Term
| Why are healthy full term infants presumed to have a lower infection rate? |
|
Definition
| d/t the protective function of the maternal antibodies |
|
|
Term
| Is viral infection rate high during the toddler and preschool years? |
|
Definition
|
|
Term
| Respiratory tract infections are less frequent when a child reaches the age of 5. But the incidence of what two infections increase during this time? |
|
Definition
strep
&
mycoplasma pneumoniae |
|
|
Term
| Why does the size of the respiratory tract have to do with risk of infections in children? |
|
Definition
| the diameter is smaller and is subject to narrowing and edematous mucous membranes and increased secretions |
|
|
Term
| Why are infants and young children subject to middle ear infections? |
|
Definition
| d/t the short and open eustachian tube |
|
|
Term
| The most common respiratory tract pathogens appear in epidemics during what months? |
|
Definition
|
|
Term
| Assessment for respiratory system should include? |
|
Definition
heart rate
respiratory rate/depth/rhythm
hydration status |
|
|
Term
| What technique could the nurse do to ease respiratory efforts? |
|
Definition
-warm or cool mist
-the moisture soothes inflamed membranes
-beneficial when there is laryngeal involvement or hoarseness |
|
|
Term
| Would you recommend that parents use a home vaporizer to ease respiratory efforts? |
|
Definition
| No, hazardous and no evidence to support this |
|
|
Term
| If your baby is congested, what should be done before feedings to promote comfort? |
|
Definition
| use nasal aspirator or rubber ear syringe to remove secretions before feeding |
|
|
Term
| What can be done to provide relief in a patient with painful cervical adentitis? |
|
Definition
| hold or cold applications |
|
|
Term
| Ideally, when should a child be isolated? |
|
Definition
| at the first sign of illness |
|
|
Term
| Why should parent be cautious when using OTC combo cold remedies? |
|
Definition
| they often contain acetaminophen |
|
|
Term
| Factoid: To reduce the temperature and minimize the chance of dehydration, encourage COOL LIQUIDS |
|
Definition
|
|
Term
| High cal liquids, such as, colas, fruit juice drinks, water flavored and sweetened with corn syrup can help prevent catabolism and dehydration, BUT should be avoided when what is present ? |
|
Definition
|
|
Term
| Your pediatric pt who is at risk for dehydrations is asleep. do you wake them up to drink fluids, or let them sleep? |
|
Definition
| Never force children to drink unless the practitioner advises it |
|
|
Term
| How would you as the nurse assess a child's level of hydration? |
|
Definition
| observe the frequency of voiding and notify nurse or doc in their is insufficient voiding |
|
|
Term
| how is urinary outout calculated in an infant who weighs 30 kg or less |
|
Definition
|
|
Term
| Group A beta-hemolytic strep can cause skin manifestations such as? |
|
Definition
| impetigo and pyoderma (pus-producing) |
|
|
Term
| Beside rheumatic fever and acute glomerulonephritis, what other disease may develop? |
|
Definition
|
|
Term
| what are the clinical manifestations of scarlet fever? |
|
Definition
| pharyngitis and a erythematous sandpaper-like rash |
|
|
Term
| Factoid: GABHS is generally a brief illness and varies from subclinical(no sx) to severe toxicity |
|
Definition
|
|
Term
| The onset of GABHS is often abrupt and characterized by what ? |
|
Definition
pharyngitis
HA
fever
ab pain |
|
|
Term
| Your pt with GABHS opens his mouth and says "aaahhh", what would you expect to observe? |
|
Definition
| tonsils and pharynx inflamed and covered in exudate |
|
|
Term
| when does the inflamed tonsils and pharynx usually manifest in strep? |
|
Definition
| by the second day of illness |
|
|
Term
| When would the complications of acute nephritis and rheumatic fever occur after the onset of GABHS? |
|
Definition
nephritis: about 10 days
RF: about 18 days |
|
|
Term
| Although 80-90% of acute pharyngitis is viral, what should be done to rule out GABHS? |
|
Definition
|
|
Term
| Your pt has a positive strep throat culture. Do they have an active disease? |
|
Definition
| No, some children normally have strep in their throats. |
|
|
Term
| Your pt has a negative rapid diagnostic test response for strep. Do they still need the culture? |
|
Definition
| Yes, they need a culture regardless. The sensitivity in these tests are questionable. |
|
|
Term
| For a pt with a strep sore throat infx present, how is it treated? |
|
Definition
| oral penicillin for at least 10 days |
|
|
Term
| Does the penicillin prevent the development of acute glomerulonephritis in children? |
|
Definition
-nope
but it may prevent the spread of a nephrogenic strain of GABHS |
|
|
Term
| IM penicillin G benzathine is appropriate therapy for strep and ensures adequate blood concentration. But why may pt not what this done? |
|
Definition
|
|
Term
| If your pt with step is allergic to penicillin, then what may be given? |
|
Definition
|
|
Term
| If children are old enough to cooperate, what may provide throat relief? |
|
Definition
|
|
Term
| Never give pencillin IV !!!!!! |
|
Definition
|
|
Term
|
Definition
close contact with afftected persons
large droplet
physical transfer of secretions |
|
|
Term
| when is the child with strep non-infectious? |
|
Definition
| 24 hrs after initiation of antibiotics |
|
|
Term
| when should the pt with strep replace their toothbrush? |
|
Definition
| after taking antibiotics for 24 hrs |
|
|
Term
| The two viruses most likely to precipitate OM are? |
|
Definition
|
|
Term
| Is there a correlation with children who have siblings or parents with chronic OM? |
|
Definition
| Yes, they have a higher incidence of OM |
|
|
Term
| What are some significant risk factors for OM? |
|
Definition
Daycare
being around smokers
|
|
|
Term
| How does passive smoking increase the risk of persistent middle ear infx? |
|
Definition
| enhances attatchment of the pathogens that cause otitis to the resp epithelium in the middle ear space, thus prolonging inflammatory response and impeding drainage through the eustachian tube |
|
|
Term
| What are the two most identifiable risk factors for the occurrence of OM? |
|
Definition
family socioeconomic status
&
extent of exposure to other children |
|
|
Term
| AOM is frequently caused by what three pathogens? |
|
Definition
Streptococcus pneumoniae
H. Influenzae
Moraxella catarrhalis |
|
|
Term
| Breast feeding may protect infants from resp viruses and allergy because it contains what Ig? |
|
Definition
|
|
Term
| IgA does what in terms of OM prevention? |
|
Definition
| limits the exposure of the eustachian tube and middle ear to pathogens and foreign protein |
|
|
Term
| OM is promarily the result of _ eustachian tube (fill in the blank) |
|
Definition
|
|
Term
| What are the three functions of the eustachian tubes? |
|
Definition
1.protect middle ear from nasopharyngeal secretions
2. drain secretions made in the middle ear to the nasopharynx
3. ventilation to equalize pressure and replenish O2 that has been absorbed |
|
|
Term
| Example of intrinsic obstruction causing OM? |
|
Definition
|
|
Term
| Extrinsic obstruction causing OM? |
|
Definition
| enlarged adenoids and nasopharyngeal tumors |
|
|
Term
| what causes hearing loss in OM? (3) |
|
Definition
negative middle ear pressure
effusion
damage to eardrum |
|
|
Term
| What is the most feared consequence of hearing loss? |
|
Definition
| development of speech, language, and cognition |
|
|
Term
| Hearing loss is a functional complication to OM, but what is a structural complication? |
|
Definition
| tympanic membrane retraction caused by continuous negative pressure |
|
|
Term
| Chronic suppurative OM, inflammation of the middle ear and mastoid, is evidenced by what? |
|
Definition
| perforation and discharge for up to 6 weeks duration |
|
|
Term
| What are clinical signs of cholesteatoma? |
|
Definition
foul smelling grayish yellow discharge
pain
permanent, progressive hearing loss |
|
|
Term
What is the treatment for cholesteatoma? |
|
Definition
| surgical excision of the entire cholesteatoma |
|
|
Term
| what would you assess in the behavior of an infant with accumulated purulent drainage in the middle ear? |
|
Definition
| holding or pulling at their ears and rolling head from side to side |
|
|
Term
| A temperature as high as _ is common, and _ and _ glands may be enlarged. (fill in the blank) OM |
|
Definition
104 degrees
postauricular
cervical |
|
|
Term
| Factoid: in OM, loss of appetite typically occurs, and sucking or chewing tends to aggravate pain |
|
Definition
|
|
Term
| When the eardrum ruptures, is the pain relieved? |
|
Definition
|
|
Term
| What happens in result of eardrum rupture?(3) |
|
Definition
relief of pain
gradual decrease in temp
purulent discharge in external canal |
|
|
Term
| Is there severe pain or fever in OME? |
|
Definition
|
|
Term
| If your pt can verbalize the feelings of having OME, what would they say? (3) |
|
Definition
feeling of fullness in the ear
popping sensation when swallowing
feeling of "motion" in the ear |
|
|
Term
| Dioagnosis of AOM is made on visual inspection if? |
|
Definition
eardrum has purulent, discolored effusion
bulging full, opacified, or reddened immobile eardrum |
|
|
Term
| On visual inspection, what would indicate OME? |
|
Definition
immobile eardrum
orange-colored membrane |
|
|
Term
| Because fever and ear pain is usually not present in OME, what nonspecific sx may occur? |
|
Definition
|
|
Term
| Factoid: waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants over 6 monthsand children |
|
Definition
|
|
Term
| for a child under 2 yrs who has sx of ear pain and fever, would the watchful eye method still comply? |
|
Definition
|
|
Term
| how is an infant under 6 months treated for OM? |
|
Definition
| antibiotics d/t immature IS |
|
|
Term
| When antibiotics are needed for OM, what is given? |
|
Definition
| oral amoxicillin is high doses |
|
|
Term
| If the child is non-compliant or if the causitive organism is resistant pneumococcus then what is given for treatment of OM? |
|
Definition
|
|
Term
| Supportive care for OM is treating pain and fever. How would you do this? |
|
Definition
acetaminophen or ibuprofen (if older than 6 months) for fever
topical pain relief with cold or warm application
benzocaine drops |
|
|
Term
| What surgery may be needed to alleviate severe pain from AOM? |
|
Definition
| myringotomy ( surgical incision of eardrum) |
|
|
Term
| What is the therapy for recurrent AOM? |
|
Definition
chemoprophylaxis with:
long term antibiotics
immunotherapy
surgery |
|
|
Term
| Why should a child undergoing long term antibiotic therapy visit the doc once a month? |
|
Definition
| to detect evidence of effusion |
|
|
Term
| what two surgical procedures are done to treat recurrent AOM? |
|
Definition
tympanostomy tube placement
&
adenoidectomy |
|
|
Term
| When would antibiotics be indicated for OME? |
|
Definition
| persistent effusion for more than 3 months |
|
|
Term
| Is OME associated with mild to moderate hearing impairment? |
|
Definition
| yes,and the major goal of therapy is to have the middle ear be fluid free and restore normal hearing |
|
|
Term
| tympanostomy tubes are recommended after how many months of bilateral effusion and bilateral hearing deficit? |
|
Definition
|
|
Term
| What vaccine has reduced the incidence of AOM in some infants and children? |
|
Definition
| pneumococcal conjugate vaccine PCV 7 (Prevnar) |
|
|
Term
| Prevnar is administered as a four dose series beginning at the age of? |
|
Definition
|
|
Term
| what would you recommend to the family with a child with an URI going onto an airplane? |
|
Definition
| nasal mucosa shrinking spray or oral decongestant before the trip |
|
|
Term
| What is the simple most effective method for inflating the middle ear on descent in an airplane? |
|
Definition
| swallowing: a pacifier or feeding would benefit an infant |
|
|
Term
| What is the predominant sx of external ear infx, or swimmer's ear? |
|
Definition
| ear pain accentuated by manipulation of the pinna, esp pressure on the tragus |
|
|
Term
| Conductive hearing loss in otitis externa d/t what ? (3) |
|
Definition
edema
secretions
accumulation of debris in canal |
|
|
Term
| What appears in ear as infx progresses? |
|
Definition
edema
erythema
cheesy blue-green discharge
tenderness |
|
|
Term
| What causes otitis externa? |
|
Definition
| normal flora that assume pathogenic characteristics under conditions of excessive dryness or wetness |
|
|
Term
| to prevent recurrent ear infx, how long should children be allowed to swim and what care should be done afterwards? |
|
Definition
| less than an hour, if possible, and ears should dry completely (1-2 hours) before entering the water again |
|
|
Term
| What two cleaning products per say can you combine to prevent ear infx? |
|
Definition
| 50:50 white vinegar and rubbing alcohol |
|
|
Term
| what does croup result from? |
|
Definition
| swelling or obstruction in the larynx |
|
|
Term
| Most cases of croup are attributed to what type of diseases? |
|
Definition
|
|
Term
| What are the key difference b/t LTB and epiglottitis? |
|
Definition
absence of cough
presence of dysphagia
high degree of toxicity
(all in epi) |
|
|
Term
FACTOID
Children with epiglottis look worse than they sound and children with LTB sound worse than they look |
|
Definition
|
|
Term
| Parents with a chiuld experiencing epiglottitis may say what about the childs condition at bedtime? |
|
Definition
| went to bed asymptomatic to awaken later with a sore throat and pain upon swallowing. The child has a fever and looks sicker than clinical findings suggest |
|
|
Term
| You have been told that your pediatric pt in the er has epiglottitis, how would you expect them to appear when you see them? |
|
Definition
sitting in tripod position
chin thrust out
mouth open & tongue protruding
drooling d/t pain on swallowing and excessive secretions
frightened expression and extremely restless
voice is thick and muffled
froglike croaking sound on inspiration
!!!!!!!!!THE CHILD IS NOT HOARSE !!!!!!!!!! |
|
|
Term
| how does the throat appear in pt's with epiglottitis? |
|
Definition
red and inflamed
distinctive, large, cherry red, edematous epiglottis is visible |
|
|
Term
| Progressive obstruction d/t epiglottits will do what to oxygen levels? |
|
Definition
hypoxia
hypercapnia
acidosis
decreased muscular tone
reduced level of consciousness
sudden death |
|
|
Term
| When a child with epi is being transported, what is the best means for transportation to reduce distress? |
|
Definition
| sitting on the parents lap |
|
|
Term
| what is considered for the child with epi with severe resp distress? |
|
Definition
| nasotracheal intubation or tracheotomy |
|
|
Term
| How can a parent help prevent acute epi? |
|
Definition
| beginning at two months receive the H. influenzae type b conjugate vaccine |
|
|
Term
what organisms are responsible for LTB? (5)
|
|
Definition
parainfluenza virus 1,2 and 3
influenza types A & B
measles
M. pneumoniae |
|
|
Term
| What is LTB characterized by? |
|
Definition
gradual onset of low grade fever
child woke up with a barky, brassy cough and at times inspiratory stridor
|
|
|
Term
| SX of LTB are typically worse during what time of day? |
|
Definition
| at night, and agitation and crying tend to exacerbate the sx |
|
|
Term
| What is the major objective in medical management of infectious LTB? |
|
Definition
| maintaining an airway and providing adequate respiratory exchange |
|
|
Term
| Why does cool temperature therapy provide relief in pt's? (ie standing in front of a freezer, cool mist, standing outside during a cool night) |
|
Definition
| constricts edematous vessels |
|
|
Term
| If LTB is not relieved by cool mist, then what will be used? |
|
Definition
| nebulized epinephrine, causes mucosal vasoconstrictionand subsequent decreased subglottic edema |
|
|
Term
| When pt is given racemic epinephrine, it is the nurses responsibilty to observe what every 2-3 hours? |
|
Definition
|
|
Term
FACTOID
The use of corticosteroids is beneficial because of the antiinflammatory effects decrease subglottic edema.
IM dexamethosone for those who cannot tolerate oral steroids |
|
Definition
|
|
Term
| In severe cases of LTB, a mixture of what may be used to reduce the work of vreathing and relieve the airway obstruction? |
|
Definition
| helium and oxygen (heliox) |
|
|
Term
| For a pt with LTB, the nurse will vigilantly monitor what three things? |
|
Definition
cardiac
respiratory status
pulse ox |
|
|
Term
| What are early signs of an impending airway obstruction? |
|
Definition
increased pulse and RR
substernal and intercostal retractions
nasal flaring
increased restlessness |
|
|
Term
| By age 3, most children have been affected by what respiratory illness ? |
|
Definition
|
|
Term
| The antibody response to RSV is inadequate and nearly 3/4's of children are reinfected |
|
Definition
|
|
Term
| Severe RSV in the first year of life represent a significant risk factor for the development of? |
|
Definition
|
|
Term
FACTOID
It is important to note that not all infants and children with RSV will develop a lower resp tract infx |
|
Definition
|
|
Term
| RSV is a paramyxovirus containing what ? |
|
Definition
| a single strand of DNA and is related to parainfluenza virus |
|
|
Term
| what is the pathphys for RSV? |
|
Definition
cilia in resp swell and protrude into the lumen and close their cilia->fusion of infected cell membrane with adjacent epi cells->forming a giant cell with multiple nuclei
->bronchiolar mucosa swells and fill with mucus and exudate-> hyperinflation, patchy areas of atelectasis |
|
|
Term
| What are classical manifestations of RSV? |
|
Definition
altered air exchange, such as:
wheezing
retractions
crackles
dyspnea
tachypnea
diminished breath sounds |
|
|
Term
| what tests are done on nasal secretions to identify RSV? |
|
Definition
|
|
Term
| Uncomplicated bronchiolitis are treated symptomatically with? |
|
Definition
oxygen
adequate fluid intake
airway maintenance
meds |
|
|
Term
| Supplemental O2 is used if infant fails to maintainconsistent oxygen sat of _ after nasal suctioning and repositioning |
|
Definition
|
|
Term
| why would fluids by mouth be contraindicated in some pt's with RSV? |
|
Definition
tachypnea
weakness
fatigue |
|
|
Term
| Approx 50% of pt's with RSV respond to what med? |
|
Definition
| short acting beta-agonist |
|
|
Term
| The only product in the US for prevention of RSV is ? |
|
Definition
palivizumab
given monthly in an IM injection |
|
|
Term
| who are good candiates for palivizumab prophylaxis? |
|
Definition
infants born before 32 wks who required medical therapy
younger than 2 with bronchopulm dysplasia who recieved med att 6 months before RSV
severe bronchopul dysplasia
congenital heart dx |
|
|
Term
| Prophylaxis should be initiated at the onset of RSV and terminated at the end of the season |
|
Definition
|
|
Term
| What type of precautions are children with RSV ? |
|
Definition
|
|
