Term
| Obstructive Pulmonary Disease |
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Definition
- Anything that leads to narrowing of airway (inflammation)
- Asthma, foreign body, bronchiolitis, croup, laryngo/or tracheomalacia |
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Term
| Restrictive Pulmonary Disease |
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Definition
- Reduction in lung volume or pulmonary compliance due to pathological changes in lung tissue, pleura, deformities, or neuromuscular disease
- pneumonia, or born with pectus excavatum, |
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Term
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Definition
- Treat underlying cause
- Humidification for only 2-3 nights
- Vaporizer – do not leave it for days and days because it produces mold
- Not given under 4 or 6 years of age
- Expectorants, Mucolytics, Antitussives
Decongestants, Antihistamines
- HONEY |
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Term
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Definition
- common lower respiratory illness of children <2 y/o: leading cause of hospitalization
- WINTER-SPRING
- Etiology: RSV (50%)
- Risk Factors: male, prematurity, age, chronic lung disease, immunodeficiency
- self-limited (1-2 weeks) charact. by airway edema and not bronchospasm |
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Term
| Bronchiolitis: Clinical sx |
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Definition
TACHYPNEA
Onset: rhinorrhea, nasal congestion, Cough prodrome 3-7 days, (or apnea)
RR 45-80 = tachypnea
Low grade fever
Wheezing, hyperresonance; noisy, raspy breathing
Severe: retractions, accessory muscle use, flaring of nares, grunting, cyanosis
(not definite hoarseness and high wheezing) |
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Term
| Bronchiolitis: Management |
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Definition
- Saline drops and bulb syringe for nasal congestion – have baby lie down, one drop in each nostril, wait one minute then suction
- Antipyretics – for fever
- *Hydration***********
- Observe Signs of respiratory distress – coughing too much and is nonstop, if around the mouth changes color to blue or black, chest is going in and out
basically, oxygen and hydration
- don't use bronchodilators, but if u do and they work, continue them |
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Term
| Bronchiolitis: discharge criteria |
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Definition
Respiratory status:
- Respiratory rate usually <80/min.
- Clearing of the infant’s airway can be performed by parent
using bulb suctioning.
- Patient is either: on room air, or on stable oxygen therapy of 1⁄2 L/min by nasal cannulae for 1 day. (really room air) |
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Term
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Definition
- Nose: unilateral purulent, foul odor
- laryngeal
- Obstructive: cough, localized wheezing, unilat. Absence of breath sounds, stridor
- Management: xray, flexible bronchoscopy, or if definite hx. rigid bronchoscopy for removal. |
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Term
| Croup/Acute Laryngotracheobronchitis |
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Definition
- Subglottic swelling, respiratory distress and inspiratory stridor; “Cry out in a hoarse voice”
- Epidemiology: 6 months – 3 years, Peak 2nd year of life, Males, Fall & early winter (cold season)
- Etiology: Parainfluenza |
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Term
| Croup/Acute Laryngotracheobronchitis: Clinical features |
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Definition
- cold, then LOW GRADE FEVER
- URI progressing to spasmodic, deep, brassy or barking tone, seal’s bark, crowing cock
- Inspiratory stridor
- Night—worse at night. +cough, distress, retractions, RR 50, rales, rhonchi, wheezes, cyanosis,
- OUTSIDE COLD AIR HELPS THEM
- Croupy symptoms 3-4 days |
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Term
| Croup/Acute Laryngotracheobronchitis: Management |
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Definition
- Mild: Night air, cold mist, steam from shower, door open of refrigerator freezer—relieves spasm
- Consider bronchodilators if bronchospasm present (wheezing)
- Corticosteroids diminish swelling of laryngeal mucosa
- Corticosteroids: 0.3-0.6 mg/kg of dexamethasone (decadron), single dose or up to 4 doses at 6 hour intervals (recent studies have shown 0.15 mg/kg as effective)
- Nebulized epinephrine may be used in ER to treat severe croup – do not send them home, observe for at least 24 hours |
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Term
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Definition
- Typical 1-5 yr. old
- Sudden onset of stridor, high fever, muffled voice
- Drooling, toxic appearance, anxiety, a sitting posture with the chin pushed forward and refusal to lie down, no barky cough
- Avoid agitating the child – DO NOT MESS WITH THEM
- A medical emergency, kid needs to go to OR
- Xray: only as an adjunct
- Dx.: Cherry-red epiglottis in OR
- If suspected, intubation must be readily available |
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Term
| If kid has asthma, do not give what? |
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Definition
MOTRIN!!!
MIGHT GIVE BRONCHOSPASM |
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Term
| Asthma: environmental measures |
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Definition
House Dust Mite Control
Encase mattress/pillows in airtight plastic covers
Wash bedding in hot water weekly
Remove stuffed toys from bedroom
Remove carpets if possible
Reduce indoor humidity to 30-50%
Use chemical agents to kill mites
Keep Pets outdoors or at least out of the pt’s bedroom
Air filters, air conditioning
Mold control
Vacuum cleaners
Avoid indoor irritants
Smoke, odors, pollutants |
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Term
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Definition
- mild intermittent
- mild persistent
- moderate persistent
- severe persistent |
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Term
| intermittent vs. persistent asthma |
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Definition
RULES OF 2
- symptoms >2x a week OR
- waking at night > 2x a month
= PERSISTENT |
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Term
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Definition
Minimal or no chronic symptoms day or night
Minimal or no exacerbations
No limitations on activities; no school/parent’s work missed
Minimal use of short-acting inhaled beta2-agonist
Minimal or no adverse effects from medications |
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Term
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Definition
- SABA: albuterol
- long term therapy: inhaled corticosteroids
- step up step down guidelines
- review tx every 1-6 mos for ability to step down, if not maintained, step up. |
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Term
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Definition
TWICE A YEAR, not 10 times a year
1-2 mg/kg/dose twice a day no more than 3-5 days
Go for the 40 mg
Prednisone |
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Term
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Definition
Primary and secondary
PERSISTENT TACHYPNEA
Risks: Cigarette smoke, low socioeconomic status, boys, underlying medical ds. (Sickle cell dz., BPD, GER, asthma, CF, CHD, & immunodeficiency sx’s)
Bacterial Etiology: S. pneumoniae (90%) |
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Term
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Definition
- The most sensitive & specific sign of pneumonia is persistent tachypnea
- Respiratory rate thresholds:
>60 per minute <2 months
>50 per minute 2-12 months
>40 per minute >12 months to 5 yrs
- Get chest x-ray above RR thresholds
- Hypoxia (decreased oxygen saturation), RR>70, retractions, flaring, grunting, cyanosis, altered mental status |
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Term
| Bacterial pneumonia: clinical presentation |
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Definition
- Mild URI with abrupt high fever, and toxicity
- Cough (may be productive)
- +/- Chest pain, absence of wheezing
- Nasal flaring, grunting, retractions
- Tachypnea
- Crackles, dullness to percussion, decreased breath sounds |
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Term
| Bacterial Pneumonia: diagnosis |
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Definition
- Chest x-ray
- Consider CBC with diff
- Consider culture of nasopharyngeal scrapings
- Lobar consolidation |
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Term
| Bacterial Pneumonia: management |
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Definition
Hospital admission: <3mo-6mo, persistent hypoxemia, dehydration, vomiting, toxic appearance or h/o chronic condition
Outpatient: S. Pneumoniae ,GP B strep: Penicillin G (100,000units/kg/24 hours) OR one 600,000 unit injection followed by oral penicillin
Amox. 80-100 mg/kg/d TID |
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Term
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Definition
RSV; adenoviruses; parainfluenza; enteroviruses
Slower onset
At risk for secondary bacterial infection
Xray: Diffuse, streaky infiltrate
Management
Hydration, antipyretics
Humidified oxygen, respiratory therapy support
Antibiotics if secondary infection |
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Term
| Mycoplasmal (Atypical Pneumonia) |
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Definition
Most common older than 5 years
Etiology: m. pneumoniae
Spread by resp. droplet
Incubation: 2-3 weeks
Symptoms: low-grade fever, usually dry cough, scant sputum, headache, sore throat, GI (abdominal pain, vomiting, etc), malaise
Signs: Harsh sounds, widespread rales |
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Term
| Atypical pneumonia: Diagnosis and meds |
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Definition
Diagnosis: Clinical, xray non-specific (bil. diffuse infiltrate) atelectasis
Erythromycin (<9 years) 20-50 mg/kg/2-4 times a day
Azithromycin 500mg day 1 250 2-5th day
Clarithromycin (tastes like chalk) |
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