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 Health CareEXAM > 5 Chronic Obstructive Breathing - Normal inspiration and prolonged expiration to overcome increased airway resistance. In a person with chronic obstructive lung disease, any situation calling for increased heart rate (exercise) may lead to dyspneic episode (air trapping) because the person does not have enough time for full expiration. Normal Adult - Rate—10 to 20 breaths/min, Depth is 500 to 800 ml, Pattern is even. The ratio of pulse to respirations is fairly constant, about 4:1. Both values increase as a normal response to exercise, fear, or fever. Depth – Air moving in and out with each respiration. Anterior Lung Sounds – Vesicular, Tracheal, Bronchial, and Bronchovesicular

 Health CareHESI > 2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which question? 2. The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: 3. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not ____ four unrelated words ____. 4. During a mental status assessment, which question by the nurse would best assess a person’s judgment? 5. Which of these individuals would the nurse consider at highest risk for a suicide attempt? 6. When reviewing the use of alcohol by older adults, the nurse notes that older adults have several characteristics that can increase the risk of alcohol use. Which would increase the bioavailability of alcohol in the blood for longer periods in the older adult? 7. During an assessment, the nurse asks a female patient, “How many alcoholic drinks do you have a week?” Which answer by the patient would indicate at-risk drinking? 8. The nurse is asking an adolescent about illicit substance abuse. The adolescent answers, “Yes, I’ve used marijuana at parties with my friends.” What is the next question the nurse should ask? 9. The nurse has completed an assessment on a patient who came to the clinic for a leg injury. As a result of the assessment, the nurse has determined that the patient has at-risk alcohol use. Which action by the nurse is most appropriate at this time? 10. A patient is brought to the emergency department. He is restless, has dilated pupils, is sweating, has a runny nose and tearing eyes, and complains of muscle and joint pains. His girlfriend thinks he has influenza, but she became concerned when his temperature went up to 39.4° C. She admits that he has been a heavy drug user, but he has been trying to stop on his own. The nurse suspects that the patient is experiencing withdrawal symptoms from which substance? 11. Patient taking ipratropium reports nausea, blurred vision, has, insomnia after using the inhaler. RN action to implement 12. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient? 13. The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? 14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? The diaphragm: 15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: 16. While measuring a patient’s blood pressure, the nurse recalls that certain factors, such as __________, help determine blood pressure. 17. A nurse is helping at a health fair at a local mall. When taking blood pressures on a variety of people, the nurse keeps in mind that: 8. The nurse notices a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. The nurse should expect the reading to: 19. A student is late for his appointment and has rushed across campus to the health clinic. The nurse should: 20. Hypoptysis (new cough) or changes in persistent cough 21. The nurse is assessing a patient’s pain. The nurse knows that the most reliable indicator of pain would be the: 22. A patient has had arthritic pain in her hips for several years since a hip fracture. She is able to move around in her room and has not offered any complaints so far this morning. However, when asked, she states that her pain is “bad this morning” and rates it at an 8 on a 1-to-10 scale. What does the nurse suspect? The patient: 23. The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system? 24. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should: 25. When assessing the quality of a patient’s pain, the nurse should ask which question? 26. When assessing a patient’s pain, the nurse knows that an example of visceral pain would

2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which question? 2. The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: 3. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not ____ four unrelated words ____. 4. During a mental status assessment, which question by the nurse would best assess a person’s judgment? 5. Which of these individuals would the nurse consider at highest risk for a suicide attempt? 6. When reviewing the use of alcohol by older adults, the nurse notes that older adults have several characteristics that can increase the risk of alcohol use. Which would increase the bioavailability of alcohol in the blood for longer periods in the older adult? 7. During an assessment, the nurse asks a female patient, “How many alcoholic drinks do you have a week?” Which answer by the patient would indicate at-risk drinking? 8. The nurse is asking an adolescent about illicit substance abuse. The adolescent answers, “Yes, I’ve used marijuana at parties with my friends.” What is the next question the nurse should ask? 9. The nurse has completed an assessment on a patient who came to the clinic for a leg injury. As a result of the assessment, the nurse has determined that the patient has at-risk alcohol use. Which action by the nurse is most appropriate at this time? 10. A patient is brought to the emergency department. He is restless, has dilated pupils, is sweating, has a runny nose and tearing eyes, and complains of muscle and joint pains. His girlfriend thinks he has influenza, but she became concerned when his temperature went up to 39.4° C. She admits that he has been a heavy drug user, but he has been trying to stop on his own. The nurse suspects that the patient is experiencing withdrawal symptoms from which substance? 11. Patient taking ipratropium reports nausea, blurred vision, has, insomnia after using the inhaler. RN action to implement 12. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient? 13. The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? 14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? The diaphragm: 15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: 16. While measuring a patient’s blood pressure, the nurse recalls that certain factors, such as __________, help determine blood pressure. 17. A nurse is helping at a health fair at a local mall. When taking blood pressures on a variety of people, the nurse keeps in mind that: 8. The nurse notices a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. The nurse should expect the reading to: 19. A student is late for his appointment and has rushed across campus to the health clinic. The nurse should: 20. Hypoptysis (new cough) or changes in persistent cough 21. The nurse is assessing a patient’s pain. The nurse knows that the most reliable indicator of pain would be the: 22. A patient has had arthritic pain in her hips for several years since a hip fracture. She is able to move around in her room and has not offered any complaints so far this morning. However, when asked, she states that her pain is “bad this morning” and rates it at an 8 on a 1-to-10 scale. What does the nurse suspect? The patient: 23. The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system? 24. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should: 25. When assessing the quality of a patient’s pain, the nurse should ask which question? 26. When assessing a patient’s pain, the nurse knows that an example of visceral pain would

2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which qu...

 Health CareHESI > 2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which question? 2. The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: 3. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not ____ four unrelated words ____. 4. During a mental status assessment, which question by the nurse would best assess a person’s judgment? 5. Which of these individuals would the nurse consider at highest risk for a suicide attempt? 6. When reviewing the use of alcohol by older adults, the nurse notes that older adults have several characteristics that can increase the risk of alcohol use. Which would increase the bioavailability of alcohol in the blood for longer periods in the older adult? 7. During an assessment, the nurse asks a female patient, “How many alcoholic drinks do you have a week?” Which answer by the patient would indicate at-risk drinking? 8. The nurse is asking an adolescent about illicit substance abuse. The adolescent answers, “Yes, I’ve used marijuana at parties with my friends.” What is the next question the nurse should ask? 9. The nurse has completed an assessment on a patient who came to the clinic for a leg injury. As a result of the assessment, the nurse has determined that the patient has at-risk alcohol use. Which action by the nurse is most appropriate at this time? 10. A patient is brought to the emergency department. He is restless, has dilated pupils, is sweating, has a runny nose and tearing eyes, and complains of muscle and joint pains. His girlfriend thinks he has influenza, but she became concerned when his temperature went up to 39.4° C. She admits that he has been a heavy drug user, but he has been trying to stop on his own. The nurse suspects that the patient is experiencing withdrawal symptoms from which substance? 11. Patient taking ipratropium reports nausea, blurred vision, has, insomnia after using the inhaler. RN action to implement 12. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient? 13. The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? 14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? The diaphragm: 15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: 16. While measuring a patient’s blood pressure, the nurse recalls that certain factors, such as __________, help determine blood pressure. 17. A nurse is helping at a health fair at a local mall. When taking blood pressures on a variety of people, the nurse keeps in mind that: 8. The nurse notices a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. The nurse should expect the reading to: 19. A student is late for his appointment and has rushed across campus to the health clinic. The nurse should: 20. Hypoptysis (new cough) or changes in persistent cough 21. The nurse is assessing a patient’s pain. The nurse knows that the most reliable indicator of pain would be the: 22. A patient has had arthritic pain in her hips for several years since a hip fracture. She is able to move around in her room and has not offered any complaints so far this morning. However, when asked, she states that her pain is “bad this morning” and rates it at an 8 on a 1-to-10 scale. What does the nurse suspect? The patient: 23. The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system? 24. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should: 25. When assessing the quality of a patient’s pain, the nurse should ask which question? 26. When assessing a patient’s pain, the nurse knows that an example of visceral pain would

2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which question? 2. The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: 3. A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not ____ four unrelated words ____. 4. During a mental status assessment, which question by the nurse would best assess a person’s judgment? 5. Which of these individuals would the nurse consider at highest risk for a suicide attempt? 6. When reviewing the use of alcohol by older adults, the nurse notes that older adults have several characteristics that can increase the risk of alcohol use. Which would increase the bioavailability of alcohol in the blood for longer periods in the older adult? 7. During an assessment, the nurse asks a female patient, “How many alcoholic drinks do you have a week?” Which answer by the patient would indicate at-risk drinking? 8. The nurse is asking an adolescent about illicit substance abuse. The adolescent answers, “Yes, I’ve used marijuana at parties with my friends.” What is the next question the nurse should ask? 9. The nurse has completed an assessment on a patient who came to the clinic for a leg injury. As a result of the assessment, the nurse has determined that the patient has at-risk alcohol use. Which action by the nurse is most appropriate at this time? 10. A patient is brought to the emergency department. He is restless, has dilated pupils, is sweating, has a runny nose and tearing eyes, and complains of muscle and joint pains. His girlfriend thinks he has influenza, but she became concerned when his temperature went up to 39.4° C. She admits that he has been a heavy drug user, but he has been trying to stop on his own. The nurse suspects that the patient is experiencing withdrawal symptoms from which substance? 11. Patient taking ipratropium reports nausea, blurred vision, has, insomnia after using the inhaler. RN action to implement 12. A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient? 13. The nurse is teaching a class on basic assessment skills. Which of these statements is true regarding the stethoscope and its use? 14. The nurse is preparing to use a stethoscope for auscultation. Which statement is true regarding the diaphragm of the stethoscope? The diaphragm: 15. Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should: 16. While measuring a patient’s blood pressure, the nurse recalls that certain factors, such as __________, help determine blood pressure. 17. A nurse is helping at a health fair at a local mall. When taking blood pressures on a variety of people, the nurse keeps in mind that: 8. The nurse notices a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. The nurse should expect the reading to: 19. A student is late for his appointment and has rushed across campus to the health clinic. The nurse should: 20. Hypoptysis (new cough) or changes in persistent cough 21. The nurse is assessing a patient’s pain. The nurse knows that the most reliable indicator of pain would be the: 22. A patient has had arthritic pain in her hips for several years since a hip fracture. She is able to move around in her room and has not offered any complaints so far this morning. However, when asked, she states that her pain is “bad this morning” and rates it at an 8 on a 1-to-10 scale. What does the nurse suspect? The patient: 23. The nurse is reviewing the principles of pain. Which type of pain is due to an abnormal processing of the pain impulse through the peripheral or central nervous system? 24. The nurse hears bilateral loud, long, and low tones when percussing over the lungs of a 4-year-old child. The nurse should: 25. When assessing the quality of a patient’s pain, the nurse should ask which question? 26. When assessing a patient’s pain, the nurse knows that an example of visceral pain would

2020/2021 HESI HEALTH ASSESSMENT NURSING RN V1 100 Questions with answers 1. During a mental status examination, the nurse wants to assess a patient’s affect. The nurse should ask the patient which qu...

 Social SciencesEXAM > Proficient word reading requires rapid recognition of all relevant layers of word structure in a mental process called ___________ ________________. - ANS - orthographic mapping English is a _________ orthography, knowing a word well means being able to identify all the aspects of language represented in the printed word, including the meaningful parts, syllables, graphemes, and phonemes. - ANS - deep A ___________ is a letter or letter combination that spells a phoneme; can be one, two, three or four letters. - ANS - grapheme A _________ is a speech sound that combines with others in a language system to make words; English has 44 phonemes. - ANS - phoneme The language from which a word came into English, as well as its history of use, often explains a word's spelling. - ANS - Language of Origin __________ -_____________ correspondences are the mapping between speech sounds and letter groups. - ANS - Phoneme-grapheme The ________ of a phoneme or grapheme in a word refers to whether it is at the beginning, middle or end of a syllable and what sounds (or letters) come before or after it. - ANS - position Over time scribes and dictionary writers have put constraints on where and in what order letters

 PharmacologyNCLEX > NCLEX Questions: Health History and Physical Assessment Vol. 2 105 Questions and Answers Physical Assessment: Mouth and Pharynx Physical Assessment: Neck Physical Assessment: Lungs and Thorax Physical Assessment: Heart Sounds Physical Assessment: Peripheral Vascular System Physical Assessment: Breasts and Axillae Physical Assessment: Abdomen Physical Assessment: Nervous System Physical Assessment: Musculoskeletal System Physical Assessment: Genitalia Physical Assessment: Anus and Rectum::: This is a collection of multiple choice questions focused on pharmacology for students preparing for the NCLEX. Questions help students identify trade names, generic names, side effects and nursing considerations associated with aminoglycosides, cephalosporins, fluoroquinolones, glycopeptides, lincosamides, macrolides, penicillins, sulfonamides, tetracyclines and topical antibacterials.

 *NURSINGEXAM > 1. Respiratory Assessment and Care Modalities a. Respiratory Assessment • Health History- Past Health, Social, and Family History i. Physical Assessment General Appearance • Clubbing • Cyanosis Upper Respiratory Structures • Nose and Sinuses • Trachea Lower Respiratory Structures and Breathing • Positioning • Thoracic Inspection • Thoracic Auscultation • Anterior/Posterior Wheeze 1. Lung Sounds • Asthma & COPD • Narrowing of Airway Coarse Crackles • PNA & Pulmonary Edema

 *NURSINGSTUDY GUIDE > NR 602 Quiz 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 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-soundsdetails/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 negativeo 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  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: antibiotics  PCN V potassium – 1st choice  Amoxicillin suspension  Benzathine pcn G IM  Allergy to PCN: o Cephalexin o Cefadroxil o Clindamycin (1st choice if chronic symptomatic carriage of GABHS) o Azithromycin o clarithromycin  If CMV or EBV: beta-lactam antibiotic causes diffuse morbilliform skin eruption  Discard/Clean: bathroom cups, toothbrush, orthodontic devices  Return to school when afebrile or on antibiotic for 24 hours  Tonsillectomy/adenoidectomy:  if > 7 throat infections in past year, >5 throat infections in past 2 years, >3 throat infections per year x 3 years  sleep apnea  adenoid hypertrophy  unresponsive rhinosinusitis  chronic otitis media (post tympanostomy tube placement) Sinusitis/Rhinosinusitis - URI lasting 10 to 14 days with no symptoms improvement or worsening symptoms o Acute (ARS): lasting as long as 4 weeks o Chronic (CRS): persist 12 weeks or more - Inflammation and edema of mucous membranes lining the sinuses - Bacterial: Strep pneumo., H. influenza, Moraxella catarrhalis, Staph. Aureus (less often) - Risk factors: o Preceding infection o Environmental irritants/allergies o Anatomic problems (septal deviation, nasal polyps, facial trauma)o GERD o CF, ciliary dyskinesia o Immunodeficiency - Clinical Findings: o Thick, yellow discharge o Worsening symptoms after initial improvement from URI o Sx: headache, fatigue, decreased appetite o Bad breath (halitosis) o Facial pain* o Facial/nasal congestion and fullness* o Purulent postnasal drainage and nasal discharge o Cough o Ear pain/fullness/pressure - Treatment: o Watchful waiting: do not over use antibiotics  Symptom management: ibuprofen, acetaminophen  Rest  Reassess after 72 hours o Chronic: referral to ENT o Antibiotics Criteria per AAP Guidelines:  URI with persistent nasal discharge, daytime cough, lasting >10 days without improvement  URI with worsening symptoms, new onset of fever, nasal discharge, or daytime cough after initial improvement  Fever > 102.2 F (39 C) with purulent nasal discharge for at least 3 days and sinusitis  Amoxicillin – 1st line x10-28 days or 7 days past symptom resolution  45 mg/kg divided into 2 doses/day  S. pneumo: 80-90 mg/kg/day (max: 1000 mg/dose)  Child < 2 yrs, daycare attendee, recent antibiotic use, or severe illness: Augmentin 80-90 mg/kg/day of amoxicillin part (max: 2 grams/dose)  Vomiting: ceftriaxone 50 mg/kg IV or IM  PCN allergy type I: 3rd generation cephalosporin (cefdinir, cefpodoxime, cefuroxime) Bronchitis/ Bronchiolitis/ Respiratory Syncytial Virus (RSV) - inflammatory process of the bronchus, or bronchioles (small airways) - most commonly caused by a Virus o MOST Common: Respiratory Syncytial Virus (RSV) o Others: influenza, parainfluenza, adenovirus, enterovirus, bocavirus, and rhinovirus o Rarely: can have rare bacterial cause: Mycoplasma pneumonia - Highly CONTAGIOUS - Direct Contact and Droplet Transmission o Incubation period before symptoms start- High Risk: children with o Prematurity o Chronic lung disease o Immunocompromised o Participating in Day Care - Symptoms: o Starts as URI o Worsening cough o Rhinorrhea o *HALLMARK: Wheezing - Exam Findings: o Increased work of breathing o Prolonged expiration o Intercostals retraction o Grunting o Nasal flaring o Wheezes and crackles *Sound bit: polyphonic wheeze found in RSV: (https://www.easyauscultation.com/heart-lung-sounds-details/144/Wheeze-Polyphonic), crackles (https://www.easyauscultation.com/heart-lung-sounds-details/72/Crackles-Fine- (Rales)) o Abdominal distention, palpable liver and spleen o Chest X-ray (not typically done): hyperinflation, atelectasis, flattening diaphragm - Complications: may progress to o Pneumonia o Respiratory distress and hypoxia o Respiratory acidosis - Treatment: o Supportive Care  Monitory pulse oximetry and respiratory status  Supplemental Oxygen  Hydration (oral, NG, IV)  Nutrition  Suction o Hospitalization  Age < 2 months  Respiratory distress  Progressive stridor or stridor at rest  Apnea  RR > 50-60 bpm (sleeping)  Cyanosis, hypoxia  Inability to tolerate oral feeding  Depressed sensorium  Presence of chronic cardiovascular or immunodeficiency diseasePertussis “Whooping Cough” - Gram-negative bacillus: Bordetella pertussis - Hallmark: high-pitched inspiratory whoop follows by spasms of coughing *Sound bit: (https://www.youtube.com/watch?v=zuK4honWVsE) - Aerosol droplet transmission - 7-10 day incubation, most contagious during first 2 weeks - Cough lasts 6-10 weeks (possibly longer in adolescents) - Vaccination: DTaP or Tdap - Symptoms: o Most severe in infants < 6 months  Apnea  Seizures induced by hypoxemia  Cough without inspiratory whoop  Tachypnea  Poor feeding  Leukocytosis nad lymphocytosis - Diagnostics: o Gold standard: culture with Dacron or Calcium alginate swab of nasopharynx (only 12%- 60% specific) o PCR (improved sensitivity) - Treatment: o Macrolide (not in infants < 1 month due to pyloric stenosis)  Azithromycin – 1st line  Clarithromycin  Erythromycin o Macrolide allergy: Bactrim o Chemoprophylaxis in household and close contact exposure: monitor x 21 days - Prevention o “Cocooning”: vaccination of all adults and relatives close to infant and protection from environmental hazards o Vaccinate Pneumonia - Bacterial or Viral o Bacterial:  less common in childhood  S. pneumo.  Most common cause  Lobar pneumonia  Methicillin resistant Staph aureus(MRSA)  Community acquired  Empyema  Necrosiso Viral:  More common in children < 2 yrs  Gradual onset - Typical or Atypical o Typical: lobar, infection of alveolar space resulting in consolidation o Atypical: non-localized consolidation  Walking pneumonia - Risk factors: neonates o Prolonged rupture of membranes o Maternal amnionitis o Premature delivery o Fetal tachycardia o Maternal intrapartum fever o Airway anomaly - Symptoms (vary by age group): o Neonates:  *Fever,  irritability,  lethargy o Older Children:  *Cough  *Fever  Tachypnea, tachycardia, air-hunger  Downward displacement of liver and spleen  Obvious illness (lethargy, decreased appetite, look unwell) o C. trachomatis: repetitive staccato cough with tachypnea, cervical adenopathy, and crackles - Treatment: o If sxs not improving after 72 hours: Chest x-ray o Neonates: admit to hospital o Supportive care:  Antipyretics  Hydration  Rest o Antibiotics: by age and causative organism  Chlamydia: azithromycin or amoxicillin, erythromycin, ethyl succinate  C.pneumo, M. pneumo: azithromycin, macrolide+ beta-lactam  S. pneumo: 3rd generation cephalosporin  S. aureus: vancomycin, clindamycin + beta-lactam - Complications: o Respiratory Distress, pneumothorax o Meningitis o CNS abscess o Endocarditis, pericarditiso Osteomyelitis, septic arthritis - Vaccination: Prevnar 13 Rotavirus Croup - Viral infection of the middle respiratory track (Larynx and bronchial tree - Laryngotraceitis / Laryngotracheobronchitis (LTB) o Viral: parainfluenza type 1 & 2 (HPIV) o LTB more severe, occurs 5 – 7 days in to the disease - Usually children < 6 yrs - Season: fall and winter - Incubation period: 2-4 days with viral shedding up to 1 week, lasts approx. 5 days - HALLMARK: Barking Cough *Sound bit: 1, 2, 3 (https://mommyhood101.com/croup-audioclips - Diagnosis: made by symptoms/clinical presentation - Symptoms: o Low grade fever o URI symptoms- gradual onset (rhinorrhea, congestion) o Barking Cough o Hoarseness o Dyspnea o Respiratory Distress (Intercostal retraction, tachypnea, cyanosis, accessory muscles, nasal flaring) - Clinical Findings: o Tachypnea o Prolonged inspiration o Inspiratory stridor (as airway obstruction worsens) *Sound bit: 4, 5 (https://mommyhood101.com/croup-audio-clips) o Wheezing (if lower airway involved) o Chest X-Ray (not typically done): subglottic narrowing – Steeple Sign - Treatment: o Supportive Care: Symptom Management  Cold air  Hydration o Glucocorticoids: reduce airway swelling  Dexamethasone 0.6 mg/kg to1 mg/kg IM PO o Aerosolized racemic epinephrine: reduce swelling of larynx and subglottis o Bronchodilator o Hospitalization:  RR > 70 bpm Stridor at rest  Temperature > 102.2 F (39C) - Complications: o Pneumonia o Respiratory distress Epiglottitis - Inflammation of epiglottis, aryepiglottic folds, and ventricular bands at the base of the epiglottis - Cause: H. influenza type B (HiB) - Prevention: HiB vaccine - Typically age 1-5 yrs (most under 2 yrs) - Symptoms: o Abrupt onset fever o Severe sore throat o Dyspnea o Inspiratory distress without stridor o *drooling o Toxic look - Clinical Findings: Emergent- Death within hours o * If epiglottitis is suspected: do NOT examine throat, do NOT place in supine position, Immediately transfer to ER o Expiratory stridor o Drooling o Aphonia (muffled, „hot potatoe‟ voice) o Rapid progression of respiratory obstruction o High fever o Flaring ala nasi and retraction of supraclavicular, intercostals, and subcostal spaces o Hyperextension of the neck - Diagnostic: o Blood culture o Lateral neck radiograph: absence of „thumb‟ sign rules out condition o Confirmed in OR - Treatment: o Establish airway (possible intubation or tracheostomy) o Start antimicrobials IV broad spectrum  Rifampin prophylaxis to all household members (20 mg/kg, max: 600 mg, x 4 days) o O2/ respiratory support Foreign Body Occlusion/ Aspiration Nasal Occlusion - Symptoms: o Recurrent, unilateral purulent nasal dischargeo Foul odor o Epistaxis o Nasal obstruction/ mouth breathing - Detection of FB in nasal passageway - Removal: o Alligator forceps o Suction with narrow tips o Cotton tipped applicators w/ or w/o topical vasoconstrictor o Hook or curette o 5-Fr catheter balloon inflation behind FB o Refer to ENT Laryngeal FB Aspiration - Symptoms: o Rapid onset hoarseness o Croupy cough o Aphonia Tracheal FB Aspiration - Symptoms: o Brassy cough o Hoarseness o dyspnea Bronchial FB Aspiration - Symptoms: o Unilateral wheeze, usually aspirated into *Right lung o Recurrent pneumonia o HX of Choking episode - Clinical Findings: o Cyanosis o Hemoptysis, blood streaked sputum o Decreased vocal fremitus o Limited chest expansion o Diminished breath sounds o Unilateral wheezes  Tracheal: homophonic wheeze: wheeze with audible „slap‟ and palpable „thud‟ on expiration - Diagnostic: o Inspiratory and forced expiratory chest radiographs o Chest fluoroscopy - Treatment: Referral to Pulmonary Specialist - Complications:o If vegetable matter: severe condition  Fever, sepsis-like sxs, dyspnea, cough o Lobar pneumonia o Status asthmaticus o Emphysema, atelectasis - Prevention: Education on high risk foods/objects: o Carrots, nuts, popcorn, hot dog chunks o Small toys, coins, buttons, etc Restrictive Airway Diseases - Less common in pediatrics - Decreased lung compliance with relatively normal flow rates - HALLMARK: tachypnea and decreased tidal volume/capacity - Causes: o Neuromuscular weakness o Lobar pneumonia o Pleural effusion or mass o Severe pectus excavatum o Abdominal distention Asthma *Know Levels of severity* Cystic Fibrosis (CF) - Genetic disorder, autosomal recessive, mutation of CFTR protein on chromosome 7 - Multisystem, progressive disease: COPD, GI disturbances, *exocrine dysfunction - Life expectancy: 41 yrs - Symptoms: o Respiratory: chronic airway inflammation and lung infections, viscous mucus, *mucociliary transport dysfunction, chronic cough, and *excess sputum production, respiratory failure o GI: meconium ileus, pancreatic insufficiency, rectal prolapsed, GI obstruction, failure to thrive, edema, hypoproteinemia, steatorrhea, poor muscle mass, GERD, *vitamin deficiencies (A, K, E, D) o Hepatic: biliary cirrhosis, jaundice, ascites, hematemesis, esophageal varices, cholelithiasis o Endocrine: recurrent acute pancreatitis, CF related diabetes (CFRD) o Musculoskeletal: osteoporosis o Reproductive: delayed sexual development, nonfunctional vas deferens (male sterility), undescended testes, hydrocele, demale decreased fertility, cervicitis o Sweat: *“taste salty”, hypochloremic alkalosis, dehydration - Diagnostic: o Newborn screening performedo Gold Standard: pilocarpine iontophoresis sweat test  Only ordered if child has more than one clinical feature of CF  Sweat chloride concentration > 60 mmol/L (age > 6 months), > 30 mmol/L (in infants) o PFTs o Glycosylated hemoglobin (elevated) - Treatment: complicated, require multidisciplinary team o Pulmonary: promote airway clearance  Inhaled dornase alfa :reduce mucus viscosity  Hypertonic saline: thins mucus  Postural drainage (cycle: active breathing, autogenic drainage, percussion, positive expiratory pressure, exercise, high frequency chest wall oscillation) BID  High dose Ibuprofen: reduce airway inflammation  Azithromycin 3x/week (ibuprofen decreases neutrophil mitigation)  Lung transplant o GI:  Pancreatic enzyme supplementation  Vitamin replacement and serum monitoring (A, D, E, K)  Osmotic laxatives, Gastrografin enemas o Endocrine  Glucose tolerance test  Diabetes management Salmonella Clostridium difficile Cryptosporidium Pyloric Stenosis Pinworms Gastric Esophageal Reflux (GERD) - Common in young infants: anatomical reasons o Spitting up after mealsForeign Body Ingestion - Common in children exploring their environment with mouths and hands - Common locations: o Thoracic inlet, pyloris, ileocecal junction - Common Culprits: Coins o Most pass without problem; 10-20% need surgery - Symptoms: o Dysphagia o odynophagia, o drooling, o regurgitation, o abdominal pain, o difficulty breathing Urinary Tract Infection - More common in females > uncircumcised male > circumcised males o Girls who have > 2 UTIs, urology consult is recommended o Boys who have >1 UTIs, urology consult is recommended - Lower UTI: uncomplicated, bladder and urethra - Upper UTI: complicated, urethra, bladder, ureters, kidneys o May require hospitalization  Fluid stabilization  Treatment  Monitoring for sepsis - Risk Factors: o Perineal irritation (soaps, bubble baths, fragrances, wipes) o Not wiping front to back o uncircumcised - Symptoms: o Infants:  Fever/hypothermia  Jaundice  Poor feeding  Irritability  Vomiting  Strong smelling urine  Failure to thrive  Sepsis o Children:  Abdominal/ flank pain  Urinary frequency  Dysuria Urgency  Enuresis  Vomiting  Fever - Diagnostics: o Urinalysis o Urine culture and sensitivity o Gram stain o Hydration status and electrolyte values - Most common cause: E. coli (85%) o Others: Klebsiella, Proteus, Enterococcus, Staphylococcus, and Streptococcus - Treatment: dependent on culture, child‟s age, and clinical guidelines Primary Enuresis Glomerulonephritis - Result of renal insult caused by immunoglobulin damage to the kidney - Red Flag: hematuria - Types: o Post-infection: most common  Post-streptococcal infection: occurs 10 to 14 days post-primary infection  Sx: edema, renal insufficiency  Dark, tea-colored urine o Membranoproliferative o IgA nephropathy o Henoch – Schonlein purpura (HSP):  Most common cause of small vessel vasculitis in children 2-7 yrs old  Sx: itching, urticaria, maculopapular rash with purpura on legs, buttocks, and elbows  Joint pain  50% chance of renal involvement o Systemic lupus o Alport syndrome Osgood-Schlatter Juvenile Rheumatoid Arthirits OsteomyelitisTranscient Synovitis of the Hip Legg-Calve’ – Perthes Disease Idiopathic Scoliosis

NR 602 Quiz 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 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-soundsdetails/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 negativeo 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  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: antibiotics  PCN V potassium – 1st choice  Amoxicillin suspension  Benzathine pcn G IM  Allergy to PCN: o Cephalexin o Cefadroxil o Clindamycin (1st choice if chronic symptomatic carriage of GABHS) o Azithromycin o clarithromycin  If CMV or EBV: beta-lactam antibiotic causes diffuse morbilliform skin eruption  Discard/Clean: bathroom cups, toothbrush, orthodontic devices  Return to school when afebrile or on antibiotic for 24 hours  Tonsillectomy/adenoidectomy:  if > 7 throat infections in past year, >5 throat infections in past 2 years, >3 throat infections per year x 3 years  sleep apnea  adenoid hypertrophy  unresponsive rhinosinusitis  chronic otitis media (post tympanostomy tube placement) Sinusitis/Rhinosinusitis - URI lasting 10 to 14 days with no symptoms improvement or worsening symptoms o Acute (ARS): lasting as long as 4 weeks o Chronic (CRS): persist 12 weeks or more - Inflammation and edema of mucous membranes lining the sinuses - Bacterial: Strep pneumo., H. influenza, Moraxella catarrhalis, Staph. Aureus (less often) - Risk factors: o Preceding infection o Environmental irritants/allergies o Anatomic problems (septal deviation, nasal polyps, facial trauma)o GERD o CF, ciliary dyskinesia o Immunodeficiency - Clinical Findings: o Thick, yellow discharge o Worsening symptoms after initial improvement from URI o Sx: headache, fatigue, decreased appetite o Bad breath (halitosis) o Facial pain* o Facial/nasal congestion and fullness* o Purulent postnasal drainage and nasal discharge o Cough o Ear pain/fullness/pressure - Treatment: o Watchful waiting: do not over use antibiotics  Symptom management: ibuprofen, acetaminophen  Rest  Reassess after 72 hours o Chronic: referral to ENT o Antibiotics Criteria per AAP Guidelines:  URI with persistent nasal discharge, daytime cough, lasting >10 days without improvement  URI with worsening symptoms, new onset of fever, nasal discharge, or daytime cough after initial improvement  Fever > 102.2 F (39 C) with purulent nasal discharge for at least 3 days and sinusitis  Amoxicillin – 1st line x10-28 days or 7 days past symptom resolution  45 mg/kg divided into 2 doses/day  S. pneumo: 80-90 mg/kg/day (max: 1000 mg/dose)  Child < 2 yrs, daycare attendee, recent antibiotic use, or severe illness: Augmentin 80-90 mg/kg/day of amoxicillin part (max: 2 grams/dose)  Vomiting: ceftriaxone 50 mg/kg IV or IM  PCN allergy type I: 3rd generation cephalosporin (cefdinir, cefpodoxime, cefuroxime) Bronchitis/ Bronchiolitis/ Respiratory Syncytial Virus (RSV) - inflammatory process of the bronchus, or bronchioles (small airways) - most commonly caused by a Virus o MOST Common: Respiratory Syncytial Virus (RSV) o Others: influenza, parainfluenza, adenovirus, enterovirus, bocavirus, and rhinovirus o Rarely: can have rare bacterial cause: Mycoplasma pneumonia - Highly CONTAGIOUS - Direct Contact and Droplet Transmission o Incubation period before symptoms start- High Risk: children with o Prematurity o Chronic lung disease o Immunocompromised o Participating in Day Care - Symptoms: o Starts as URI o Worsening cough o Rhinorrhea o *HALLMARK: Wheezing - Exam Findings: o Increased work of breathing o Prolonged expiration o Intercostals retraction o Grunting o Nasal flaring o Wheezes and crackles *Sound bit: polyphonic wheeze found in RSV: (https://www.easyauscultation.com/heart-lung-sounds-details/144/Wheeze-Polyphonic), crackles (https://www.easyauscultation.com/heart-lung-sounds-details/72/Crackles-Fine- (Rales)) o Abdominal distention, palpable liver and spleen o Chest X-ray (not typically done): hyperinflation, atelectasis, flattening diaphragm - Complications: may progress to o Pneumonia o Respiratory distress and hypoxia o Respiratory acidosis - Treatment: o Supportive Care  Monitory pulse oximetry and respiratory status  Supplemental Oxygen  Hydration (oral, NG, IV)  Nutrition  Suction o Hospitalization  Age < 2 months  Respiratory distress  Progressive stridor or stridor at rest  Apnea  RR > 50-60 bpm (sleeping)  Cyanosis, hypoxia  Inability to tolerate oral feeding  Depressed sensorium  Presence of chronic cardiovascular or immunodeficiency diseasePertussis “Whooping Cough” - Gram-negative bacillus: Bordetella pertussis - Hallmark: high-pitched inspiratory whoop follows by spasms of coughing *Sound bit: (https://www.youtube.com/watch?v=zuK4honWVsE) - Aerosol droplet transmission - 7-10 day incubation, most contagious during first 2 weeks - Cough lasts 6-10 weeks (possibly longer in adolescents) - Vaccination: DTaP or Tdap - Symptoms: o Most severe in infants < 6 months  Apnea  Seizures induced by hypoxemia  Cough without inspiratory whoop  Tachypnea  Poor feeding  Leukocytosis nad lymphocytosis - Diagnostics: o Gold standard: culture with Dacron or Calcium alginate swab of nasopharynx (only 12%- 60% specific) o PCR (improved sensitivity) - Treatment: o Macrolide (not in infants < 1 month due to pyloric stenosis)  Azithromycin – 1st line  Clarithromycin  Erythromycin o Macrolide allergy: Bactrim o Chemoprophylaxis in household and close contact exposure: monitor x 21 days - Prevention o “Cocooning”: vaccination of all adults and relatives close to infant and protection from environmental hazards o Vaccinate Pneumonia - Bacterial or Viral o Bacterial:  less common in childhood  S. pneumo.  Most common cause  Lobar pneumonia  Methicillin resistant Staph aureus(MRSA)  Community acquired  Empyema  Necrosiso Viral:  More common in children < 2 yrs  Gradual onset - Typical or Atypical o Typical: lobar, infection of alveolar space resulting in consolidation o Atypical: non-localized consolidation  Walking pneumonia - Risk factors: neonates o Prolonged rupture of membranes o Maternal amnionitis o Premature delivery o Fetal tachycardia o Maternal intrapartum fever o Airway anomaly - Symptoms (vary by age group): o Neonates:  *Fever,  irritability,  lethargy o Older Children:  *Cough  *Fever  Tachypnea, tachycardia, air-hunger  Downward displacement of liver and spleen  Obvious illness (lethargy, decreased appetite, look unwell) o C. trachomatis: repetitive staccato cough with tachypnea, cervical adenopathy, and crackles - Treatment: o If sxs not improving after 72 hours: Chest x-ray o Neonates: admit to hospital o Supportive care:  Antipyretics  Hydration  Rest o Antibiotics: by age and causative organism  Chlamydia: azithromycin or amoxicillin, erythromycin, ethyl succinate  C.pneumo, M. pneumo: azithromycin, macrolide+ beta-lactam  S. pneumo: 3rd generation cephalosporin  S. aureus: vancomycin, clindamycin + beta-lactam - Complications: o Respiratory Distress, pneumothorax o Meningitis o CNS abscess o Endocarditis, pericarditiso Osteomyelitis, septic arthritis - Vaccination: Prevnar 13 Rotavirus Croup - Viral infection of the middle respiratory track (Larynx and bronchial tree - Laryngotraceitis / Laryngotracheobronchitis (LTB) o Viral: parainfluenza type 1 & 2 (HPIV) o LTB more severe, occurs 5 – 7 days in to the disease - Usually children < 6 yrs - Season: fall and winter - Incubation period: 2-4 days with viral shedding up to 1 week, lasts approx. 5 days - HALLMARK: Barking Cough *Sound bit: 1, 2, 3 (https://mommyhood101.com/croup-audioclips - Diagnosis: made by symptoms/clinical presentation - Symptoms: o Low grade fever o URI symptoms- gradual onset (rhinorrhea, congestion) o Barking Cough o Hoarseness o Dyspnea o Respiratory Distress (Intercostal retraction, tachypnea, cyanosis, accessory muscles, nasal flaring) - Clinical Findings: o Tachypnea o Prolonged inspiration o Inspiratory stridor (as airway obstruction worsens) *Sound bit: 4, 5 (https://mommyhood101.com/croup-audio-clips) o Wheezing (if lower airway involved) o Chest X-Ray (not typically done): subglottic narrowing – Steeple Sign - Treatment: o Supportive Care: Symptom Management  Cold air  Hydration o Glucocorticoids: reduce airway swelling  Dexamethasone 0.6 mg/kg to1 mg/kg IM PO o Aerosolized racemic epinephrine: reduce swelling of larynx and subglottis o Bronchodilator o Hospitalization:  RR > 70 bpm Stridor at rest  Temperature > 102.2 F (39C) - Complications: o Pneumonia o Respiratory distress Epiglottitis - Inflammation of epiglottis, aryepiglottic folds, and ventricular bands at the base of the epiglottis - Cause: H. influenza type B (HiB) - Prevention: HiB vaccine - Typically age 1-5 yrs (most under 2 yrs) - Symptoms: o Abrupt onset fever o Severe sore throat o Dyspnea o Inspiratory distress without stridor o *drooling o Toxic look - Clinical Findings: Emergent- Death within hours o * If epiglottitis is suspected: do NOT examine throat, do NOT place in supine position, Immediately transfer to ER o Expiratory stridor o Drooling o Aphonia (muffled, „hot potatoe‟ voice) o Rapid progression of respiratory obstruction o High fever o Flaring ala nasi and retraction of supraclavicular, intercostals, and subcostal spaces o Hyperextension of the neck - Diagnostic: o Blood culture o Lateral neck radiograph: absence of „thumb‟ sign rules out condition o Confirmed in OR - Treatment: o Establish airway (possible intubation or tracheostomy) o Start antimicrobials IV broad spectrum  Rifampin prophylaxis to all household members (20 mg/kg, max: 600 mg, x 4 days) o O2/ respiratory support Foreign Body Occlusion/ Aspiration Nasal Occlusion - Symptoms: o Recurrent, unilateral purulent nasal dischargeo Foul odor o Epistaxis o Nasal obstruction/ mouth breathing - Detection of FB in nasal passageway - Removal: o Alligator forceps o Suction with narrow tips o Cotton tipped applicators w/ or w/o topical vasoconstrictor o Hook or curette o 5-Fr catheter balloon inflation behind FB o Refer to ENT Laryngeal FB Aspiration - Symptoms: o Rapid onset hoarseness o Croupy cough o Aphonia Tracheal FB Aspiration - Symptoms: o Brassy cough o Hoarseness o dyspnea Bronchial FB Aspiration - Symptoms: o Unilateral wheeze, usually aspirated into *Right lung o Recurrent pneumonia o HX of Choking episode - Clinical Findings: o Cyanosis o Hemoptysis, blood streaked sputum o Decreased vocal fremitus o Limited chest expansion o Diminished breath sounds o Unilateral wheezes  Tracheal: homophonic wheeze: wheeze with audible „slap‟ and palpable „thud‟ on expiration - Diagnostic: o Inspiratory and forced expiratory chest radiographs o Chest fluoroscopy - Treatment: Referral to Pulmonary Specialist - Complications:o If vegetable matter: severe condition  Fever, sepsis-like sxs, dyspnea, cough o Lobar pneumonia o Status asthmaticus o Emphysema, atelectasis - Prevention: Education on high risk foods/objects: o Carrots, nuts, popcorn, hot dog chunks o Small toys, coins, buttons, etc Restrictive Airway Diseases - Less common in pediatrics - Decreased lung compliance with relatively normal flow rates - HALLMARK: tachypnea and decreased tidal volume/capacity - Causes: o Neuromuscular weakness o Lobar pneumonia o Pleural effusion or mass o Severe pectus excavatum o Abdominal distention Asthma *Know Levels of severity* Cystic Fibrosis (CF) - Genetic disorder, autosomal recessive, mutation of CFTR protein on chromosome 7 - Multisystem, progressive disease: COPD, GI disturbances, *exocrine dysfunction - Life expectancy: 41 yrs - Symptoms: o Respiratory: chronic airway inflammation and lung infections, viscous mucus, *mucociliary transport dysfunction, chronic cough, and *excess sputum production, respiratory failure o GI: meconium ileus, pancreatic insufficiency, rectal prolapsed, GI obstruction, failure to thrive, edema, hypoproteinemia, steatorrhea, poor muscle mass, GERD, *vitamin deficiencies (A, K, E, D) o Hepatic: biliary cirrhosis, jaundice, ascites, hematemesis, esophageal varices, cholelithiasis o Endocrine: recurrent acute pancreatitis, CF related diabetes (CFRD) o Musculoskeletal: osteoporosis o Reproductive: delayed sexual development, nonfunctional vas deferens (male sterility), undescended testes, hydrocele, demale decreased fertility, cervicitis o Sweat: *“taste salty”, hypochloremic alkalosis, dehydration - Diagnostic: o Newborn screening performedo Gold Standard: pilocarpine iontophoresis sweat test  Only ordered if child has more than one clinical feature of CF  Sweat chloride concentration > 60 mmol/L (age > 6 months), > 30 mmol/L (in infants) o PFTs o Glycosylated hemoglobin (elevated) - Treatment: complicated, require multidisciplinary team o Pulmonary: promote airway clearance  Inhaled dornase alfa :reduce mucus viscosity  Hypertonic saline: thins mucus  Postural drainage (cycle: active breathing, autogenic drainage, percussion, positive expiratory pressure, exercise, high frequency chest wall oscillation) BID  High dose Ibuprofen: reduce airway inflammation  Azithromycin 3x/week (ibuprofen decreases neutrophil mitigation)  Lung transplant o GI:  Pancreatic enzyme supplementation  Vitamin replacement and serum monitoring (A, D, E, K)  Osmotic laxatives, Gastrografin enemas o Endocrine  Glucose tolerance test  Diabetes management Salmonella Clostridium difficile Cryptosporidium Pyloric Stenosis Pinworms Gastric Esophageal Reflux (GERD) - Common in young infants: anatomical reasons o Spitting up after mealsForeign Body Ingestion - Common in children exploring their environment with mouths and hands - Common locations: o Thoracic inlet, pyloris, ileocecal junction - Common Culprits: Coins o Most pass without problem; 10-20% need surgery - Symptoms: o Dysphagia o odynophagia, o drooling, o regurgitation, o abdominal pain, o difficulty breathing Urinary Tract Infection - More common in females > uncircumcised male > circumcised males o Girls who have > 2 UTIs, urology consult is recommended o Boys who have >1 UTIs, urology consult is recommended - Lower UTI: uncomplicated, bladder and urethra - Upper UTI: complicated, urethra, bladder, ureters, kidneys o May require hospitalization  Fluid stabilization  Treatment  Monitoring for sepsis - Risk Factors: o Perineal irritation (soaps, bubble baths, fragrances, wipes) o Not wiping front to back o uncircumcised - Symptoms: o Infants:  Fever/hypothermia  Jaundice  Poor feeding  Irritability  Vomiting  Strong smelling urine  Failure to thrive  Sepsis o Children:  Abdominal/ flank pain  Urinary frequency  Dysuria Urgency  Enuresis  Vomiting  Fever - Diagnostics: o Urinalysis o Urine culture and sensitivity o Gram stain o Hydration status and electrolyte values - Most common cause: E. coli (85%) o Others: Klebsiella, Proteus, Enterococcus, Staphylococcus, and Streptococcus - Treatment: dependent on culture, child‟s age, and clinical guidelines Primary Enuresis Glomerulonephritis - Result of renal insult caused by immunoglobulin damage to the kidney - Red Flag: hematuria - Types: o Post-infection: most common  Post-streptococcal infection: occurs 10 to 14 days post-primary infection  Sx: edema, renal insufficiency  Dark, tea-colored urine o Membranoproliferative o IgA nephropathy o Henoch – Schonlein purpura (HSP):  Most common cause of small vessel vasculitis in children 2-7 yrs old  Sx: itching, urticaria, maculopapular rash with purpura on legs, buttocks, and elbows  Joint pain  50% chance of renal involvement o Systemic lupus o Alport syndrome Osgood-Schlatter Juvenile Rheumatoid Arthirits OsteomyelitisTranscient Synovitis of the Hip Legg-Calve’ – Perthes Disease Idiopathic Scoliosis

1 NR 602 Quiz 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 ke...

 *NURSINGEXAM > a client is getting weaned from the ventilator. Which setting will give partial support (continue to give ventilations and allow spontaneous breathing) and is used during the weaning process? SIMV • which lab value is most important to monitor for a client receiving a heparin infusion for tx of a PE? Activated partial thromboplasatin time • * a client in the critical care unit has an arterial line. The nurse is aware that an advantage to having an arterial line includes which one of following? Continuous BP monitoring • * respiratory distress caused by a wide spread inflammatory response, damaged alveoli, and decreased O2 saturations even with 100% is called? ARDS • * which of the following rhythms will require immediate application of an external pacemaker? Sinus brady with bp 70/30 • a client with fluid volume excess will exhibit which of the following s/s? weak thready pulse • which of the following s/s and labs indicate a client has COPD? SATA Barrel chest Clubbing fingers Pursed-lip breathing • * Following a Motor vehicle collision, a client is diagnosed with a flail chest. The nurse will anticipate which interventions? SATA Endotracheal intubation Surgical Stabilization of flail segment Administration of humidified oxygen • * A client is admitted to the ICU with a flail chest and placed on mechanical ventilator. Breath sounds are clear bilaterally. The nurse should monitor which of the following? Pneumonia because the client is a high risk for acquiring an infection • Following a myocardial infarction, a client begins to feel lightheaded. The cardiac monitor shows a third-degree heart block. The nurse administers oxygen and anticipates which next treatment?

a client is getting weaned from the ventilator. Which setting will give partial support (continue to give ventilations and allow spontaneous breathing) and is used during the weaning process? SIMV • which lab value is most important to monitor for a client receiving a heparin infusion for tx of a PE? Activated partial thromboplasatin time • * a client in the critical care unit has an arterial line. The nurse is aware that an advantage to having an arterial line includes which one of following? Continuous BP monitoring • * respiratory distress caused by a wide spread inflammatory response, damaged alveoli, and decreased O2 saturations even with 100% is called? ARDS • * which of the following rhythms will require immediate application of an external pacemaker? Sinus brady with bp 70/30 • a client with fluid volume excess will exhibit which of the following s/s? weak thready pulse • which of the following s/s and labs indicate a client has COPD? SATA Barrel chest Clubbing fingers Pursed-lip breathing • * Following a Motor vehicle collision, a client is diagnosed with a flail chest. The nurse will anticipate which interventions? SATA Endotracheal intubation Surgical Stabilization of flail segment Administration of humidified oxygen • * A client is admitted to the ICU with a flail chest and placed on mechanical ventilator. Breath sounds are clear bilaterally. The nurse should monitor which of the following? Pneumonia because the client is a high risk for acquiring an infection • Following a myocardial infarction, a client begins to feel lightheaded. The cardiac monitor shows a third-degree heart block. The nurse administers oxygen and anticipates which next treatment?

dinitis and is not sure what this means. As part of teaching, the clinician explains that the condition is caused by inflammation of one or more of the tendons. Which of the following describes tend...

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