consolidation
Walking pneumonia
- Risk factors: neonates
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Rotavirus
Croup
- Viral infection of the middle respiratory track (Larynx and bronchial tree
- Laryngotraceitis / Laryngotracheobronchitis (LTB)
o Viral: parainfluenza type 1 & 2 (HPIV)
o LTB more severe, occurs 5 – 7 days in to the disease
- Usually children < 6 yrs
- Season: fall and winter
- Incubation period: 2-4 days with viral shedding up to 1 week, lasts approx. 5 days
- HALLMARK: Barking Cough *Sound bit: 1, 2, 3 (https://mommyhood101.com/croup-audio-clips
- Diagnosis: made by symptoms/clinical presentation
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- Symptoms:
o Low grade fever
o URI symptoms- gradual onset (rhinorrhea, congestion)
o Barking Cough
o Hoarseness
o Dyspnea
o Respiratory Distress (Intercostal retraction, tachypnea, cyanosis, accessory muscles, nasal flaring)
- Clinical Findings:
o Tachypnea
o Prolonged inspiration
o Inspiratory stridor (as airway obstruction worsens) *Sound bit: 4, 5
(https://mommyhood101.com/croup-audio-clips)
o Wheezing (if lower airway involved)
o Chest X-Ray (not typically done): subglottic narrowing – Steeple Sign
- Treatment:
o Supportive Care: Symptom Management
Cold air
Hydration
o Glucocorticoids: reduce airway swelling
Dexamethasone 0.6 mg/kg to1 mg/kg IM PO
o Aerosolized racemic epinephrine: reduce swelling of larynx and subglottis
o Bronchodilator
o Hospitalization:
RR > 70 bpm
Stridor at rest
Temperature > 102.2 F (39C)
- Complications:
o Pneumonia
o Respiratory distress
Epiglottitis
- Inflammation of epiglottis, aryepiglottic folds, and ventricular bands at the base of the epiglottis
- Cause: H. influenza type B (HiB)
- Prevention: HiB vaccine
- Typically age 1-5 yrs (most under 2 yrs)
- Symptoms:
o Abrupt onset fever
o Severe sore throat
o Dyspnea
o Inspiratory distress without stridor
o *drooling
o Toxic look
- Clinical Findings: Emergent- Death within hours
o * If epiglottitis is suspected: do NOT examine throat, do NOT place in supine position,
Immediately transfer to ER
o Expiratory stridor
o Drooling
o Aphonia (muffled, ‘hot potatoe’ voice)
o Rapid progression of respiratory obstruction
o High fever
o Flaring ala nasi and retraction of supraclavicular, intercostals, and subcostal spaces
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Nasal Occlusion
- Symptoms:
o Recurrent, unilateral purulent nasal discharge
o Foul odor
o Epistaxis
o Nasal obstruction/ mouth breathing
- Detection of FB in nasal passageway
- Removal:
o Alligator forceps
o Suction with narrow tips
o Cotton tipped applicators w/ or w/o topical vasoconstrictor
o Hook or curette
o 5-Fr catheter balloon inflation behind FB
o Refer to ENT
Laryngeal FB Aspiration
- Symptoms:
o Rapid onset hoarseness
o Croupy cough
o Aphonia
Tracheal FB Aspiration
- Symptoms:
o Brassy cough
o Hoarseness
o dyspnea
Bronchial FB Aspiration
- Symptoms:
o Unilateral wheeze, usually aspirated into *Right lung
o Recurrent pneumonia
o HX of Choking episode
- Clinical Findings:
o Cyanosis
o Hemoptysis, blood streaked sputum
o Decreased vocal fremitus
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- Diagnostic:
o Newborn screening performed
o Gold Standard: pilocarpine iontophoresis sweat test
Only ordered if child has more than one clinical feature of CF
Sweat chloride concentration > 60 mmol/L (age > 6 months), > 30 mmol/L (in infants)
o PFTs
o Glycosylated hemoglobin (elevated)
- Treatment: complicated, require multidisciplinary team
o Pulmonary: promote airway clearance
Inhaled dornase alfa :reduce mucus viscosity
Hypertonic saline: thins mucus
Postural drainage (cycle: active breathing, autogenic drainage, percussion, positive
expiratory pressure, exercise, high frequency chest wall oscillation) BID
High dose Ibuprofen: reduce airway inflammation
Azithromycin 3x/week (ibuprofen decreases neutrophil mitigation)
Lung transplant
o GI:
Pancreatic enzyme supplementation
Vitamin replacement and serum monitoring (A, D, E, K)
Osmotic laxatives, Gastrografin enemas
o Endocrine
Glucose tolerance test
Diabetes management
Salmonella
Clostridium difficile
Cryptosporidium
Pyloric Stenosis
Pinworms
Primary Enuresis
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Glomerulonephritis
Osgood-Schlatter
Osteomyelitis
Idiopathic Scoliosis
1. How should the APRN teach the parents to manage the child’s symptoms?
2. Fevers in children under 36 months of age can have potentially serious consequences.
For a 2 month old infant, which tests should the APRN considering ordering?