Infants & Respiratory Infections

• < 3 months- maternal antibodies protect from viral infections
• 3-6 months infection rates increases b/c lack of maternal antibodies

• Clears mucous by rhythmic striking of the chest wall with cupped hands or 1/2 of suction ball
• 1-2 minutes per lung segment
• Automatic vest: for cystic fibrosis

• nasal flaring
• sternal retraction
• tripodding
• using accessory muscles to breath
• tachypnea
• cyanotic
• increased RR (50-60)

• S/S: fever, stiffness in back & neck, vomiting, diarrhea, cough, hoarseness, grunting, headache, pain, anorexia, abdominal pain, chest pain, nasal blockage, nasal discharge, stridor, wheezing, sore throat
• <1yr more severe: increased coughing/wheezing, air hunger, shallow respirations, tachypnea (60-80), retractions, nasal flaring, cyanosis, listlessness, apnea spells
• Caused by: usually Parainfluenza virus
• Treatment: oxygenation, IGIV, RespiGam (prevention)
• Nursing: Respiratory Assessment: RR, patterns, sputum. Monitor hydration status, I/O, direct contact precautions

• Common cold, caused by many viruses
• Self-limiting (4-7days). 
• No treatment: rest, decongestants (>6 months), antipyretics.
• Prevention: wash hands!

• inflammation of pharynx
• Causes: sinus infection->throat, strep->acute rheumatic fever
• S/S: sore throat, fever, ha, joint/muscle pain, skin rashes, swollen lymph nodes
• Diagnosis: rule out strep, penicillin, erythromycin
• Nursing: avoid antibiotics if virus, warm liquids, gargle, popsicles/lozenges, cool mist vaporizer, tylenol

• caused by pharyngitis
• determine viral/bacterial.
• S/S: fever, sore throat, large tonsils, reddness of soft palate, visible exudate (white patches)
• Treatment: antibiotics, fluids, analgesics, antipyretics
• Tonsillectomy if: 3 per yr for 3 yrs, 5 per year for 2 yrs, or 7+ in 1 yr.
• Nursing: Monitor for hemorrhage, frequent swallowing. No milk, vomit dark blood-ok, vomit bright red=new bleed, Bleed after 7-10 days=scabs fall off

• Caused by EBV, transmitted through oral secretions
• S/S: prolonged fever, malaise, sore throat, tender posterior cervical lymph nodes, skin rash on trunk, ha, enlarged spleen
• Diagnosis: blood test- antibodies to EBV
• Treatment: rest, tylenol, runs course in 2-4 weeks
• Nursing: rest & treatment

• S/S: chills, fever, sore throat, muscle pains, ha, coughing, weakness, fatigue, overall discomfort
• Treatment: No antibiotics. Antipyretics, decongestants, rest, Tamiflu: w/in 24-48 hrs to help relieve symptoms
• Prevention: flu shot, transmitted through air by coughs or sneezes

• inflammation of tympanic membrane. Often in 6-20 months of age
• S/S: Temp 103-104F, enlarged glands, increased pressure->pain
• Diagnosis: ear exam->inflammed middle ear w/ fluid present instead of air
• Complications: ear drum scarring->hearing loss->decreased speech development->learning difficulties
• Treatment: benzocaine ear drops for pain (after exams only), if < 2yrs + fever=hospital

• purulent, secondary to bacterial infection (usually)
• S. pneumonia & H.influenza
• Smoke exposure increases risk

• 3 times in 6 months or 4 times in 1 yr
• Treatment: PE tubes, less antibiotics=less resistance

• affects larynx, trachea & bronchi
• can be bacterial or viral (Parainfluenza, adenovirus, RSV)
• 3 months-3 yrs
• abrupt onset, at night

• medical emergency
• age 2-5 yrs
• abrupt onset, progresses rapidly
• S/S: high fever, intense sore throat, dysphagia

• S/S: sore throat, pain, tripod positioning, retractions, inspiratory stridor, mild hypoxia, distress
• Nursing considerations: prep for respiratory obstruction: trach tray/intubation @ bedside, don't use tongue blade to examine
• Prevention: Hib vaccine

• S/S preceded by runny nose, barking cough @ night, hoarseness, self-limiting

• most common croup syndrome, viral.
• affects < 5yrs
• Causes: P. influenza, M.pneumonia, influenza a&b
• S/S: inspiratory stridor, retractions, hoarseness, barking cough, respiratory distress, hypoxia->respiratory acidosis->respiratory failure & death
• Nursing: airway, hydration, humidity, O2, nebs, fluids if RR under 60 (aspiration)

• S/S: croup cough, respiratory stridor, onset @night, brief episodes & occur over 2-3 nights, recur during the year. Less severe symptoms

• all or one large segment of a lobe. 
• bilateral=double pneumonia

• acute inflammation of walls of smaller bronchial tubes
• irregular areas of consolidation b/c spreads to bronchials & alveolar ducts

• Inflammation of tissue in interstitial area of lungs (space around air sacs).

• s/s: rapid fever of 103-105F, respiratroy distress, tachycardia & tachypnea, cough, abdominal distention, N/V, ha, muscle aches, fatigue
• Diagnosis: sputum test C&S, CBC, PFT

• Child w/ feeding difficulties at risk
• Prevent: thicken fluids, feed upright, no bottle in bed

• Goals: maintain respiratory function, O₂ saturation, hydration, IV fluids, temp, prevent OM, conserve energy
• Treatment: antibiotics/anti-infectives, Vaccination-PCV for <5yrs (4 doses).

• Incubation period of 7-10 days (can be 42)
• Infectious from onset of symptoms->3 weeks
• Caused by Bordetella pertussis
• Spread by respiratory droplets
• Vaccine: TDAP
• S/S: productive cough w/bloody sputum, night sweats, weight loss, fatigue, chest pain
• Diagnosis: nasopharygneal swab
• Treatment: erythromycin during catarrhal phase, trimethoprim-sulfamethoxasole

• Catarrhal- begins with URI symptoms: runny nose, scratchy throat, mild cough. 1-2 weeks: eye watering & harsh, severe cough.
• Paroxysmal-violent cough, vomits, apneic spells, cyanotic. Lasts 2-6 weeks, worse at night.

• Common 1-3 yrs
• Causes: hotdogs, hard candies, grapes, etc.
• Diagnosis: choking/gagging=higher in bronchials, unilateral nasal drainage, foul smelling, frequent sneezing.
• Inability to speak=airway obstruction
• Laryngeal=dyspnea, cough, coarseness, stridor
• Bronchial=cough, wheezing, decreases airway, dyspnea
• Can lead to respiratory distress & death
• May dissolve, but could swell & occlude opening. 
• Treatment: obstruct nares and blow out, EN&T remove it.
• Nursing: teach parents not to dig object out. Cut food in smaller pieces.

• chronic inflammatory disorder of airways
• leading reason for school absences and hospitalizations of kids <15yrs
• Meds: Metered dose inhalers, Corticosteriods, Albuterol, etc.

• Exocrine gland dysfunction->mechanical obstruction of increased, thickened mucus.
• S/S: Infants:Meconium ileus, bile stained emesis, distended abdomen, absence of stool, clay/pale colored, foul smelling stool, salty skin, delayed puberty, sterile males. 
• Respiratory S/S: non productive cough/wheeze cyanosis, barrel chest, clubbing of fingers, increased mucus/congestion, recurrent pneumonia/bronchial infections, SOB.
• Stagnation of mucus->bacteria destroy lung tissue
• Pancreatic enzyme deficiency- unable to breakdown protein/fat in food. Frequent BMs, digestive enzymes with meals
• Diagnosis: Quantitative Sweat Chloride Test. Salt 2-5 times higher than normal, CXray, PFT, stool sample
• Treatment: CPT, bronchodilators, aggressive antibiotics, flu & pneumonia vaccines, lung transplants
• Nursing: airway, breathing, prevent infection, nutrition, support, teaching