respiratory peds

• All of these differences PUT CHILDREN AT GREATER RISK FOR OBSTRUCTION OF THE AIRWAY BY MUCUS EDEMA AND FOREIGN BODY
• Respiratory assessment

  1. How does the patient look? (Alert or listless? Restless or irritable? Color, skin perfusion, position or comfort)

  2. Listen (Auscultate chest for breath sounds, cough (dry, wet, brassy, barking, effort is it strong, weak, or absent))

  3. VS (Temperature, HR, RR, fever shows all other VS)
• Signs of respiratory distress

  • Tachypnea
  • Tachycardia
  • Retractions
  • Nasal flaring
  • Grunting
  • Stridor or wheezing
  • Mottled color
  • Change in responsiveness
  • Hypoxemia
  • Hypercarbia
• Late signs of respiratory distress

  • Poor air entry
  • Weak cry
  • Apnea or gasping
  • Deterioration in systemic perfusion
  • Bradycardia
  • Cyanosis
• Tonsillitis/Pharyngitis

  Viral unless positive strep test, young children can have herpangina, very painful with herpetic lesions inside mouth and pharynx
• Symptoms of viral tonsillitis

  Sore throat, fever, malaise, swollen lymph glands
• Strep throat

  Caused by group A beta hemolytic streptococcal bacteria, can cause bacterial endocarditis and glomurenephritis
• Symptoms of strep throat

  Fever, red and sore throat, exudative tonsils, stomach ache, palatal petechiae, swollen submandibular lymph nodes, red sandpaper rash develops= scarlet fever
• Treatment for strep throat

  Responds well to antibiotics, PCN, erythromycin if PCN allergy, cephalosporin, school age children antibiotics x 24 hrs before return to school
• Tonsillectomy

  Indications: frequent strep infections, peritonsillar abscesses, hypertrophy obstructing breathing or eating
• Tonsillectomy preoperative

  Teaching and coagulation status
• Tonsillectomy postoperative

  1. Positioning for drainage (sitting up)

  2. Ice collar

  3. Cool liquids first then soft food (avoid red flavors)

  4. Analgesics

  5. Caution with suctioning and avoid straws

  6. Refrain from nose blowing and coughing

  7. Observe for constant swallowing, swallowed blood going to throw it up
• Otitis externa

  External ear infection, "Swimmer's Ear", caused by normal ear flora and excessive wetness or dryness, inflammation pain drainage
• Treatment for otitis externa

  Keep clean and dry, analgesics, otic drops (polymyxin, neomycin, corticosteroids)
• Otitis media with effusion (OME)

  Presence of fluid in middle ear w/o signs of acute ear infection
• Acute otitis media (AOM)

  Acute onset middle ear effusion and inflammation due to infection
• Diagnosis of acute otitis media


  Acute onset, presence of middle ear effusion (TM bulging or full with limited mobility or otorrhea), distinct TM erythema or otalgia preventing normal activity or sleep
• Treatment for acute otitis media


  Antibiotics, 5-7 day course, 10 day course in younger children or other problems
• Pain control for acute otitis media


  Acetaminophen/ibuprofen, lidocaine/benzocaine topical treatment may be helpful
• Follow up for acute otitis media


  Complete all medication, must be seen for recheck, hearing and language development may need to be followed long term
• Treatment for otitis media with effusion (OME)


  Screen hearing/language, follow up over time, prolonged consider antibiotics/corticosteroids, tympanostomy tubes, manage allergies
• Myringotomy with tympanostomy tubes

  Tubes inserted to equalize pressure and facilitate drainage and ventilation of the middle ear, will not prevent infections, will facilitate sound transmission and language development, avoid swimming/shower/bath tubs
• Postoperative care for tympanostomy tubes

  Analgesia needed is mild, home instructions are to finish antibiotics tubes will fall out on their own 6 month to 1 year but may need to be removed if haven't follow up with PCP for hearing/language
• Croup syndromes

  Most caused by virus, RSV, influenza A&B, adenovirus, HIB and pneumococcal vaccine has decreased incidence
• Acute epiglottitis or supraglottitis

  Acute inflammation and swelling of the epiglottis and surrounding tissue, usual cause of H.flu or inhalation caustic agent, rapidly progressing upper trachea edema resulting in obstruction of airway, diagnosis lateral neck film and clinical presentation, LIFE THREATENING
• Symptoms of acute epiglottitis

  Drooling (big one), dysphagia, dysphonia (trouble talking), distressed inspiratory effort
• Management of acute epiglottitis

  Primary goal maintenance of patent airway, continuous monitoring of respiratory status and oxygenation, mechanical ventilation may be necessary, NPO, antibiotics, steroids, maintain quiet environment, educate parents on disease process and plan of care as rapid progression of illness can be frightening
• Laryngotracheobronchitis (LTB)

  Inflammation of larynx and trachea with narrowing of airway, viral with URI often precedes, children less than 5 years most often 3-36 months, symptoms usually worse at night, happens in different stages, CHARACTERIZED BY BARKING COUGH-CROUP COUGH
• Management of laryngotracheobronchitis (LTB)

  Primary goal maintain airway and adequate gas exchange, racemic epinephrine (nebulized epi), steroids like dexamethasone or prednisone, oxygen administration as needed with pulse oximetry
• Bronchiolitis

  Small airway with large amount of thick secretions, inflammation of the bronchioles, ACUTE VIRAL INFECTION, most often RSV or adenoviruses or parainfluenza, don't have to have a definitive diagnosis because it is treated the same way
• Symptoms of bronchiolitis

  Dyspnea, tachypnea with retractions, tachycardia, wheezing, crackles, or rhonchi, temperature may vary from hypothermic to febrile, naso-pharyngeal aspirate to help diagnosis
• Management of bronchiolitis

  Frequent assessment of respiratory status and oxygenation with pulse oximetry, humidified oxygen, heated high flow NC, assessment of adequate hydration, suctioning as needed to clear mucous from airway, include parents in care as much as possible and provide education to decrease anxiety
• Heated high flow NC

  Delivery of heated and humidified oxygen at higher than normal rates usually greater than 5L, based on weight, humidity helps to loosen dried secretions, high flow rate helps ensure airway patency, percentage of oxygen being delivered can also be adjusted, patients are typically NPO on this to avoid aspiration because of pressure changes
• Pneumonia

  Inflammation of the lung parenchyma, MAY BE VIRAL OR BACTERIAL, common viruses are adenoviruses influenza and RSV, common bacterial agents are strep staph and enteric bacilli
• Symptoms of pneumonia

  Elevated temp, cough, tachypnea, retractions, nasal flaring, cyanosis
• Diagnosis of pneumonia

  CXR, sputum cultures to give correct antibiotic, pulmonary lavage
• Neonatal pneumonia

  Infant's newborn to about 19 weeks, chlamydia trachomatis group b strep and herpes simplex, ascending infection from mother just before or during birth
• Complications of neonatal pneumonia

  Infant apnea, pleural effusion, necrotizing pneumonia, pericardial effusion, acute respiratory distress syndrome, severe sepsis
• Symptoms of chlamydia pneumonia

  Afebrile, persistent cough, tachypnea, treatment with erythromycin for 2-3 weeks
• Pertussis (whooping cough)

  Bordetella pertussis virus, HIGHLY CONTAGIOUS, direct contact or droplet spread; indirect contact with freshly contaminated items, highest incidence in spring and summer, usually last 4-6 weeks