Respiratory Disease [Peds]

baby with Croup Stridor Barking Cough visual & audio sound (Enclavar)

Peds - Croup / Viral Infection

Types of Croup: Laryngotracheobronchitis (LTB = Most Common/Viral), Bacterial Tracheitis (Viral), Acute Epiglottitis (Bacterial/Haemophilus influenzae type b (Hib) Symptoms: "Barking" Seal Cough  Musical breathing = STRIDOR Tachypnea (Fast Breathing) Retractions Steeple Sign (In LTB) = Subglottic [below vocal chords] narrowing Tripod Position - Requires IMMEDIATE attention Coughing at night Treatment: Increase fluids (IV Therapy), Oxygen, Can be treated at home, artificial airway, Racemic epinephrine , provide a cool humidified environment (Night Air), keep calm crying aggravates the airway.    

Pie de foto: : The hallmark sign of croup is a harsh “barky” or “seal”-like cough.

1. Acute Spasmodic Laryngitis = Viral & Subglottic 2. Acute Laryngotracheobronchitis (LTB) = Viral & Subglottic 3. Acute Epiglottitis = Supraglottic (above vocal cords)/ Bacterial (caused by Haemophilus influenzae type b (Hib) Parainfluenza virus is the most common cause of croup!

Types of Croup

Croup (binary/octet-stream)

Pie de foto: : Overview of Croup

Medications for Croup

1.) Racemic Epinephrine Nebulized with oxygen - to decrease demand and bronchospasms.  2.) Dexamethasone - Given PO, IV or IM to decrease airway inflammation. 3.) Antibiotics - For bacterial croup infections only! 4.) Acetaminophen may be given to reduce fever.

Hospitalization

For children with severe symptoms (progressively worsening stridor, cyanosis, decreased oxygen saturation, retractions), hospitalization is necessary. Humidified oxygen and IV fluids are given until respiratory distress subsides and the child can take adequate fluids by mouth. Hospitalized children may also receive racemic epinephrine, and/or dexamethasone. Provide cool humidified mist / Night Air = Most Relief for Croup Intercostal Retractions = Means respiratory distress is getting worse! Emphasize hand washing to stop the spread of infection.

Epiglottis - Bacterial Form of Croup

Signs of Epiglottitis—Four D’s Drooling Dysphagia (difficulty swallowing) Dysphonia (difficulty talking) Distressed inspiratory efforts Also Includes: High Fever Epiglottis is edematous and cherry red

Acute+Epiglottitis +Clinical+Features (binary/octet-stream)

Pie de foto: : Tripod positioning is common

Epiglottis

Caused by: Haemophilus influenzae type b (Hib) Be on the Look out for the 4 Signs: Drooling, Dysphagia (Difficulty swallowing), Dsyphonia (Difficulty speaking), Distressed Inspirations

Signs of Epiglottis Require Immed. Atten!

A 5-year-old child brought to the emergency department with signs of apprehension and whose voice is thick and muffled also has drooling, agitation, and no spontaneous cough. What is the most effective nursing intervention? Have the child seen by a primary care provider immediately. In this case, the child needs immediate medical intervention, because the symptoms are rapidly progressive. Otherwise give IV antibiotic therapy. Meds: Vancomycin (Adv. Reac. - Rash)

Bronchitis

Inflammation of the bronchi. Rarely exists by itself, occurs wth a common cold. Signs & Symptoms: Fever Persistant Cough Wheezing Rhonchi Crackles in Lung Prolonged expiration Acute bronchitis is usually viral in origin. More common in boys and winter months.

Chronic Bronchitis (binary/octet-stream)

Pie de foto: : Chronic Bronchitis

Treatment

AVOID Antihistamines should be avoided because of their drying effect on secretions. Cough suppressants are not recommended unless the cough interferes with the child’s ability to rest.  Exposure to cigarette smoke should be avoided

GIVE Antibiotics should be given only if a bacterial infection is confirmed by culture or if the clinical findings support the diagnosis.  Encourage fluids  Acetaminophen is administered for an elevated temperature (usually above 38.3° C [101° F]) Quiet activities should be provided for diversion

Bronchiolitis

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Respiratory syncytial virus (RSV) is the causative agent in more than half of cases. A mild upper respiratory tract infection usually precedes the development of bronchiolitis. • Tachypnea—respiratory rates of 60 to 80 breaths/min • Tachycardia—heart rate greater than 140 beats/min • Wheezing, crackles, or rhonchi • Intercostal and subcostal retractions with or without nasal flaring • Cyanosis Feeding may be difficult because of increased respirations, which interfere with sucking and swallowing. The body temperature varies from hypothermic to as high as 41° C (105.8° F).

RSV prevention = Intramuscular palivizumab (Synagis) administered monthly throughout the RSV season Parenteral administration of fluids may be necessary for acutely ill infants who are dehydrated from tachypnea or poor intake  Cool, humidified oxygen is delivered if the oxygen saturation decreases to less than 90% on room air to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea  The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. Isolate the infant with RSV infection in a single room or place the infant in a room with other RSV-infected infants. Meticulous hand hygiene is imperative. Nurses caring for these infants should not care for other high-risk children. Maintaining Contact Precautions (i.e., wearing a gown and gloves) reduces nosocomial transmission of RSV.

Treatment

Pertussis (Whooping Cough)

Symptoms: Runny nose Fever / Chronic cough Violent and uncontrollable  coughing (Paroxysms) Place on droplet precaution   Prevented by a TDap shot The drug clarithromycin, which is an antibiotic to treat pertussis, should be administered to the child. Provide humidified oxygenation and suction. Give fluids  The child should be placed on his or her side

Pertussis (whooping cough) - causes, symptoms, diagnosis, treatment, pathology (Enclavar)

What Requires Droplet Precautions?

Mumps Influenza Pertussis * Remember M.I.P = Most Important Person *

Asthma

Corticosteroids are the first-line therapy for inflammation in children with asthma.   WHEEZING = Asthma The normal respiratory rate for newborns is 30 to 60 breaths/min Status Asthmaticus can be described as constant and unrelieved by bronchodilators. Short acting Vs Long acting bronchodilators

Asthma - causes, symptoms, diagnosis, treatment, pathology (Enclavar)

The possible side effects of short-acting inhaled beta agonists include a fast heartbeat, nervousness and tremors/  shakiness, which usually pass quickly when the medicine is inhaled.    EXAMPLES - ENDINGS OF "ROL" Albuterol (Ventolin®, Proventil®, Airet®) Albuterol sulfate (ProAir HFA®) Levalbuterol (Xopenex®) Metaproterenol sulfate (Alupent®, Arm-a-Med®, Metaprel®) Pirbuterol acetate (Maxair®) Terbutaline sulfate (Brethair®, Brethine®, Bricanyl®) Bitolterol mesylate (Tornalate®)

SHORT ACTING (QUICK RELIEF)

LONG ACTING (ASTHMA CONTROL)

Taken everyday, even when symptoms are not present. Do not show immediate results, but work slowly over time Used together with a steroid medication   Examples Serevent® (salmeterol) Foradil® (formoterol)  

Parts of the Lower Airway

Bronchi Bronchioles Alveoli

if PCo2 levels are greater than 45mmHg = Respiratory Acidosis