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Respiratory Development
- 2-4 weeks: laryngotracheal groove
- 7th week: diaphragm
- 24-28 weeks: aveoli and capillaries
- 24 weeks: lethicin and sphingomyelin production begins
- 35 weeks: lungs fully mature (assessed with amnio)
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Normal Respirations
- Infant: 30-50
- One year: 20-40
- 6 years: 12-20
- Use abd muscles until 3 yrs
- Breathe through nose up
- Sternal/intercostals retractions indicate resp. distress
- Small bronchial tree - edema/spasms cause distress
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Ventilation
- Medulla - respiratory center
- Intercostals and diaphragm used to breathe
- Intercostals, phrenic, and vagus nerves assist
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Nasopharyngitis
- Inflammation and edema of membranes in URT
- Most common respiratory disorder
- Caused by rhinovirus or corona virus
- Spread by sneezing, coughing, direct contact
- Age, health, nutrition contribute
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Nasopharyngitis S/S
- fever (up to 104 - febrile seizures)
- nasal discharge - clear then purulent
- irritability
- sore throat
- HA
- fatigue
- general discomfort
- vomiting
- diarrhea
- contagious prior to symptoms + 8 hrs after
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Nasopharyngitis Complications
- bronchitis
- pneumonitis
- otitis media
- febrile seizures
- secondary bacterial infection
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Nasopharyngitis Treatment
- rest
- clear airway (saline drops, suction)
- increase fluids
- ibuprofen/acetaminophen for fever
- vaseline for nasal irritation
- cool air humidifier
- patient teaching - cover mouth/nose, handwashing
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Pharyngitis
- inflammation of the throat or pharynx
- affects 5-15 year olds
- 80% viral, 20% strep
- < 3 usually caused by flu
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Pharyngitis S/S
- fever
- malaise
- dysphagia
- anorexia
- if viral - conjunctivitis, rhinitis, cough, hoarseness
- gradual onset - lasts 5 days
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Strep Throat
- fever and dysphagia > 1 week
- C&S
- anti-infective (PCN or erythromycin)
- teach compliance
- gargle with salt water
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Sinusitis
- inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection
- ethmoid and macillary sinuses most often infected
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Sinusitis S/S
- URT > 10 days
- day cough
- halitosis
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Sinusitis Rx
- anti-infectives
- teach compliance
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Croup
- inflammation and narrowing of the larynx (voice box) and the trachea (windpipe) caused by an infection
- barking cough and inspiratory stridor
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Types of Croup
- spasmodic laryngitis - virus, allergy, GERD, psychological
- laryngotracheobronchitis - virus
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Spasmodic Laryngitis S/S
- sudden onset
- barking cough
- resp. distress
- anxiety
- lasts several hours at night, morning OK
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Spasmodic Laryngitis Rx
- high humidity
- increase fluids
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Laryngotracheobronchitis S/S
- preceded by URI
- barking cough
- stridor
- resp. distress
- cyanosis
- restlessness
- anxiety
- hypoxia
- tachycardia
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Laryngotracheobronchitis Rx
- high humidity
- vaporizer (clean daily)
- mist/croupette tent
- increase fluids/IV
- space care
- VS, O2 sats q 2-4 hours
- O2 therapy
- steroids
- nebs w/ epinephrine
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Epiglottitis
- inflammation of the epiglottis
- swelling above vocal cords, narrowed airway
- caused by Hemophilus influenza type b (Hib)
- affects 3-6 year olds
- give H. Influenza B vaccine
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Epiglottitis S/S
- rapid onset - emergency
- leans forward w. mouth open
- drooling
- difficulty swallowing
- elevated temp
- anxious
- beefy red epiglottis
- restlessness
- croaking on inspiration
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Epiglottitis Rx
- tracheostomy or endotracheal tube
- O2
- anti-infectives
- IV fluids
- VS, O2 sat q 2-4 hrs
- space care
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Bronchitis
- inflammation of the mucous membranes of the bronchi
- children under 4
- many organisms
- poor nutrition, allergies, chronic RTI
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Bronchitis S/S
- hacking cough preceded by URI or cold
- purulent sputum (children under 7 may swallow)
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Bronchitis Rx
- cough suppressant
- antihistamines
- expectorants
- steroids
- bronchodilators
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Bronchiolitis
- inflammation of the bronchioles (viral
- 6 mos - 2 years
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Bronchiolitis S/S
- URI or cold
- fever
- clear nasal discharge
- wheezing
- cough/resp. distress
- apneic periods
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Bronchiolitis Rx
- treat symptoms
- elevate HOB
- IVs
- I&O
- increased humidity
- nebs w. bronchodilators
- VS, O2 sats q 2-4 hrs
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Respiratory Synctival Virus (RSV)
- causes respiratory tract infections
- 50% of bronchitis cases
- babies can become seriously ill
- spread by direct contact (not airborne), survives for > 6 hours
- 4 day incubation period
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RSV Dx
- test secretions for RSV antigens
- symptoms
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RSV S/S
- low grade fever
- shallow, rapid respirations
- harsh cough
- expiratory wheeze
- rales, ronchi
- resp. distress
- fatigue
- irritability
- anorexia
- restlessness
- cyanosis
- hypoxia
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RSV Rx
- semi-fowler's
- IV fluids
- I&O - urine output 1-2 ml/kg/hr
- high humidity
- rest
- adequate nutrition
- ribavirin (aerosol mist - no pregnant women)
- contact isolation
- hand washing
- liquid soap
- daily weight
- O2 therapy
- VS, O2 sats
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