Pediatric Respiratory System ACUTE
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Questions and Answers

Which of the following is a characteristic of a newborn's respiratory system that increases their susceptibility to respiratory infections?

  • Stronger immune system
  • Lack of surfactant (correct)
  • Greater surface area for gas exchange in the alveoli
  • Larger trachea and lower airway compared to adults

What is the normal respiratory rate for a toddler/preschooler?

  • 30-35 breaths per minute
  • 20-30 breaths per minute (correct)
  • 18-20 breaths per minute
  • 16-20 breaths per minute

What type of retractions are observed near the trachea in a child experiencing severe respiratory distress?

  • Intercostal retractions
  • Substernal retractions
  • Suprasternal retractions (correct)
  • All of the above

What is the term for difficulty breathing?

<p>Dyspnea (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of infant respiratory anatomy?

<p>Infants can breathe through their mouths effectively (D)</p> Signup and view all the answers

What is the color of nasal discharge that is typically associated with an allergy rather than an infection?

<p>Clear (C)</p> Signup and view all the answers

What type of cough is associated with asthma?

<p>Wheezing cough upon expiration (B)</p> Signup and view all the answers

What is the medical term for breathing too fast?

<p>Tachypnea (D)</p> Signup and view all the answers

Which of the following is NOT a common clinical manifestation of bacterial pneumonia in children?

<p>Rhinitis (C)</p> Signup and view all the answers

A child presents with sudden onset of fever, chills, and a hacking, nonproductive cough. Chest X-ray reveals patchy infiltrates. Which type of pneumonia is most likely?

<p>Atypical bacterial pneumonia (D)</p> Signup and view all the answers

What is the first-line treatment for bacterial pneumonia in children?

<p>Amoxicillin (C)</p> Signup and view all the answers

Which of the following is a common complication of pneumonia in children?

<p>Pleural effusion (A)</p> Signup and view all the answers

Which of the following is a characteristic of viral pneumonia in children?

<p>Mild, low-grade fever (D)</p> Signup and view all the answers

Which of the following diagnostic tools is NOT typically used in the diagnosis of pneumonia in children?

<p>Electrocardiogram (C)</p> Signup and view all the answers

What is the most common causative agent of upper respiratory tract infections in children?

<p>Respiratory syncytial virus (RSV) (C)</p> Signup and view all the answers

Which type of pneumonia involves inflammation of the terminal bronchioles and nearby lobules?

<p>Bronchopneumonia (A)</p> Signup and view all the answers

What is a common finding on chest X-ray in a child with Mycoplasma pneumoniae?

<p>Patchy infiltrates (D)</p> Signup and view all the answers

Which of the following is NOT considered a supportive treatment for viral pneumonia in children?

<p>Antibiotics (B)</p> Signup and view all the answers

Which of the following is NOT a common laboratory test for respiratory disorders?

<p>Liver function tests (A)</p> Signup and view all the answers

Which symptom is primarily associated with dysphagia in respiratory complications?

<p>Difficulty swallowing (A)</p> Signup and view all the answers

What is the primary viral agent responsible for most cases of nasopharyngitis?

<p>Rhinovirus (B)</p> Signup and view all the answers

In the diagnosis of nasopharyngitis, a throat culture is NOT recommended if which symptom is present?

<p>Nasal symptoms (D)</p> Signup and view all the answers

Which treatment is recommended to relieve symptoms of nasopharyngitis in older children?

<p>Humidifier usage (C)</p> Signup and view all the answers

What age group is primarily affected by conditions such as croup?

<p>Children aged 3 months to 3 years (B)</p> Signup and view all the answers

Which of the following is NOT a clinical manifestation of croup?

<p>Rash (A)</p> Signup and view all the answers

What is a recommended treatment for a child diagnosed with croup?

<p>Nebulized Racemic Epinephrine (D)</p> Signup and view all the answers

Which diagnostic tool is primarily used to assess for narrowing of the airway due to inflammation in croup?

<p>Lateral neck x-ray (D)</p> Signup and view all the answers

Which of the following statements about acute epiglottitis is correct?

<p>It primarily affects children aged 2 to 7 years. (C)</p> Signup and view all the answers

What defines frequent tonsillitis in a patient?

<p>At least seven episodes in the preceding year (D)</p> Signup and view all the answers

Which of the following conditions may warrant a tonsillectomy?

<p>Obstructive sleep apnea (C)</p> Signup and view all the answers

What post-operative care is recommended for a child who has undergone tonsillectomy?

<p>Monitor for signs of bleeding (D)</p> Signup and view all the answers

What is a common peak incidence age for otitis media?

<p>6-12 months (C)</p> Signup and view all the answers

What is a recommended first-line antibiotic treatment for otitis media in children?

<p>Amoxicillin 80-100 mg/kg/day (C)</p> Signup and view all the answers

Which statement regarding Eustachian tubes in children is accurate?

<p>They are wider, shorter, and straighter in younger children. (D)</p> Signup and view all the answers

What is a potential complication of croup?

<p>Swelling of the mucosa in the upper airway (B)</p> Signup and view all the answers

Which of the following behaviors can reduce the risk of recurrent otitis media?

<p>Avoiding smoke exposure (C)</p> Signup and view all the answers

What is a common physical characteristic in a child with epiglottitis?

<p>Muffled voice (A), High fever (B)</p> Signup and view all the answers

Which position might a child with epiglottitis assume to aid their breathing?

<p>Tripod position (A)</p> Signup and view all the answers

What is the most common cause of epiglottitis in children?

<p>Haemophilus influenzae type B (A)</p> Signup and view all the answers

What should NOT be done when examining a throat suspected of epiglottitis?

<p>Perform throat examination (C)</p> Signup and view all the answers

Which treatment is indicated for a child diagnosed with epiglottitis?

<p>Provide emotional support (A)</p> Signup and view all the answers

What is a distinguishing symptom of epiglottitis compared to croup?

<p>Drooling and inability to swallow (A), Cherry red swollen epiglottis (C)</p> Signup and view all the answers

What should be avoided in a child with epiglottitis?

<p>Examination of the throat (D)</p> Signup and view all the answers

What is the recommended prevention strategy for epiglottitis?

<p>HIB vaccination (C)</p> Signup and view all the answers

What condition is characterized by inflammation of the lung affecting bronchioles and alveoli?

<p>Pneumonia (D)</p> Signup and view all the answers

What is a key sign of bronchiolitis in children?

<p>Frequent respiratory assessment (D)</p> Signup and view all the answers

A child presents with a persistent cough, fever greater than 101.5°F, and use of accessory muscles. These symptoms are indicative of which condition?

<p>Respiratory Complications (C)</p> Signup and view all the answers

Which laboratory test is used to assess for cystic fibrosis impacting the respiratory system?

<p>Sweat Chloride Test (C)</p> Signup and view all the answers

Which symptom is least associated with a diagnosis of acute nasopharyngitis?

<p>High fever (B)</p> Signup and view all the answers

What is the most appropriate first step for treating a 3 month old infant with nasal congestion associated with nasopharyngitis?

<p>Saline nose drops and bulb syringe suction (D)</p> Signup and view all the answers

A throat culture is typically avoided in the diagnosis of nasopharyngitis when which of the following is also present?

<p>Nasal discharge (C)</p> Signup and view all the answers

A child presents with a sore throat, fever, and a rash described as small and macular. Palpable cervical nodes are also noted. Which condition is MOST likely?

<p>Group A streptococcal pharyngitis (C)</p> Signup and view all the answers

A child has been diagnosed with acute pharyngitis. Which finding would MOST clearly indicate a viral, rather than a bacterial, etiology?

<p>Hoarseness and cough (A)</p> Signup and view all the answers

A child is evaluated for tonsillitis. Which clinical finding would be MOST concerning for a peritonsillar abscess requiring drainage?

<p>Enlarged tonsils with purulent matter (C)</p> Signup and view all the answers

A throat culture is ordered for a child suspected of having tonsillitis. Which of the following is a primary reason for obtaining a throat culture?

<p>To determine if the infection is viral or bacterial (A)</p> Signup and view all the answers

A child is diagnosed with bacterial tonsillitis and is prescribed penicillin. Which of the following is an appropriate nursing education point for this child and their caregivers?

<p>Complete the entire course of antibiotic therapy as prescribed (C)</p> Signup and view all the answers

A child presents with nasal congestion, sore throat, and mild fever lasting for 5 days. According to the text, what is the MOST appropriate initial nursing intervention?

<p>Assess for respiratory distress (D)</p> Signup and view all the answers

If tonsillitis is NOT treated promptly, which of the following complications is MOST serious?

<p>Glomerulonephritis (B)</p> Signup and view all the answers

During a physical assessment of a child with a suspected upper respiratory infection, which diagnostic procedure helps identify the presence of infection in multiple sites?

<p>Otoscopic examination of the throat, ears, and nose (A)</p> Signup and view all the answers

A child with suspected tonsillitis is being evaluated. Palpation of the neck reveals enlarged lymph nodes. Which of the following statements best explains the significance of this finding?

<p>Enlarged lymph nodes are a common sign of inflammation or infection (B)</p> Signup and view all the answers

Which of the following is the PRIMARY indication for a tonsillectomy?

<p>Frequently recurring or chronic tonsillitis (A)</p> Signup and view all the answers

Which clinical manifestation is specifically associated with inflammation in the larynx in croup?

<p>Barking cough (D)</p> Signup and view all the answers

What is a common diagnostic tool for diagnosing croup in children?

<p>Lateral neck x-ray (A)</p> Signup and view all the answers

Which treatment is NOT recommended for children diagnosed with croup?

<p>Steamy showers (B)</p> Signup and view all the answers

What symptom might indicate that respiratory distress is worsening in a child at night?

<p>Anxiety and air hunger (B)</p> Signup and view all the answers

What age group is primarily affected by acute epiglottitis?

<p>Children aged 2-7 years (D)</p> Signup and view all the answers

What type of pneumonia is characterized by patchy infiltrates on a chest X-ray and is often associated with children older than 5 years?

<p>Atypical pneumonia (D)</p> Signup and view all the answers

Which symptom is most indicative of bacterial pneumonia rather than viral pneumonia?

<p>High fever (A)</p> Signup and view all the answers

What is the first-line treatment for atypical pneumonia caused by Mycoplasma pneumoniae?

<p>Azithromycin (C)</p> Signup and view all the answers

Which diagnostic tool is least useful for diagnosing viral pneumonia?

<p>Sputum culture (B)</p> Signup and view all the answers

What is a common complication of pneumonia that may occur due to infection?

<p>Pleural effusion (D)</p> Signup and view all the answers

Which set of symptoms is most associated with viral pneumonia in children?

<p>Mild fever, wheezing, nonproductive cough (C)</p> Signup and view all the answers

What is considered frequent tonsillitis in a patient?

<p>At least seven episodes in the preceding year (A)</p> Signup and view all the answers

What respiratory examination finding is expected with a lung infiltrate?

<p>Diminished breath sounds (C)</p> Signup and view all the answers

In which pneumonia type is a productive cough most prevalent?

<p>Bacterial pneumonia (B)</p> Signup and view all the answers

Which of the following is a common reason for performing a tonsillectomy?

<p>Obstructive sleep apnea due to tonsillitis (B)</p> Signup and view all the answers

Which of the following is a key aspect of management in viral pneumonia?

<p>Providing supportive care like hydration and rest (D)</p> Signup and view all the answers

In post-operative care for tonsillectomy, which of the following should be closely monitored?

<p>Frequent swallowing indicating potential bleeding (A)</p> Signup and view all the answers

Which antibiotic is recommended as a first-line treatment for otitis media in children?

<p>Amoxicillin (A)</p> Signup and view all the answers

Which characteristic differentiates lobar pneumonia from bronchopneumonia?

<p>Localized to one lobe (D)</p> Signup and view all the answers

What is a key characteristic of Eustachian tubes in children under three months of age?

<p>Wider, shorter, and straighter than in older children (D)</p> Signup and view all the answers

Which statement about croup is correct?

<p>It leads to swelling of mucosa and muscle spasms in the airway. (B)</p> Signup and view all the answers

Which treatment is NOT recommended for managing a child diagnosed with croup?

<p>Administering antibiotics routinely (B)</p> Signup and view all the answers

What complication is associated with untreated or recurrent otitis media?

<p>Temporary or permanent hearing loss (D)</p> Signup and view all the answers

What is a common posture assumed by a child with epiglottitis to facilitate breathing?

<p>Leaning forward with hands on their knees (A)</p> Signup and view all the answers

Which of the following symptoms is typically absent in a child with epiglottitis but present in croup?

<p>Barky seal cough (D)</p> Signup and view all the answers

What is the initial critical step in the management of a child suspected of having epiglottitis?

<p>Call for emergency medical assistance (B)</p> Signup and view all the answers

Which medication is commonly administered as part of the treatment protocol for epiglottitis?

<p>Antibiotics (A)</p> Signup and view all the answers

What is a key clinical feature of epiglottitis that distinguishes it from other respiratory conditions?

<p>Cherry red, swollen epiglottis (A)</p> Signup and view all the answers

How should a child suspected of epiglottitis be positioned while waiting for medical intervention?

<p>In an upright position (D)</p> Signup and view all the answers

What is a primary cause of epiglottitis in children?

<p>Bacterial infections (B)</p> Signup and view all the answers

What sign indicates a potential airway compromise in a child with epiglottitis?

<p>Drooling and inability to swallow (C)</p> Signup and view all the answers

Which of the following is NOT a recommended treatment for epiglottitis?

<p>API therapy with ribavirin (A)</p> Signup and view all the answers

In what age range is epiglottitis most commonly observed?

<p>2-7 years (A)</p> Signup and view all the answers

What is a common clinical manifestation of croup in children aged 3 months to 3 years?

<p>Barking cough (D)</p> Signup and view all the answers

Which of the following diagnostic tools is commonly used to assess narrowing of the airway in croup?

<p>Lateral neck x-ray (A)</p> Signup and view all the answers

What is the recommended immediate treatment for a child diagnosed with croup exhibiting severe symptoms?

<p>Nebulized Racemic Epinephrine (C)</p> Signup and view all the answers

What symptom is commonly associated with respiratory distress in children experiencing croup?

<p>Cyanosis (A)</p> Signup and view all the answers

Which complication is most commonly associated with the need for a tonsillectomy?

<p>Obstructive sleep apnea (A)</p> Signup and view all the answers

Which medication should be avoided post-tonsillectomy to differentiate bleeding from red dye?

<p>Red popsicles (D)</p> Signup and view all the answers

When is otitis media most likely to occur based on age?

<p>6-12 months (A)</p> Signup and view all the answers

What is the recommended dose of standard antibiotics for a child with otitis media?

<p>80-100 mg/kg/day for 10 days (D)</p> Signup and view all the answers

Which characteristic of Eustachian tubes in children contributes to an increased incidence of otitis media?

<p>Wider, shorter, and straighter (C)</p> Signup and view all the answers

What behavior can help reduce the risk of recurrent otitis media?

<p>Breastfeeding exclusively for the first 6 months (D)</p> Signup and view all the answers

What is a common symptom of croup?

<p>Coughing with a barking sound (C)</p> Signup and view all the answers

What is a common characteristic of bacterial pneumonia compared to viral pneumonia?

<p>High fever (B)</p> Signup and view all the answers

Which type of pneumonia is primarily identified by patchy infiltrates on a chest X-ray?

<p>Atypical pneumonia (B)</p> Signup and view all the answers

What is a major complication associated with pneumonia?

<p>Pleural effusion (B)</p> Signup and view all the answers

Which of the following laboratory findings is typically associated with bacterial pneumonia?

<p>Elevated neutrophils (C)</p> Signup and view all the answers

Which symptom is less likely to be associated with a viral pneumonia infection?

<p>High fever (B)</p> Signup and view all the answers

In a child with atypical pneumonia, what symptom might they exhibit?

<p>Malaise (D)</p> Signup and view all the answers

Why is promoting pneumococcal immunization important?

<p>To prevent otitis media and pneumonia (D)</p> Signup and view all the answers

Which treatment option is primarily focused on symptom relief for viral pneumonia?

<p>Supportive care including fluids (D)</p> Signup and view all the answers

What can be a sign of respiratory distress in children with pneumonia?

<p>Decreased breath sounds (B)</p> Signup and view all the answers

Which of the following symptoms, if present in a young child, would least likely suggest a diagnosis of acute nasopharyngitis?

<p>Fever greater than 101.5°F (D)</p> Signup and view all the answers

A child presents with a barking cough, hoarseness, and inspiratory stridor. These symptoms are most likely indicative of which of the following conditions?

<p>Croup (B)</p> Signup and view all the answers

A newborn infant presents with respiratory distress, including nasal flaring and retractions. The most appropriate initial step in management should be:

<p>Providing supplemental oxygen (B)</p> Signup and view all the answers

What are the three main types of retractions observed in children with respiratory distress?

<p>Intercostal, Substernal, Suprasternal (B)</p> Signup and view all the answers

Which of the following is a recommended intervention for a child with nasopharyngitis, specifically for older children and adolescents?

<p>Use of a cool-mist humidifier (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of a newborn's respiratory system?

<p>Larger trachea compared to adults (C)</p> Signup and view all the answers

A child with a history of frequent tonsillitis episodes who experiences significant difficulty swallowing, and whose tonsils are repeatedly enlarged, may benefit from which of the following interventions?

<p>Tonsillectomy (D)</p> Signup and view all the answers

Which of the following is a TRUE statement regarding the presence of a cough in a child with a respiratory infection?

<p>Infants are unable to blow their nose or cough out mucus effectively, often swallowing secretions. (B)</p> Signup and view all the answers

What is the primary concern associated with retractions in a child with respiratory distress?

<p>It is a sign that the child is using accessory muscles to breathe. (D)</p> Signup and view all the answers

Why is a baby's airway more susceptible to obstruction?

<p>Their trachea and lower airways are half the size of an adult’s. (C)</p> Signup and view all the answers

What does "tachypneic" mean in the context of a child's respiratory rate?

<p>Breathing too rapidly. (C)</p> Signup and view all the answers

Which of these conditions are associated with a wheezing sound upon inspiration?

<p>Croup and Bronchiolitis (B)</p> Signup and view all the answers

What is the primary reason why infants and young children are more vulnerable to respiratory infections?

<p>Their respiratory system is smaller and more sensitive. (A)</p> Signup and view all the answers

Which of the following statements about the clinical manifestations of epiglottitis is true?

<p>Epiglottitis typically presents with a cherry red, swollen epiglottis. (C)</p> Signup and view all the answers

Which of the following is NOT a method of managing a child diagnosed with epiglottitis?

<p>Performing a throat examination (C)</p> Signup and view all the answers

In the comparison between croup and epiglottitis, which of the following statements is accurate?

<p>Children with epiglottitis tend to sit forward in a tripod position. (B)</p> Signup and view all the answers

What is the primary causative agent of epiglottitis in children?

<p>Haemophilus influenzae type B (A)</p> Signup and view all the answers

Which of these interventions is critical for a child with epiglottitis before reaching the hospital?

<p>Keeping the child in an upright position (A)</p> Signup and view all the answers

Which of the following conditions requires hospitalization and possible mechanical ventilation?

<p>Dehydrated with respiratory distress (A)</p> Signup and view all the answers

What is a major clinical feature that differentiates bronchiolitis from epiglottitis?

<p>Presence of a cherry red epiglottis (A)</p> Signup and view all the answers

What is a critical step in the treatment of epiglottitis?

<p>Intubating the child in a controlled environment (A)</p> Signup and view all the answers

Which emotional state is commonly observed in a child with epiglottitis?

<p>Anxious and fearful (B)</p> Signup and view all the answers

What is the primary preventive measure against epiglottitis?

<p>Administration of the Hib vaccine (A)</p> Signup and view all the answers

Flashcards

Persistent cough

A continuous cough that may indicate respiratory issues.

Acute Pharyngitis

Inflammation of the throat, commonly known as strep throat.

Common Cold

Virally caused illness characterized by nasal congestion and sneezing.

Sweat chloride test

A test used to diagnose cystic fibrosis by measuring sweat electrolyte levels.

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Dysphagia

Difficulty swallowing, often a symptom in respiratory complications.

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Infant Trachea Size

The trachea of an infant is half the size compared to an adult's.

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Nose Breathers

Infants primarily breathe through their nose, making them prone to obstruction.

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Alveolar Surface

Infants have limited alveolar surface area for gas exchange.

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Respiratory Rates by Age

Normal respiratory rates decrease with age: Infant 30-35/min, Toddler 20-30/min, School-ager 18-20/min, Adolescent 16-20/min.

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Tachypnea

Rapid breathing; common in respiratory infections (40-100/min).

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Retractions

Inward movement of chest wall tissues during inspiration, indicating respiratory distress.

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Temperature Elevation

A sign of potential infection; can spike at night.

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Sputum Color

The color of sputum can indicate illness: clear (allergy), yellow (infection).

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Incidence of Croup

Most common in children aged 3 months to 3 years, especially in winter.

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Key Symptoms of Croup

Includes hoarseness, barking cough, stridor, retractions, and low-grade fever.

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Croup Diagnosis

Diagnosis is made via chest x-ray, neck x-ray, and WBC differential.

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Croup Treatment

Treatment includes nebulized epinephrine, corticosteroids, fluids, and rest.

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Acute Epiglottitis

A medical emergency involving swelling of the epiglottis, commonly in children 2-7 years.

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Frequent Tonsillitis

Defined as at least seven episodes in a year, five in two years, or three in three years.

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Tonsillectomy Indications

Surgical removal of tonsils due to complications like obstructive sleep apnea or swallowing difficulty.

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Post-op Monitoring

Monitor for frequent swallowing, bleeding, and infection after tonsillectomy.

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Cool Liquid Recommendations

Post-op patients should have cool, non-acidic, non-carbonated drinks; avoid red liquids.

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Otitis Media

Inflammation of the middle ear; can be acute or chronic with or without fluid buildup.

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Eustachian Tube Anatomy

Children's tubes are shorter and wider, increasing infection risk.

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Croup

A viral infection causing swelling in the larynx, trachea, and bronchi, leading to breathing difficulties.

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Antibiotic Administration

Ensure the full course of antibiotics is given for 10 days to prevent recurrence of ear infections.

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Pneumonia

Inflammation of the lungs affecting gas exchange.

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Lobar pneumonia

A type of pneumonia affecting one or more lobes of the lung.

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Bronchopneumonia

Infection of terminal bronchioles and nearby lobules in the lungs.

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Interstitial pneumonia

Affects the alveolar walls and surrounding lung tissue.

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Viral pneumonia symptoms

Mild fever, nonproductive cough, wheezing, resolves in days.

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Bacterial pneumonia symptoms

High fever, productive cough, chest pain, respiratory distress.

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Mycoplasma pneumonia

Atypical pneumonia common in children, causes patchy infiltrates.

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Sputum culture

A test to identify bacteria in respiratory secretions.

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Supportive care treatment

Treatment for viral pneumonia focusing on fluids and rest.

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Multisystem Inflammatory Syndrome (MIS-C)

Condition in children causing inflammation across various body parts.

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Epiglottitis

Inflammation of the epiglottis, can block the airway.

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High fever in epiglottitis

Patients often present with high fever (>102º F) and toxic appearance.

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Tripod position

A posture of leaning forward to facilitate breathing, often seen in epiglottitis.

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Drooling

Inability to swallow secretions due to inflammation in epiglottitis.

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Croup vs. Epiglottitis

Croup is viral in younger kids; Epiglottitis is bacterial in older children.

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Bacterial Infection (HIB)

Haemophilus influenzae type B is the primary cause of epiglottitis.

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Airway compromise

Swelling can occlude trachea, blocking airflow within minutes.

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Treatment for Epiglottitis

Involves hospitalization, stabilization, IV antibiotics, and possibly intubation.

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RSV Prevention

Synagis (Palivizumab) is an antibody injection used to prevent RSV in high-risk children.

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Respiratory Complications

Conditions like dysphagia and persistent cough that indicate respiratory issues.

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Chest X-ray

An imaging test used to rule out infections such as pneumonia.

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Gastric Washings for AFB

A test procedure to detect tuberculosis by examining gastric contents.

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Common Cold Manifestations

Symptoms include nasal stuffiness, sneezing, and low-grade fever.

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Treatment for Nasopharyngitis

Includes antipyretics, saline drops, and encouraging fluid intake.

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Acute Pharyngitis Signs

Symptoms include sore throat and possible fever, often due to strep.

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Tonsillitis Causes

Inflammation of tonsils, primarily caused by Group A strep.

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Symptoms of Tonsillitis

Includes severe sore throat, difficulty swallowing, fever, and enlarged tonsils.

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Tonsillitis Diagnosis

Conduct throat examination, check for swelling, and throat culture.

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Treatment for Viral Tonsillitis

Includes warm saline gargles, analgesics, and hydration.

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Antibiotic Options for Strep

Penicillin, Amoxicillin, and Erythromycin are common treatments.

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Major Complications of Strep

Potential complications include glomerulonephritis, meningitis, and rheumatic fever.

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Presence of Purulent Matter

Indicates possible bacterial infection in tonsils or throat.

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Chronic Tonsillitis

Frequent episodes requiring tonsillectomy if unresponsive to treatment.

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Differential Diagnosis

Includes infectious mononucleosis and epiglottitis among others.

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Epiglottitis Symptoms

High fever, sore throat, difficulty swallowing, drooling due to inflamed epiglottis.

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Tonsillectomy Complications

May involve obstructive sleep apnea, breathing, or swallowing difficulties.

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Frequent Tonsillitis Criteria

Defined as seven episodes in one year, five in two years, or three in three years.

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Causes of Epiglottitis

Primarily caused by bacterial infection, especially Haemophilus influenzae type B.

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Myringotomy Purpose

Facilitates drainage and ventilation of the middle ear during otitis media.

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Drooling in Epiglottitis

Inability to swallow secretions due to swollen epiglottis, leading to drooling.

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Rapid Decompensation

Epiglottitis can lead to quick airway blockage; immediate emergency care is crucial.

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Signs of Middle Ear Infection

Includes fever and signs of otitis media, such as ear pain.

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High-Risk Age for Epiglottitis

Most common in children aged 2-7 years.

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Post-op Tonsillectomy Care

Monitor for frequent swallowing, bleeding, and infection after surgery.

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Contraindicated Throat Exam

Examining the throat in suspected epiglottitis can worsen airway obstruction.

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Acute vs Chronic Otitis Media

Acute is sudden and painful; chronic lasts longer with less severity.

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Cool Liquid Recommendations Post-op

Patients should have non-acidic, non-carbonated, cool drinks; avoid red liquids.

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Antibiotic Treatment for Epiglottitis

IV antibiotics for 3 days followed by oral for 7-10 days are standard.

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Emergency Response

Hospitalization and possible intubation are necessary for severe cases of epiglottitis.

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Croup Symptoms

Includes hoarseness, barking cough, stridor, and retractions.

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Comparison of Croup and Epiglottitis

Croup is viral and affects younger kids; epiglottitis is bacterial and affects older ones.

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Pneumonia symptoms

Inflammation of the lungs causing cough, fever, and difficulty breathing.

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Viral pneumonia

Mild pneumonia with low-grade fever, nonproductive cough, and resolves in 5-7 days.

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Bacterial pneumonia

Severe pneumonia with high fever, productive cough, and respiratory distress.

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Diagnosis methods

Includes sputum culture, CXR, WBC count for distinguishing pneumonia types.

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Supportive care

Treatment for viral pneumonia involving fluids and rest.

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Signs of Respiratory Complications

Symptoms that indicate possible respiratory issues, such as fever and persistent cough.

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Common Cold Causes

Most commonly caused by viruses such as rhinovirus, adenovirus, and RSV.

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Chest X-ray Purpose

Used to rule out respiratory infections like pneumonia by imaging the lungs.

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Key Symptom of Epiglottitis

High fever and difficulty swallowing are primary indicators of inflamed epiglottis.

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Limited Alveolar Surface

Infants have a smaller surface area in their lungs for gas exchange.

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Chest Expansion in Newborns

Newborns experience poor chest expansion and decreased lung volume.

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Immature Immune System

Infants have an underdeveloped immune system, raising infection risk.

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Frequent Tonsillitis Definition

Defined as at least seven episodes in a year, five in two years, or three in three years.

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Otitis Media Types

Inflammation of the middle ear, can be acute, chronic, infectious, or non-infectious.

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Signs of Otitis Media

Includes fever and signs of infection like ear pain, especially in children.

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Croup Incidence

Most common in children aged 3 months to 3 years, particularly during winter months.

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Signs of Respiratory Distress

Symptoms include anxiety, tachypnea, retractions, and cyanosis in severe cases.

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Diagnosis of pneumonia

Involves sputum culture, CXR to check for consolidations, and WBC count.

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Complications of pneumonia

Include pleural effusion and abnormal breath sounds over infiltrates.

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Supportive care for viral pneumonia

Involves fluids, rest, and sometimes oxygen therapy; antibiotics are not used.

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Epiglottitis Causes

Bacterial infection primarily caused by Haemophilus influenzae type B.

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Signs of Epiglottitis

Includes high fever, extreme sore throat, drooling, and absence of cough.

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Emergency Response for Epiglottitis

Immediate hospitalization and possible intubation required for airway obstruction.

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Hospitalization Treatment

Includes IV antibiotics, corticosteroids, and keeping the child NPO.

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Bacterial vs Viral Infections

Epiglottitis is a bacterial infection, while croup is viral.

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Clinical Manifestations of Epiglottitis

Manifestations include toxic appearance, high fever, and anxious demeanor.

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Study Notes

Anatomical Differences

  • Infant's trachea and lower airway are half the size of an adult's.
  • Infants are primarily nose breathers, making them more susceptible to airway obstruction.
  • Newborns have a limited alveolar surface area for gas exchange.
  • Poor chest expansion and decreased lung volume occur during expiration in newborns.
  • Immature immune systems and a lack of surfactant increase susceptibility to respiratory infections.
  • Infants have greater metabolic and oxygen demands.

Bifurcation in Infants

  • Bifurcation in infants is larger than in adults.
  • Trachea in infants is smaller than in adults.

Respiratory Assessment of Infants and Children

  • Normal respiratory rates vary by age:

    • Infants (30-35 breaths/min)
    • Toddlers/Preschoolers (20-30 breaths/min)
    • School-agers (18-20 breaths/min)
    • Adolescents (16-20 breaths/min)
  • Assess respiratory rate, depth, and rhythm on the chest.

  • Check for tachypnea (rapid breathing) which can indicate respiratory infections (40-100 breaths/min).

  • Note the ease of respirations.

  • Assess for dyspnea (difficulty breathing).

Retractions

  • Retractions are inward movements of soft tissues in the chest wall during inhalation.
  • They indicate increased respiratory effort and are a sign of impending respiratory failure.
  • Respiratory infections often cause dyspnea and retractions.
  • Intercostal retractions occur around the ribs.
  • Substernal retractions are seen on the sides of the sternum.
  • Suprasternal retractions are evident near the trachea in severe respiratory distress.

Caring for a Child With a Respiratory Infection

  • Monitor temperature (can spike at night).
  • Observe nasal discharge (clear, yellow, or green).
  • Assess for presence of cough (moist, dry, productive, or non-productive).
  • Note pain location (chest, muscles used for coughing - anterior or posterior).
  • Look for sputum color and frequency of swallowing.
  • Check for presence of wheezing or stridor (during inspiration or expiration).
  • Evaluate odor of breath.

Early Manifestations of Respiratory Complications

  • Dysphagia (difficulty swallowing)
  • Use of accessory muscles
  • Listlessness
  • Persistent cough
  • Earache
  • Fever greater than 101.5°F

Common Laboratory Tests for Respiratory Diseases

  • Chest X-ray (rule out infections like pneumonia)
  • Fluorescent antibody testing
  • Gastric washings for AFB
  • Pulmonary Function Tests (peak expiratory flow rate)
  • Rapid flu, rapid strep tests
  • Sweat chloride test (cystic fibrosis)

Acute Infectious Respiratory Disorders

  • Common cold (acute nasopharyngitis)
  • Strep throat (acute pharyngitis)
  • Tonsillitis
  • Otitis media
  • Acute laryngitis
  • Croup syndromes
  • Acute epiglottitis
  • Bronchiolitis & RSV
  • Pneumonia
  • Bronchitis

Common Pediatric Respiratory Disorders

  • Nasopharyngitis ("common cold")
    • Causative agents: rhinovirus, adenovirus, influenza, RSV, parainfluenza viruses.
    • Can include: nasal stuffiness, sneezing, nasal discharge, coughing, sore throat, low-grade fever, irritability, poor feeding, vomiting, and diarrhea.

Nasopharyngitis (Diagnosis and Treatment)

  • Diagnosis, usually afebrile and normal WBC count. RADT if sore throat is the main complaint.
  • Treatment: antipyretics, non-aspirin analgesics, saline nose drops/suctioning; encourage fluid intake to prevent dehydration. Cough suppressants and decongestant nasal drops can be used for older children only.

Acute Pharyngitis

  • Often called "sore throat."
  • Can be Group A strep (15-30% of cases).
  • Look for exudate, white patches, secretions, palpable cervical nodes, scarlatiniform rash (redness in small macular rash)
  • Treatment involves nursing care (education on gargles), completing antibiotic therapy (Penicillin or Cephalexin if allergic to PCN), hydration, and pain relief.

Tonsillitis

  • Tonsils are lymphoid tissues in the oropharynx protecting from invading organisms.
  • Inflammation or infection of the palatine tonsils can cause peritonsillar abscess (swollen, enlarged, purulent matter).
  • Causative agent: Group A beta-hemolytic streptococci (GABHS).
  • Potential complications (if untreated): otitis media, scarlet fever, suppurative infection of tissues, glomerulonephritis, meningitis, and rheumatic fever.

Clinical Manifestations of Tonsillitis

  • Sore throat and difficulty swallowing
  • Fever
  • Nasal congestion
  • Pain and headache
  • Nausea and vomiting
  • Diarrhea
  • Enlarged tonsils and adenoids
  • Kissing tonsils (3+ or 4+)
  • Halitosis (bad breath)
  • Purulent drainage

Diagnosis of Tonsillitis

  • Examine throat, ears, and nose using an otoscope.
  • Check for scarlatina (a rash).
  • Palpate the neck for enlarged lymph nodes.
  • Listen to breath sounds bilaterally.
  • Check for splenomegaly (enlarged spleen).
  • Perform CBC and throat culture.

Differential Diagnoses

  • Acute tonsillitis
  • Infectious mononucleosis
  • Epiglottitis
  • Peritonsillar abscess
  • Retropharyngeal abscess
  • Diphtheria
  • HIV infection

Treatment of Tonsillitis

  • Antipyretics and non-aspirin analgesics (for viral tonsillitis).
  • Antibiotics for bacterial tonsillitis.
  • Tonsillectomy may be considered for recurring or chronic cases, especially when antibiotic treatment isn't effective.
  • Adenoidectomy may be needed if both tonsils and adenoids are affected.

Treatment - Antibiotic Therapy

  • Treatment options depend on confirming Group A beta-hemolytic streptococcus infections with antigen testing or throat culture.
  • Primary options include penicillin V potassium (dosage depends on child's weight and age).
  • Secondary options (if allergic to PCN): azithromycin, clarithromycin, erythromycin.

Treatment - Surgery (outpatient)

  • Tonsillectomy may be performed for frequent, chronic or bacterial tonsillitis that doesn't respond to antibiotics
  • Indications for tonsillectomy: At least 7 episodes in the preceding year; At least 5 episodes a year in the past two years; At least 3 episodes a year in the past three years.
  • Potential complications of tonsillitis that warrant tonsillectomy: obstructive sleep apnea, breathing difficulty, trouble swallowing (particularly solid foods), and abscess that doesn't improve with antibiotics.

Patient Education (Post-op)

  • Assess for frequent swallowing (early sign of bleeding).
  • Monitor for bleeding (from the nose or throat).
  • Advise children not to cough or blow their nose (to avoid causing trauma).
  • Offer crushed ice and sips of water as first means of controlling bleeding; ice/sips of water are for controlling bleeding and decreasing facial swelling.
  • Provide cool (non-carbonated, non-acidic) liquids (avoid red drinks and foods as they can be mistaken for blood).
  • Promote cool humidification.
  • Administer acetaminophen for pain relief. Administer an ice collar for pain relief, especially to the neck

Otitis Media

  • Inflammation of the middle ear.
  • Can be acute, chronic, infectious, or noninfectious.
  • Fluid may build up in the middle ear (effusion), sometimes clear or pus-like (purulent).
  • Peak incidence: 6–12 months, winter months.
  • Eustachian tubes are wider, shorter, and straighter in children under 3 years; fluid drainage may be inadequate.
  • Common causes: Viral infections, Streptococcus pneumoniae, Haemophilus influenzae (often precipitated by influenza or RSV), which causes respiratory infection along with the OM infection.
  • Eustachian tube dysfunction can lead to fluid accumulation in the middle ear, causing hearing impairment.
  • Rupture of the tympanic membrane can result from untreated otitis media.
  • Facial malformations, like Down Syndrome and cleft lip/palate, can increase vulnerability to OM.

Clinical Manifestations of Otitis Media

  • Pain (tugging, pulling).
  • Fever.
  • Irritability.
  • Diarrhea and vomiting.
  • Symptoms of URI (common cold).
  • Complications: hearing loss, or speech delays due to frequent ear infections.

Diagnosis of Otitis Media

  • Otoscopic examination (inspection with otoscope).
  • Pneumatic otoscopic assessment (evaluating tympanic membrane movement with air).

Differential Diagnoses of Otitis Media

  • Acute Otitis Media
  • Myringitis
  • Mastoiditis
  • Cholesteatoma

Treatment of Otitis Media

  • Initial: wait-and-see approach (especially if viral).
  • Oral antibiotics (10 days) if bacterial.
  • Secondary options if allergic to penicillin: Cefdinir, Cefuroxime axetil.
  • Myringotomy with tympanostomy tube insertion (in certain cases).

Patient Education (Otitis Media)

  • Teach parents how to administer antibiotic therapy for the full course.
  • Educate parents on monitoring fever and other OM symptoms.
  • Inform parents that secondary smoke exposure can cause recurrent OM infections.
  • Encourage breastfeeding because breast milk provides good drainage to the ear.
  • Possible temporary or permanent hearing loss.

Croup (Laryngotracheobronchitis)

  • Viral infection of the larynx, trachea, and large bronchi.
  • Swelling of the mucosa and muscle spasms in the upper airway.
  • Peak incidence: children 3 months to 3 years of age.
  • Common causes: parainfluenza viruses, influenza viruses, RSV, adenoviruses, commonly occurs in winter months,
  • Rare cases may require hospitalization.

Clinical Manifestations of Croup

  • Hoarseness (laryngeal swelling)
  • Barking cough (laryngeal swelling and inflammation)
  • Inspiratory stridor (narrowing of the glottic area)
  • Suprasternal retractions
  • Anxiety and air hunger
  • Nasal drainage
  • Sore throat and rhinorrhea
  • Low-grade fever
  • Tachycardia and tachypnea
  • Wheezing
  • Fatigue
  • Pallor or cyanosis
  • Lateral neck X-ray (may reveal narrowing)

Diagnosis & Treatment of Croup

  • Diagnosis: CXR, neck X-ray, WBC count with differential
  • Treatment: Nebulized racemic epinephrine, one dose of corticosteroids (dexamethasone), fluids, rest, cool mist (avoid steamy showers).

Patient Care (Croup)

  • Ensure patent airway
  • Humidity and supplemental oxygen
  • Upright position for ventilation
  • Emergency intubation equipment at bedside
  • Administer medications
  • Informing parents of symptom changes, especially worsening at night, and how to recognize respiratory distress signs.

Acute Epiglottitis

  • A type of croup, considered a medical emergency.
  • Inflammation and swelling of the epiglottis primarily affecting children aged 2 to 7 years.
  • Life-threatening because the swelling blocks the airway and can occlude the trachea within minutes.
  • Contraindicated: Examination of the throat (can further compromise the airway).
  • Causative agent: Bacterial infection (commonly Haemophilus influenzae type B).

Clinical Manifestations of Acute Epiglottitis

  • Sudden onset, previously healthy child. Often sudden illness with high fever (over 102°F).
  • Toxic appearance (overall presentation)
  • Anxious, fearful
  • Mouth open and neck extended (tripod position)
  • Drooling (cannot swallow secretions due to inflamed epiglottis)
  • Absence of cough
  • Extreme sore throat; with cherry-red, swollen epiglottis
  • Rapid deterioration/decompensation. Requires immediate ED/OR visit to protect airway

Diagnosis & Treatment of Acute Epiglottitis

  • Diagnosis: Hospitalization, CXR, blood cultures, and gases performed in OR.
  • Treatment: IV antibiotics (3 days, followed by oral antibiotics 7-10 days); corticosteroids; antipyretics (for fever and sore throat); emotional support; discuss HIB vaccination.

Bronchiolitis

  • Inflammation of the bronchioles with edema and excess mucus accumulation.
  • Air trapping and atelectasis result from increased airway resistance.
  • RSV is the primary causative agent.
  • Commonly occurs during winter and spring months, often starting as early as September.
  • Peak incidence: 6 months.
  • Begins with mild upper respiratory infection (URI), and can progress to hypoxemia and respiratory acidosis due to air trapping and atelectasis.

Clinical Manifestations of Bronchiolitis

  • Symptoms of URI (air hunger, congestion, cough, rhinitis)
  • Wheezing
  • Tachypnea (>70 breaths/min)
  • Nasal flaring
  • Retractions
  • Crackles/rales
  • Intermittent cyanosis
  • Apneic episodes
  • Marked diminished breath sounds.
  • Uncomplicated bronchiolitis resolves within 7-10 days.

Diagnosis & Treatment of Bronchiolitis

  • Diagnosis: CXR (revealing air trapping and infiltrates), most cases are managed at home with rest, fluids, and fever management.
  • Treatment: Supportive care (fluids, rest, adequate oxygen intake, fever control, and monitoring pulse oximetry).
  • Possible mechanical ventilation (hospitalization) for cases with respiratory distress or failure.
  • Ribavirin (aerosol antiviral medication) can be used in specific cases (high-risk children).
  • Synagis or Palivizumab (antibody injections) for prevention in high-risk infants.

Patient Education (Bronchiolitis)

  • Teach parents on administering antibiotics and recognizing signs and symptoms of RSV infection.
  • Educate parents on monitoring for fever, respiratory distress signs, and how to administer the full course of antibiotics.
  • Instruct parents on administering appropriate supportive care, including fluids, rest, and monitoring for signs of respiratory distress or worsening symptoms.
  • Teach parents how to recognize signs of respiratory distress (and complications).

Pneumonia

  • Lung inflammation affecting bronchioles and alveoli.
  • Common causes: Viral infections (RSV, parainfluenza, influenza); bacterial infections (S. Pneumoniae, atypical bacteria like Mycoplasma Pneumoniae).
  • Types of Pneumonia:
    • Lobar pneumonia (one or more lobes)
    • Bronchopneumonia (terminal bronchioles and nearby lobules)
    • Interstitial pneumonia (confined to alveolar walls, peribronchial and interlobular tissue).

Clinical Manifestations of Pneumonia

  • Fever, cough, crackles (or rales), wheezing, possible transient lobar infiltrates on CXR; symptoms may progress in terms of severity & appearance of symptoms..
  • Viral Pneumonia: mild low-grade fever, no productive cough, rhinitis, symptoms last 5-7 days, wheezing, tachypnea, and increased respiratory distress.
  • Bacterial Pneumonia: high fever, productive cough, ill appearance, retractions, grunting respirations, chills, chest pain, respiratory distress, restlessness, and anxiety.
  • Usually occurs after viral infection

Diagnosis & Treatment of Pneumonia

  • Diagnosis: Sputum culture, CXR (patchy infiltrates, consolidation, fluid), arterial blood gases, WBC count.
  • Treatment: Supportive care (fluids, rest) and antibiotics if bacterial (often macrolides), acetaminophen or ibuprofen for fever and pain, and oxygen therapy or chest physiotherapy as needed.

Mycoplasma Pneumonia

  • Atypical pneumonia.
  • Similar to viral pneumonia.
  • More common in school-aged children (over 5 years).
  • CXR often reveals patchy infiltrates.
  • Elevated WBC count.
  • Symptoms include: sudden fever, chills, diffuse crackles/wheezes, hacking nonproductive cough, and sore throat.

COVID-19 and Children (MIS-C)

  • Condition where different body parts (heart, lungs, kidneys, brain, skin, eyes, and the gastrointestinal organs) become inflamed in children. This inflammation develops due to infection with the COVID-19 virus or exposure to someone infected with the virus.
  • Symptoms: fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, feeling extra tired.
  • Usually resolves with treatment, but it's important to receive medical attention due to the potential for the condition to be serious and even life-threatening.

Symptoms

  • Fever
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Neck pain
  • Rash
  • Bloodshot eyes
  • Feeling extra tired
  • Be aware that not all children will have all the same symptoms.

Diffuse, red, patchy rash on torso

Case Study (Infant Follow-up)

  • Highest priority: Decreased pulse oximeter saturation (indicating respiratory distress). Increased temperature, increased heart rate, and decreased bowel sounds are also important but less immediately critical.

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Pediatric Respiratory ACUTE PDF

Description

Test your knowledge on the respiratory anatomy and common conditions seen in children. This quiz covers characteristics of a newborn's respiratory system, normal respiratory rates for toddlers, and various respiratory issues faced by children. Ensure you understand the clinical manifestations and treatments related to pediatric pneumonia and respiratory distress.

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