pediaaaa (uppp, loww)

• Functions of the respiratory system

  • Provides oxygen for metabolism in the tissues
  • Removes carbon dioxide, the waste product of metabolism

  
• Secondary functions of the respiratory system

  • Facilitates the sense of smell
  • Produces speech
  • Maintains acid-base balance
  • Maintains body water levels
  • Maintains a heat balance
• Major functions of the upper respiratory system

  • Air conditioning
  • Defense against pathogens
• Major functions of the lower respiratory system

  • Speech and other respiratory sounds
  • Gas exchange
  • Maintenance of homeostasis (e.g. pH)
• Acute streptococcal pharyngitis (strep throat)


  Bacterial pharyngitis caused by Group A beta-hemolytic streptococcus
• Children who experience Group A beta-hemolytic streptococcus (GABHS) infection of the upper airway are at risk of rheumatic fever (RF), an inflammatory disease of the heart, joints, and central nervous system, and acute glomerulonephritis (AGN), an acute kidney infection

  
• Permanent damage can result from these sequela, especially RF
• GABHS may also cause skin manifestations like Impetigo and pyoderma
• Clinical manifestations of acute streptococcal pharyngitis

  • Pharyngitis
  • Headache
  • Fever
  • Abdominal pain
  • Inflamed and exudative tonsils and pharynx
  • Edematous and red tongue (strawberry tongue)
  • Sandpaper rash
  • Edematous and red uvula
  • Anterior cervical lymphadenopathy
  • Dysphagia
• Other signs and symptoms of strep throat

  • Sore throat
  • Inflamed tonsils
  • Tender lymph nodes
  • Sores on the back of the mouth
  • Foul breath
  • White patches inside the mouth
  • Headache
  • Stomach pain
  • Ear pain
  • Nausea
  • Rashes
  • General feeling of discomfort
• Diagnosing strep throat in a child is essential to prevent serious but uncommon complications such as rheumatic fever, post-streptococcal glomerulonephritis, scarlet fever, and toxic shock syndrome
• Diagnostic evaluation for strep throat

  • Throat culture
  • Rapid streptococcal identification test
• Throat culture


  Provides a more accurate result than a rapid strep test, but takes longer (2-3 days) to receive the results
• Rapid strep test


  A diagnostic procedure that helps physicians quickly identify if a patient has Group A Streptococcal pharyngitis in less than 15 minutes
• Medications for strep throat

  • Penicillin
  • Amoxicillin
  • Erythromycin
  • Azithromycin
  • Clarithromycin
  • Oral cephalosporin
  • Amoxicillin and clavulanic acid (Augmentin)
• Therapeutic management for strep throat

  • Oral penicillin
  • IM benzathine penicillin G
  • Oral erythromycin
  • Oral hygiene
  • Proper handwashing
  • Sanitation
  • Alcohol-based hand sanitizers
  • Warm salt-water gargle
  • Easy-to-swallow foods
  • Hydration
• Nursing care management for strep throat

  • Obtain throat swab for culture or rapid antigen testing
  • Instruct parents on correct antibiotic administration
  • Administer prescribed analgesics
  • Apply cold/warm compresses
  • Warm saline gargles
  • Ensure fluid intake
  • Administer injections properly
  • Use EMLA or LMX4 to numb injection site
  • Isolate patient
  • Ensure rest
  • Replace toothbrushes
  • Wash orthodontic appliances
  • Isolate eating utensils
  • Further evaluation if symptoms persist
• Never administer penicillin G procaine or penicillin G benzathine suspension intravenously as they may cause an embolism or toxic reaction
• Tonsils


  Masses of lymphoid tissue located in the pharyngeal cavity that filter and protect the respiratory and alimentary tracts from invasion by pathogenic organisms and play a role in antibody formation
• Tonsillitis


  Inflammation of the tonsils, usually caused by viral or bacterial infection
• Types of tonsils

  • Palatine
  • Pharyngeal (adenoids)
  • Lingual
  • Tubal

  
• Types of tonsillitis

  • Acute
  • Recurrent
  • Chronic
• Tonsillitis often occurs with pharyngitis and is common in young children due to the abundant lymphoid tissue and frequency of upper respiratory infections
• Tonsillitis


  • As the palatine tonsils enlarge from edema, they may meet at the midline (kissing tonsils)

  
• Tubal tonsils


  On the posterior nasopharyngeal opening of the eustachian tubes, are not part of the Waldeyer ring

  
• Tonsillitis


  Develops when the pathogen, viral or bacterial, infects the tonsils and elicits an inflammatory response. It develops when the viruses infiltrate the tonsils and cause an inflammatory response of up-regulated cytokines
• Types of tonsillitis

  • Acute tonsillitis
  • Recurrent tonsillitis
  • Chronic tonsillitis

  
• Acute tonsillitis


  Symptoms usually last 3 or 4 days but can last up to 2 weeks
• Recurrent tonsillitis


  When you get tonsillitis several times in a year
• Chronic tonsillitis


  When you have a long-term tonsil infection
• Tonsillitis often occurs with pharyngitis
• Tonsillitis is common in young children due to the abundant lymphoid tissue and the frequency of upper respiratory infections
• Causative agent of tonsillitis can be viral or bacterial
• Kissing tonsils

  As palatine tonsils enlarge from edema, they may meet at the midline obstructing the passage of air or food
• Mouth breathing


  Child breathes through the mouth due to the enlargement of the adenoids, the space behind the posterior nares becomes blocked
• Absolute indications for tonsillectomy

  • Recurrent peritonsillar abscess
  • Airway obstruction
  • Tonsillitis resulting in febrile convulsions
  • Tonsils requiring tissue pathology

  
• Relative indications for tonsillectomy

  • 3 or more tonsil infections per year
  • Persistent foul taste or breath caused by chronic tonsillitis
  • Unilateral tonsil hypertrophy presumed to be malignant
  • Chronic tonsillitis in streptococcus carrier who fails to respond to antibiotics

  
• Indications for adenoidectomy

  • Hypertrophied adenoids that obstruct nasal breathing
  • Recurrent adenoiditis and sinusitis
  • Chronic otitis media with effusion (especially if associated with hearing loss)
  • Airway obstruction and subsequent sleep-disordered breathing
  • Persistent nasal breathing
  • Nasal speech
  • Recurrent nasopharyngitis
• Contraindications for tonsillectomy or adenoidectomy


  • Cleft palate
  • Acute infections at the time of surgery
  • Uncontrolled systemic diseases or blood dyscrasias (bleeding disorder)
  • Poor anesthetic risk

  
• Nursing care management for tonsillectomy/adenoidectomy

  • Providing comfort and minimizing activities or activities that precipitate bleeding
  • Close monitoring of airway and breathing postoperatively for patients with sleep-disordered breathing
  • Soft diet
  • Cool-mist vaporizer to keep the mucous membrane moist during periods of mouth breathing
  • Warm-salt water gargles, throat lozenges, and analgesic and antipyretic
  • Psychological preparations and physical care as any surgical procedure
  • Placing on abdomen or side to facilitate drainage of secretions until fully awake
  • Avoiding routine suctioning, but when performed, done carefully to avoid trauma
  • Preferring sitting up when alert
  • Discouraging coughing, clearing the throat, blowing the nose, and any other activity that may aggravate the operative site
  • Inspecting all secretions and vomitus for evidence of fresh blood
  • Ice collar for sore throat after surgery
  • Administering analgesic at regular intervals even at night
  • Administering antiemetic postoperatively if nausea or vomiting is present
  • Restricting foods and liquids until the child is fully alert and there are no signs of hemorrhage
  • Avoiding citrus juice, milk, ice cream, and pudding
  • Observing the throat directly for evidence of bleeding
  • Monitoring for signs of hemorrhage: tachycardia, pallor, frequent clearing of the throat or swallowing, vomiting of bright red blood, decreasing BP
  • Suctioning equipment and oxygen should be available after tonsillectomy