Respiratory Dysfunction

  1. T or F: Under 3 months of age will have a higher URI rate than 3 months-toddlers
  2. This is an inflammatory respiratory condition. It's caused by a virus (RSV) that affects the smallest air passages in the lungs
  3. 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.
  4. Can you use neosynephrine for an infant with a cold?
    No, only used for emergencies
  5. You should not use nasal spray for cold tx longer than ___ days, due to ____
    3 days; rebound swelling
  6. Fill in: Rhinovirus can live up to __a__ on your skin and can survive up to __b__ on objects
    a & b: 3 hours
  7. What is the leading cause of PNA and bronchiolitis in the first 2 years of life?
  8. List s/s of severe RSV infection
    • difficult or rapid breathing with color changes
    • wheezing / course
    • irritability and restlessness
    • poor appetite
  9. 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
  10. What is the abx tx for AOM?
    Amoicillin (80-90 mg/kg/day) for 10-14 days
  11. 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
  12. 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.
  13. When are flu vaccines recommended for children?
    6 months
  14. T or F: Allergic rhinitis and nasopharynginitis are the same thing
  15. 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
  16. State whether AOM or OME
    1. Diarrhea often present
    2. Opaque
    3. Very red and immobile
    • 1. OME
    • 2. AOM
    • 3. AOM
  17. 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
  18. 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.
  19. T or F: Antibiotics are given for both AOM and OME
    False: not for OME unless it lasts longer than 3 months
  20. What is the abx and dose for AOM?
    Amoxicillin: 80-90 mg/kd/day for 2 weeks
  21. This is 80-90% of viral throat infections. It can lead to streptococcal infection and scarlet fever if left untreated.
  22. What can Pharyngitis lead to if left untreated?
    Streptococcal infection, which causes rheumatic (Scarlet) fever or acute glomerular nephritis
  23. How will you position a child while they are are waking up in postop?
    Abdomen or side until fully awake
  24. T or F: you want to discourage coughing and blowing nose after a tonsilitis surgery
  25. What are indications of hemorrhage after a tonsillits surgery?
    • Frequent swallowing
    • Increase pulse
    • pallor
    • Vomiting bright red blood
  26. T or F: With T&A surgery care, you can give citrus or milk products
  27. With T&A care, you can give phenergen for nausea, but not via IV
  28. This  is caused by any virus that infects the voice box (larynx) and windpipe (trachea). What can it present as?
    Croup: Barky cough
  29. What are the three main causes of croup?
    • RSV
    • Influenza A & B
    • Mycoplasma PNA
  30. 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
  31. What are the three significant signs of acute distress in acute epiglottis (croup?
    • 1. absence of spontaneous cough
    • 2. Drooling
    • 3. Agitaton
  32. During an Epiglottitis emergency (croup), what are the immediate interventions?
    • Trach right away
    • Steroids to get the swelling down
  33. T or F: Bronchiolitis requires isolation precaution
  34. What is the diagnostic test of Bronchiolitis?
    ELISA from direct aspiration of nasal secretions
  35. List interventions for bronchiolitis
    • High flow O2
    • High humidity for heavy secretions
    • fluid intake / possible IVF
    • Promote rest
  36. Bronchiolitis is caused by __a__ greater than 50% of the time
  37. T or F: Pertussis can lead to periods of apnea
  38. How is CF diagnosed?
    A sweat test around 6-12 months: elevated Sweat Cl 2-5x higher than normal  or >60 mEq
  39. Stretococcus pneumoniae is the most common bacteriam to cause this
  40. 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
  41. 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)
  42. 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%
  43. 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
  44. BPD (Bronchopulmonary dysplasia) is often seen in which kinds of infants?
    VLBW (<1000g) premature infants
  45. 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
  46. Which organs does Cystic fibrosis effect?
    Lungs and pancrease are clogged from mucus, which build up bacteria
  47. How is Cystic Fibrosis dx?
    • - Hx in family
    • - Absence of pancreatic enzyme
    • - Increase in electrolyte concentration of sweat >60mEq/L) 
    • - Chronic Pulmonary involvement
  48. What are the three medication types for CF?
    • 1. Mucus thinner: Pulmozyme
    • 2. Bronchodilator: Albuterol, Proventil
    • 3. Abx: Inhaled abx called TOBI
  49. How often do CF patients need to be seen?
    Depending on severity, usually q2-4month
  50. Fill in: Flu vaccines are recommended for children at age ____.
    6 months
  51. 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.
  52. Fill in: most acute otitis media occur in __a__ years. It is infrequent after _b_ years.
    • a. 2
    • b. 7
  53. 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
  54. T or F: OME is treated with abx if it lasts longer than 3 months
  55. What is the tx for chronic OM?
    Myringotomy: surgical placement of tubes to drain effusion
  56. 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
  57. 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
  58. What can frequent swallowing indicate for a T&A patient?
    indications of hemorrhage
  59. 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)
  60. T or F: with spasmodic croup, overexcitement can make symptoms worse
  61. 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
  62. T or F: Group B strep PNA is most common in children >5 years
    false: Group A strep

    GBS is common in newborns
  63. 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
  64. Difference of a viral pna vs. bacterial pna
    resp. involvement happens slowly
  65. What is a walking pna?
    A cough that is persistent, lasting up to 3-4 weeks. Indicative of Mycoplasma PNA.
  66. What are diagnostic tools for PNA
    • CXR
    • blood tests
    • sputum culture
    • pulse ox
  67. 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)
  68. Why is food digestion hindered with cystic fibrosis?
    Mucus build up can clog up the pancreas, which will reduce pancreatic enzymes to breakdown food.
  69. What can these s/s indicate:
    gray colored stools
    Mucopurulent sputum (mucus and pus)
    Cystic Fibrosis
  70. Amenorrhea and sterility can occur in teenagers with this dz
    Cystic fibrosis
  71. What are GI interventions with Cystic Fibrosis
    • Pancreatic enzymes with meals
    • High protein and high calorie
    • Fat soluble vitamin replacement
  72. Pulmozyme and TOBI are meds used for what?
    • Cystic fibrosis
    • Pulmozyme (mucus thinner)
    • TOBI (tobramycin) abx commonly used for CF
  73. You shouldn't use nasal spray for the cold longer than ___ days
  74. What age should high-risk infants be immunized against influenza?
    6 months
  75. When is taking aspirin contraindicated with these two illnesses in children?
    Chickenpox and Influenza
  76. 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.
  77. 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
  78. 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
  79. What are the types of croup?
    • 1. Acute Spasmodic Laryngitis
    • 2. Ltb (Laryngotracheo - bronchitis) 
    • 3. Acute epiglottitis
    • 4. Acute Tracheitis
  80. Fill in the common age risks for each type of croup:

    1. Acute Spasmodic Laryngitis ____
    2. Ltb (Laryngotracheo - bronchitis) ____
    3. Acute epiglottitis ____
    4. Acute Tracheitis ____
    • 1. Acute Spasmodic Laryngitis __1-3 years__
    • 2. Ltb (Laryngotracheo - bronchitis) __3m-3yr__
    • 3. Acute epiglottitis __3-7 years__
    • 4. Acute Tracheitis __1m-6 years__
  81. This type of croup is characterized by barking cough, inspiratory stridor, hoarseness. 

    Hospitilization may be necessary
    Acute Laryngo tracheo bronchitis
  82. This type of croup is a severe emergency. You want to be ready for intubation / trach.
    Epiglottitis: swelling decreases after 24 hours of abx and steroids for edema.
  83. List indication for Synagis. Which months is it indicated for?
    Bronchiolitis and RSV: Prevention of serious respiratory tract disease due to respiratory syncytial virus (RSV) in children ≤ 24 months

    Oct-April: RSV months
  84. What should you do first if you notice an apneic episode (>20 seconds) on an infant, with a constant elevated HR?
    Call MD
  85. What is Isoniazid indicated for?
  86. What is the drug of choice for TB?
Card Set
Respiratory Dysfunction
Exam 3 Lecture notes