SONIA NR 602 QUZ 3 STUDY GUIDE

Respiratory Infections - Leading cause of morbidity and mortality in children - Respiratory failure can develop rapidly with ominous symptoms - Be able to recognize key respiratory sounds o Croup cough vs. other coug ...

Respiratory Infections - Leading cause of morbidity and mortality in children - Respiratory failure can develop rapidly with ominous symptoms - Be able to recognize key respiratory sounds o Croup cough vs. other coughs *Sound bit croup cough: see link under Croup* o Inspiratory stridor *Sound bit: (https://www.easyauscultation.com/heart-lung-soundsdetails/140/Stridor) o Wheezing * Sound bit: (https://www.easyauscultation.com/heart-lung-sounds-details/71/Wheeze) - Critical Sign: Tachypnea! o Respiratory Rates:  Infants (birth to 12 months): 30-53 bpm (RR > 60 requires further evaluation)  Toddlers (1-2 yrs): 22-37 bpm (RR > 40 requires further evaluation)  Preschool (3-5 yrs): 20-28 bpm  School Age (6-9 yrs): 18-25 bpm  Pre-Adolescent (10-11 yrs): 18-25 bpm  Adolescent (12yrs and older): 12-20 bpm o Red Flags: Tachypnea +  grunting,  nasal flaring,  use of accessory muscles - Upper Respiratory Infections are the most common (common cold) o Most often Viral  Rhinovirus, Parainfluenza, RSV, Coronavirus, human metapneumovirus  Self-limiting lasting 7-10days o Peak: Spring and Winter o Common Sxs: (gradual onset)  Low grade fever  Nasal Congestion  Sore throat, hoarseness  *Hallmark: Rhinorrhea (clear at first, progresses to purulent)  Cough/Sneezing o Clinical Findings:  Conjunctiva: mild injection  Erythematous nasal mucosa with mucus  Erythematous posterior oropharynx  Anterior cervical lymphadenopathy - Diagnostics: o ONLY if in doubt of URI: sore throat without drainage or cough  Rapid antigen detection test (RADT): rapid strep  Throat culture if RADT negative o Treatment: Supportive Care  Hydration  OTC antipyretics as directed (weight dose)  Normal saline nasal rinse  Topical menthol  NO Antibiotics prophylactically o Complications: secondary infection  Bacterial infection  Otitis media SONIA NR 602 QUZ 3 STUDY GUIDE 2  Sinusitis  Asthma exacerbation - Pharyngitis, Tonsillitis, and Tonsillopharyngitis o Inflammation of mucosal lining of the throat structures o Infectious or noninfectious causes  Viral or bacterial  Viral (most common): adenovirus (pharyngitis primary sx), Epstein-Barr (EBV), herpes simplex (HSV), cytomegalovirus (CMV), enterovirus, parainfluenza, HIV o Upper nasal symptoms, cough and rhinorrhea, hoarseness, conjunctivitis, rash, diarrhea o Occur year round, except adenovirus which is predominantly summer (contaminated swimming pools)  Bacterial: GABHS (most common in 5-13 year olds), gonococcal (15-19 year olds), Corynebacterium diphtheria (RARE), Arcanobacterium haemolyticum, Neisseria gonorrheae(adolescents), Chlamydia trachomatis (adolescents), Francisella tularensis, Mycoplasma pneumonia, Group C & G Strep o GABHS: typically late winter and early spring o Acute abrupt onset: sore throat, headache, nausea, vomiting, abdominal pain, myalgia, arthralgia, malaise  Respiratory irritants (smoke) o Clinical Findings:  Erythematous tonsils and pharynx  EBV: exudates on tonsils, petechiae on soft palate, diffuse adenopathy  Adenovirus: follicular pattern on pharynx  Enterovirus: vesicles or ulcers on tonsillar pillars, coryza, vomiting, diarrhea  Herpes: anterior ulcers, adenopathy  Parainfluenza and RSV: lower respiratory sx, stridor, rales, and wheezing  Influenza: cough, fever, systemic sxs  M. pneumo & Chlamydophila pneumo: cough, pharyngitis  GABHS: exudative Erythematous pharyngitis with follicular pattern without presence of cough or nasal symptoms, swollen beefy red uvula, enlarged tonsillopharyngeal tissue, anterior cervical lymphadenopathy, bad breath, scarlatiniform rash, strawberry tongue  A. haemolyticum: exudative pharyngitis, marked erythema and pruritic, fine scarlatiniform rash o Diagnostics:  RADT and/or throat culture if >3 years old with pharyngitis or if someone in household is + Strep  Culture if RADT negative, or suspect A. haemolyticum, N. gonorrhea or C. diphtheria  If suspect Mononucleosis: CBC o Treatment:  Supportive care: ibuprofen, acetaminophen  Hydration  GABHS with + RADT or + culture: antibiotic