Chapter 28 - RTIs, Neoplasms, & Childhood Disorders

• the influenza virus has symptoms that are indistinguishable from other viral infections
• one distinguishing feature of an influenza viral infection is the rapid onset of profound malaise, sometimes in as little as 1 to 2 minutes
• the classic presentation of viral influenza includes abrupt onset of fever and chills, malaise, muscle aching, headache, profuse water nasal discharge, nonproductive cough, and sore throat
• the goals of treatment for influenza are designed to limit the infection to the upper respiratory tract
• the symptomatic approach for treatment of uncomplicated influenza focuses on rest, keeping warm, and drinking large amounts of liquids
• analgesics can also be utilized for symptomatic relief of fever and aching muscles in influenza, but it should be remembered that aspirin should be avoided in children because of the risk of Reye syndrome
• rest decreases the oxygen requirements of the body and reduces the respiratory rate and the chance of spreading the influenza virus from the upper to lower respiratory tract
• viral replication occurs at sub-core temperatures of approximately 35 degrees C, thus keeping warm for those with influenza helps maintain the respiratory epithelium at a core body temperature
• drinking large amounts of liquids during influenza ensures that the function of the epithelial lining of the respiratory tract is not further compromised by dehydration
• the formation of influenza vaccines must be changed in response to antigenic changes in the influenza virus
• the CDC annually updates its recommendations for the composition of the influenza vaccine
• the effectiveness of the influenza vaccine in preventing and lessening of the effects of influenza infection depends primarily on the age and immunocompetence of the recipient and the match between the virus strains included in the vaccine and those that circulate during influenza season
• the most common cause of bacterial pneumonia is S. pneumoniae
• pathology resulting from infection by S. pneumoniae causes the alveoli to become filled with protein-rich edema fluid
• capillary congestion follows with a massive outpouring of polymorphonuclear cells, RBCs, and other leukocytes in bacterial pneumonia
• in bacterial pneumonia, macrophages phagocytize the polymorphonuclear cells, RBCs, and other cellular debris
• the alveolar exudate in bacterial pneumonia is removed with productive coughing
• atypical pneumonias produce patchy inflammatory changes that are confined to the alveolar septum and the interstitium of the lung (not the alveoli)
• atypical pneumonia denotes a lack of lung consolidation and production of moderate amounts of sputum
• in atypical pneumonias, there is a lack of alveolar infiltration; hence, the cough (if present at all) is nonproductive
• the common causative agent/pathogen implicated in bronchiolitis is the respiratory syncytial virus
• the respiratory syncytial virus produces inflammatory obstruction of the small airways and necrosis of the cells lining the lower airways
• in bronchiolitis, the source of infection is a family member with a minor respiratory illness
• RSV treatment is supportive and may include supplemental oxygen if necessary
• with RSV, the infant usually is able to take in sufficient air but has trouble exhaling it
• in RSV, air becomes trapped in the lung distal to the site of the obstruction and interferes with gas exchange; because the obstruction causes airway resistance, this resistance increases the work of breathing
• children with respiratory disease will need to compensate for the increased work of breathing and during this time, retractions will be seen as the child intrinsically increases intrathoracic pressure to overcome the airway resistance
• signs of impending respiratory failure in the infant and small child:

  • severe increase in respiratory effort, including severe retractions or grunting and decreased chest movement
  • cyanosis that is not relieved by oxygen administration
  • HR of 150 bpm or greater or bradycardia
  • very rapid breathing (newborn to 6 months: >60 per minute; 6 months to 2 years: >30 per minute)
  • very depressed breathing (<20 per minute)
  • retractions of the supraclavicular area, sternum, epigastrum, and intercostal spaces
  • extreme anxiety and agitation
  • fatigue
  • decreased level of consciousness
• upper respiratory tract infections involve the nose, oropharynx, and larynx
• lower respiratory tract infections include the lower airways and lungs
• viruses are the most frequent cause of respiratory tract infections
• factors affecting the signs and symptoms of respiratory tract infections:

  • the function of the structure involved
  • the severity of the infectious process
  • the person's age and general health status
• the common cold is caused by a viral infection of the upper respiratory tract such as rhinoviruses, parainfluenza virus, respiratory synctytial virus, corona virus, and adenoviruses
• the nasal mucosa and conjunctival surface of the eyes are the most common ports of entry for viral infections
• the common cold is an acute and self-limiting illness that is normally limited to 7 to 10 days
• rhinitis is an inflammation of the nasal mucosa
• sinusitis is an inflammation of the paranasal sinuses
• rhinosinusitis is most commonly caused by upper respiratory viral infection or allergic rhinitis that causes mucosal edema obstructing ostia and inhibiting clearance
• acute rhinosinusitis may be of viral, bacterial, or mixed viral-bacterial origin and may last from 5 to 7 days up to 4 weeks
• symptoms of acute rhinosinusitis match with the common cold (e.g., facial pain, headache, purulent nasal discharge, decreased sense of smell, fever)