nr602 primary care of the childbearing and childrearing family
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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-sounds-
details/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
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
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