T or F: Under 3 months of age will have a higher URI rate than 3 months-toddlers
False
This is an inflammatory respiratory condition. It's caused by a virus (RSV) that affects the smallest air passages in the lungs
Bronchiolitis
This is also known as swine flu. It's called swine flu because in the past, the people who caught it had direct contact with pigs. That changed several years ago, when a new virus emerged that spread among people who hadn't been near pigs.
H1N1
Can you use neosynephrine for an infant with a cold?
No, only used for emergencies
You should not use nasal spray for cold tx longer than ___ days, due to ____
3 days; rebound swelling
Fill in: Rhinovirus can live up to __a__ on your skin and can survive up to __b__ on objects
a & b: 3 hours
What is the leading cause of PNA and bronchiolitis in the first 2 years of life?
RSV
List s/s of severe RSV infection
difficult or rapid breathing with color changes
wheezing / course
irritability and restlessness
poor appetite
Allergic shiners
dark circles under the eyes caused by congestion of the nose and sinuses. They're usually described as dark, shadowy pigments that resemble bruises
What is the abx tx for AOM?
Amoicillin (80-90 mg/kg/day) for 10-14 days
Match:
1. With Bronchiolitis lung sounds, you will hear ___.
2. With RSV, you will hear ___.
a. Rhonci
b. Wheezing
c. Course
1. b
2. c
What is the dangers of giving Aspirin with influenza?
It can lead to Reye's Syndrome: Swelling may also occur in the brain, which can cause seizures, convulsions or loss of consciousness.
When are flu vaccines recommended for children?
6 months
T or F: Allergic rhinitis and nasopharynginitis are the same thing
false
State whether this is AOM or EMO
1. Purulent effusion
2. Immobility of membrane
3. orange discolored membrane
4. bulging or full tympanic membrane
5. s/s of pain, cough, rhinitis
1. AOM
2. OME
3. OME
4. AOM
5. OME
State whether AOM or OME
1. Diarrhea often present
2. Opaque
3. Very red and immobile
1. OME
2. AOM
3. AOM
This is Inflammation of the middle ear in which there is fluid in the middle ear accompanied by signs or symptoms of ear infection.
What are its s/s?
Acute Otitis Media (AOM):
- bulging or full tympanic membrane
- drainage or purulent effusion
- Opaque, red and immobile
This is a collection of non-infected fluid in the middle ear space. It is also called serous or secretory otitis media (SOM). This fluid may accumulate in the middle ear as a result of a cold, sore throat or upper respiratory infection.
OME
T or F: Antibiotics are given for both AOM and OME
False: not for OME unless it lasts longer than 3 months
What is the abx and dose for AOM?
Amoxicillin: 80-90 mg/kd/day for 2 weeks
This is 80-90% of viral throat infections. It can lead to streptococcal infection and scarlet fever if left untreated.
Pharyngitis
What can Pharyngitis lead to if left untreated?
Streptococcal infection, which causes rheumatic (Scarlet) fever or acute glomerular nephritis
How will you position a child while they are are waking up in postop?
Abdomen or side until fully awake
T or F: you want to discourage coughing and blowing nose after a tonsilitis surgery
True
What are indications of hemorrhage after a tonsillits surgery?
Frequent swallowing
Increase pulse
pallor
Vomiting bright red blood
T or F: With T&A surgery care, you can give citrus or milk products
False
With T&A care, you can give phenergen for nausea, but not via IV
true
This is caused by any virus that infects the voice box (larynx) and windpipe (trachea). What can it present as?
Croup: Barky cough
What are the three main causes of croup?
RSV
Influenza A & B
Mycoplasma PNA
This is Acute spasm of the larynx characterized by the sudden onset of cough and inspiratory stridor.
When does it usually present (time of day)
Acute Spasmodic Laryngitis (Croup)
Usually reoccrs at night, over the next several nights
What are the three significant signs of acute distress in acute epiglottis (croup?
1. absence of spontaneous cough
2. Drooling
3. Agitaton
During an Epiglottitis emergency (croup), what are the immediate interventions?
Trach right away
Steroids to get the swelling down
T or F: Bronchiolitis requires isolation precaution
Tru
What is the diagnostic test of Bronchiolitis?
ELISA from direct aspiration of nasal secretions
List interventions for bronchiolitis
High flow O2
High humidity for heavy secretions
fluid intake / possible IVF
Promote rest
Bronchiolitis is caused by __a__ greater than 50% of the time
RSV
T or F: Pertussis can lead to periods of apnea
true
How is CF diagnosed?
A sweat test around 6-12 months: elevated Sweat Cl 2-5x higher than normal or >60 mEq
Stretococcus pneumoniae is the most common bacteriam to cause this
PNA
What can these s/s indicate?
- Quick onset
- productive cough
- pain in the chest "like glass"
- n/v/d
- decrease in appetite and fatigue
Bacterial PNA
What are the first two things to develop with a Mycoplama pneumoia?
How long can the cough last?
Fever and cough
Persistent that may last 3-4 weeks (walking PNA)
T or F: Someone who has a moderate persistent asthma, will have a PEFR les than or equal to 60% of predicted
False: < or = to 60% is severe persistent
Moderate is 60-80%
This is the condition that results if symptoms of RDS continue for more than one month after birth. Typically occurs with infants with underdeveloped lungs.
BPD: Bronchopulmonary dysplasia
BPD (Bronchopulmonary dysplasia) is often seen in which kinds of infants?
VLBW (<1000g) premature infants
This is an inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body. It affects the cells that produce mucus, sweat and digestive juices
Cystic Fibrosis
Which organs does Cystic fibrosis effect?
Lungs and pancrease are clogged from mucus, which build up bacteria
How is Cystic Fibrosis dx?
- Hx in family
- Absence of pancreatic enzyme
- Increase in electrolyte concentration of sweat >60mEq/L)
- Chronic Pulmonary involvement
What are the three medication types for CF?
1. Mucus thinner: Pulmozyme
2. Bronchodilator: Albuterol, Proventil
3. Abx: Inhaled abx called TOBI
How often do CF patients need to be seen?
Depending on severity, usually q2-4month
Fill in: Flu vaccines are recommended for children at age ____.
6 months
What is tx for sinusitis if it does not resolve on its own within 3 days
Rx: Amoxicillin
Other tx: analgesics, hydration, and moist heat.
Antihistamines to treat allergy symptoms with chronic sinutis.
Fill in: most acute otitis media occur in __a__ years. It is infrequent after _b_ years.
a. 2
b. 7
Say if this is AOM or OME:
1. Immobility of membrane
2. Bulging or full tympanic membrane
3. Orange discolored membrane
4. Opaque
5. Purulent effusion
6. Very red and immobile
7. Diarrhea often present
8. symptoms of pain, cough, rhinitis may be ascent
1. OME
2. AOM
3. OME
4. AOM
5. AOM
6. AOM
7. OME
8. OME
T or F: OME is treated with abx if it lasts longer than 3 months
False
What is the tx for chronic OM?
Myringotomy: surgical placement of tubes to drain effusion
Removal of tonsils is considered controversial. What are the 3 indications for why they are generally removed?
1. upper airway obstruction
2. peri-tonsillar abscess
3. obstructive sleep apnea
What position for a postop tonsillectomy patient until they are fully awake?
What will you discourage the patient from doing?
abdomen or side
Then situp on bedrest for a day.
Discourage: coughing, clearing throat, blowing nose
What can frequent swallowing indicate for a T&A patient?
indications of hemorrhage
When can you give PO fluids to a T&A patient, and which kinds of fluid is contraindicated?
No citrus or milk products.
Allowed: cool water, ice pops, diluted juice (no red or brown colors)
T or F: with spasmodic croup, overexcitement can make symptoms worse
true
For infants born 35 or earlier with Bronchiolitis and RSV, you want to administer this med via IM monthly (oct. through april)
Synagis and or RSV immune globulin
T or F: Group B strep PNA is most common in children >5 years
false: Group A strep
GBS is common in newborns
What do these s/s indicate:
productive cough
pain in chest, "like glass" even when breathing
vomit and diarrhea
decrease in appetite, fatigue
Bacterial PNA
Difference of a viral pna vs. bacterial pna
resp. involvement happens slowly
What is a walking pna?
A cough that is persistent, lasting up to 3-4 weeks. Indicative of Mycoplasma PNA.
What are diagnostic tools for PNA
CXR
blood tests
sputum culture
pulse ox
This type of chronic lung disease results from damage to the lungs caused by mechanical ventilations, and long term use of oxygen.
Which kinds of newborns are at high risk?
Bronchopulmonary dysplasia (BPD)
VLBW (<1000G) AND PREMATURE INFANTS
Why is food digestion hindered with cystic fibrosis?
Mucus build up can clog up the pancreas, which will reduce pancreatic enzymes to breakdown food.
What can these s/s indicate:
gray colored stools
Mucopurulent sputum (mucus and pus)
Cystic Fibrosis
Amenorrhea and sterility can occur in teenagers with this dz
Cystic fibrosis
What are GI interventions with Cystic Fibrosis
Pancreatic enzymes with meals
High protein and high calorie
Fat soluble vitamin replacement
Pulmozyme and TOBI are meds used for what?
Cystic fibrosis
Pulmozyme (mucus thinner)
TOBI (tobramycin) abx commonly used for CF
You shouldn't use nasal spray for the cold longer than ___ days
3
What age should high-risk infants be immunized against influenza?
6 months
When is taking aspirin contraindicated with these two illnesses in children?
Chickenpox and Influenza
What is a Myringotomy indicated for, and what are the post-op teachings to the parents?
Indicated for Otitis Media (Insertion of tympanostomy tubes):
tell parents small amount of reddish drainge is normal in first few days, but parents should report heavier bleeding in later than 3 days.
Avoid blowing nose for 7-10 days.
Keep ears dry; avoid bath and lake waters, or chlorinated swimming pools.
Can place cotton balls with petroleum jelly during baths and shampoos.
List ways to prevent recurrent Otitis Media during infancy
breastfeeding during infancy
d/c bottle feeding as soon as possible
feeding in an upright position
Don't smoke around child
What kinds of food (texture) will you offer to children with Pharyngitis?
When should the parent call the provider in regards to the child's fever?
Cool, bland liquids
Soft foods such as gelatin, soup, mashed potatoes.
Call if fever lasts more than 3 days
What are the types of croup?
1. Acute Spasmodic Laryngitis
2. Ltb (Laryngotracheo - bronchitis)
3. Acute epiglottitis
4. Acute Tracheitis
Fill in the common age risks for each type of croup:
