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548 Exam 1
Respiratory- Lower
37
Nursing
Graduate
10/11/2011

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Cards

Term
What are key points of the respiratory history?
Definition
-child's age
-time of year
-general health status
-OLDCART/PQRST
-fever & timing
-cough
-congestion
-sore throat
-HA
-ear pain
-medications
-exposure to similar s/s
-length of s/s
-appetite
-elimination
-sleep
-activity
-ETS or tobacco and marijuana use
-childcare
-siblings
-travel: part of the world, airplane
-previous respiratory illness
-hospitalizations
-vaccinations: flu, RSV
Term
What vital signs and measurements are taken?
Definition
-temp
-RR
-pulse ox
-wt
Term
What are age guidelines for RR?
Definition
< 2 mos: < 60
2-12 mos: < 50
1-5 yrs: < 40
6-8 yrs: < 30
Term
What are components of the physical exam?
Definition
-general appearance
-HEENT
-neck: lymphadenopathy
-chest: adventitious sounds, retractions, flaring
-skin: rashes
-mucous membranes: hydration
Term
What is the most common infective pathogen of URIs?
Definition
RSV
Term
Children average ___?___ colds/yr with peak incidence during the first ___?___ yrs.
Definition
5-8

2
Term
What are s/s of a cold in infants?
Definition
-irritability & restlessness
-fever: 100-102
-occasional GI upset: diarrhea
-changing in eating and sleep patterns
-desire to be held
Term
What are physical findings in a cold?
Definition
-erythematous nasal mucosa
-edematous nasal turbinates
-nasal discharge
-erythematous tonsils and pharynx
-cervical lymphadenopathy
Term
What is the most common serious acute illness of young children and infants?
Definition
bronchiolitis
Term
When is the peak time of year for bronchiolitis? peak age group?
Definition
mid winter to early spring

2-6 month olds
Term
What factors increase severity of bronchiolitis?
Definition
-male
-not breastfed
-low SES: crowded conditions
-group childcare
Term
What are s/s of bronchiolitis?
Definition
initial:
-rhinorrhea
-congestion
-cough
-decreased appetite
-low grade fever

progression:
-increased WOB
-tachypnea
-decreased appetite and poor suck
-decreased activity
-forced expiratory phase

infants, especially premature:
-apnea
-lethargy
-irritability
-poor feeding
Term
What are physical exam findings in bronchiolitis?
Definition
-***wheezing (crackles and decreased breath sounds suggest more severe dz)
-tachypnea
-shallow breathing
-retractions
-nasal flaring
-prolonged expiratory phase
-paroxysmal wheezy cough
-rhinorrhea
-otitis
-conjunctivitis
-pharyngitis
-afebrile or low grade fever
-palpable liver or spleen d/t hyperinflation of lungs
Term
After bronchiolitis, hyperinflation may persist on CXR for ___?___ months. Many children will have permanent airway hyperreactivity.
Definition
3-6
Term
What are the most common organisms that cause croup/laryngotracheobronchitis?
Definition
1) parainfluenza virus
2) RSV
3) influenza A & B
Term
What is the most common age range for croup?
Definition
6 mos-5 yrs
Term
Females are more affected by croup than males. true/false
Definition
false- males are more affected
Term
What are s/s of croup?
Definition
-initial URI
-rapid onset of "barky" cough & inspiratory stridor
-afebrile or low grade fever
-NO drooling
Term
What worsens croup s/s?
Definition
-nighttime
-agitation, crying
Term
Croup peaks in severity at ___?___ days.
Definition
3-5
Term
What are physical findings of croup?
Definition
-inspiratory stridor
-barking cough
-dyspnea
-exipiratory stridor, if severe
-low grade fever
-clear chest
-no involvement of lower respiratory tract
Term
What medications are used to treat croup?
Definition
-nebulized racemic or L-epinephrine
-corticosteroids
Term
Chronic bronchitis lasts longer than ___?___
Definition
2 wks
Term
What are viral causes of bronchitis?
Definition
-parainfluenza
-RSV
-rhinovirus
Term
What are bacterial causes of bronchitis?
Definition
-mycoplasma
-chlamydia
-strep cornynebacterium
-diptheria
-H. flu
Term
What are s/s of bronchitis?
Definition
-initial URI
-dry then productive cough
-sputum: purulunt; swallowing causes nausea
-retrosternal chest pain with coughing
-malaise
-decreased appetite
Term
What are physical findings of bronchitis?
Definition
-brassy cough
-coarse, bronchial breath sounds in periphery
-rhonchi
-tracheal tenderness with palpation
Term
When are abx used in bronchitis?
Definition
-bacterial suspected and cough >10-14 days
-chronic pulmonary dz
Term
What is the peak age for foreign body aspiration?
Definition
2 yo
Term
What are physical findings with foreign body aspiration?
Definition
-unilateral wheezing
-decreased breath sounds: on side of apiration, or bilateral
-persistent cough
-voice changes
-stridor
-dyspnea
-sputum
-emesis
-bronchiectasis
-abscess formation
-recurrent pneumonia
-hemoptysis
Term
What diagnostic tests are used in foreign body aspiration?
Definition
-pulse ox: decreased if significant obstruction
-CXR: only 10-25% of objects aspirated are opaque
-expiratory chest films
-rigid or flexible bronchoscopy
Term
What follow-up care is needed after foreign body aspiration?
Definition
-humidification
-bronchodilators
-anti-inflammatory medications
-CXR after 8 wks
Term
How is pertussis spread?
Definition
aerosolized droplets
Term
At what age is pertussis most common and severe?
Definition
< 6 mos
Term
What is the incubation period for pertussis?
Definition
5-21 days, usually 7-10
Term
How do infants present with pertussis?
Definition
-short catarrhal stage
-gagging
-gasping
-apneic episodes
-cyanosis
Term
When is pertussis most contagious?
Definition
-catarrhal stage: mild respiratory symptoms
-1st 2 weeks after cough onset
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