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Objective 1: features of the child upper respiratory
- Abdominal and diaphragm for primary breathing
- Accessory muscles
- Nose breathers
- Smaller airway
- Airway cartilage soft
- Less alveoli
- ↑ RR
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Objextive 2: Effects of aging on Upper respiratory
- Stiffing of the chest wall
- ↓ Elastic Recoil
- ↓ chest wall Compliance
- ↓ functioning alveoli
- ↓ Exp muscle strength
- Costal cartilage calcification
- ↑ Residual Volume
- ↑ Ant/Pst Thoracic cage diameter
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Obj.# 2: Pediatric considerations of Upper Respiratory disorders
- Anorexia
- Irritability
- GI symptoms w/infection (Abd pain, vomiting, diarrhea => URIs, UTIs, pneumonia & Otis Media )
- Risk: dehydration & Fluid imbalences
- URI complications (Otis Media, Lower Resp. Infection, Septicemia, Meningitis)
- <3 yrs react more severely
- Viruses esp sever in infants
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Obj#3: Acute Pharyngitis (Strep Throat)
-Patho
-Clinical Manifestations
- Patho: inflammation of the structures of the throat.
- -common between 5-15 yrs
- -80% caused by beta-hemolytic streptococcus
- -Influenza common cause in chlidren <3 yrs
CM: Fever, Malaise, Dysphagia, Anorexia, Red throat w/ tonsilar exudate, Swollen lymph nodes
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Obj# 3: Acute Pharyngitis (Strep Throat)
-Treatment
-Interventions
- Throat culture (routine:24-48hrs, rapid:10-15min)
- Antibiotics
- Antipyretics (ibuprofen, Tylenol)
- Teach Pt.'s antibiotics must be finished to prevent complications
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Obj#3: Epiglottitis
Patho
Clinical Manifestations
- Patho: infection & inflammation of epiglottitis
- CM: dysphagia, drooling, resp distress: Insp. stridor, tachypnea, nasal flaring, tripod positioning, anxiety/agitation), fever, sore throat,
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Obj#3: Epiglottitis
Treatment
Interventions
- Emergency!
- Anticipate intubation w/oxygen
- Do not inspect throat
- Do not leave child unattended
- Do not upset the child
- Avoid sedation until airway secured
- Cool-mist O2 therapy per order
- Monitor VS closely
- Blood culture
- Antibiotics
- IV fluids
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Obj#3: Laryngotracheobronchitis (Croup)
Patho
Clinical Manifestations
- Patho: inflammation of the larynx, trachea, bronchi
- CM:
- usually preceeded by URI
- Mostly children <5 yrs
- Progresses slowly in stages (stages 1-4)
- Symptoms worse @ night, better in day
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Obj#3: Laryngotracheobronchitis (Croup)
Treatment/Interventions
- Maintain patent airway (accessory muscle use?, cyanosis?)
- Elevate HOB
- Rest and fluid
- Humidified air
- Bronchodialators
- Nebulizers
- Corticosteroids
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Obj#3: Laryngotracheobronchitis (Croup)
Stage progression
- Stage 1:
- Low-grade fever
- Brassy, Barking cough
- Insp. Stridor
- hoarseness
- Fear; restlessness
- Stage 2:
- labored breathing
- crackles
- wheezing
- retractions
- Stage 3:
- Hypoxia & Hypercapnia: anxiety, diaphoresis, Tachypnea, Tachycardia
- Stage 4:
- Cyanosis
- Resp. arrest
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Obj #3: Tonsillitis & Adenoiditis
Patho
Clinical Manifestations
- Patho: persistent/recurrent swollen, red, inflammed tonsils/adnoids
- CM:
- viral>bacterial
- most common cause is Step throat
- droplet precautions
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Obj #3: Tonsillitis
Clinical manifestations (S/S)
- persistent/recurrent sore throat
- fever
- headache
- tonsils red, edematous, w/white exudate
- dysphagia
- swollen, tender Lymph nodes
- reffered ear pain
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Obj #3: Adenoiditis
Clinical manifestations (S/S)
- mouth breathing
- noisy breathing
- nasal speech
- Rhinorrhea
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Obj #3: Tonsillitis & Adenoiditis
Pre-Op: Treatment/Interventions
- Tonsillectomy & Adenoidectomy
- PostOp:
- bleeding?
- clotting studies
- inform child throat will be sore and will need to drink lots of fluids
- loose teeth? (aspiration risk)
- CBC, Platelet count
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Obj #3: Tonsillitis & Adenoiditis
Post-Op: Treatment/Interventions
- Position prone or side lying
- suction for airway obstr
- assess S/S hemorrhage
- Discourage coughing, throat clearing
- clear liquids (no citris or carbonation)
- No straws, forks, or sharp objects in mouth
- Admin pain med
- Teach if fever, ear ache, or bleeding notify physician
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