Respiratory Infection: Causes and Characteristics

Respiratory Infection: causes + characteristics Common infectious agents: - Viruses: RSV, rhinovirus, influenza, adenovirus Bacteria: group a b-hemolytic streptococci, staphylococcus, mycoplasma pneumoniae, haemophilus influenzae Age related risks: - <3 months: protected by maternal antibodies 3-6 months: infection rates increase as maternal antibodies wean Toddlers + preschoolers: high rate of viral infections >5 years: increased r/f mycoplasma pneumoniae + streptococcal infections Increased immunity with age Other risk factors: small airways (obstruction risk), weaker immune system, malnutrition, anemia, asthma, cardiac anomalies, CF, secondhand smoke exposure, daycare, preterm birth, eustachian tubes are short and open Seasonal variations: Winter + spring: increased resp. infections, Fall + winter: mycoplasmal infections peak, RSV season: winter + spring Clinical manifestations + assessment (6 mo-3 yr olds respond more to resp. infections) - General symptoms: fever, anorexia, vomiting, diarrhea, abd pain, cough, sore throat, nasal blockage, discharge, meningismus (meningeal irritation) Resp sounds: wheezing, crackles, stridor Assessment considerations: - Resp eTort: rate, rhythm, depth, accessory muscle use, retractions, nasal flaring Oxygenation: pulse oximetry, skin color, activity level + comfort Other: deterioration, increased resp. distress, RR, HR, decrease LOC, lethargy, poor perfusion, worsening hypoxia Management strategies: ease resp. eTort (moisturized air, fluinose drops/throat gargles, nasal aspirator/bulb syringe, vapor rubs for >2, teaching children how to cough/sneeze), promote rest + comfort, prevent spread of infection, controlling fever important, voiding (1 ml/kg/hr <30kg and 30ml/hr >30kg), hydration + nutrition, support + reassurance Upper Respiratory Tract Infections Nasopharyngitis (Common cold) - Causes: RSV, rhinovirus, adenovirus, influenza Symptoms: fever (varies by age), nasal congestion, sore throat Mgmnt: symptomatic care at home Acute Streptococcal Pharyngitis “infection of the upper airway (strep throat) - Cause: Group A β-hemolytic streptococci, Sequelae: rheumatic fever + acute glomerulonephritis Diagnosis: streptococcal antigen testing, rapid diagnostic testing Tx: abx (penicillin), azith for those who are allergic to penicillin Nursing care: cold/warm compresses to neck, warm saline gargles, ibuprofen (6mo+), cool liquids, discard old toothbrush Strep: sudden onset, fever 103-104, positive RST, high WBC, sore throat, erythema, exudate, tonsillitis, abd pain, ha Viral: gradual, low-grade fever, negative RST, slight WBC elevation, sore throat, less erythema, hoarseness, rhinitis, cough Tonsillitis (occurs w/ pharyngitis) - Tx: tonsillectomy if recurrent infection Post-op care: hydration, soft diet, monitor for continuous swallowing (sign for bleeding, call surgeon/ENT immediately) Manifestations: palatine tonsils enlarged (airway obstruction), mouth odor, impaired senses of taste/smell, persistent cough, dry mucous membranes Pain management: ice, nausea. Cold drinks (no dairy at first), citrus avoided, move to soft foods, hemorrhage unusual but could occur between 5-10 days Otitis Media (Middle ear infection) Types (box 40.5) (most common in first 2 years, daycare, smoking, URI involved): - OM = inflammation of middle ear w/o infectious process present AOM = inflammation of middle ear w/ rapid onset + s/sx of acute infection OME = fluid in middle space w/o symptoms of acute infection Tx: abx for 10-14 days for AOM, analgesics, decongestant Prevention of recurrence: pneumococcal vaccine Diagnostic: tympanic mobility w/ pneumatic otoscope AOM: bright red, bulging TM w/ thick fluid OME: dull gray TM w/ clear fluid or fluid level Mgmnt: watchful waiting (not if under 2), abx Surgical: myringotomy (sx incision on eardrum), tympanostomy tube placement + adenoidectomy (>3 episodes in <6 mo) for recurrent chronic OM (not <4), hearing test should be performed Prolonged complications: cholesteatoma (epithelial lining forms scales in middle space), tympanosclerosis (eardrum scarring), adhesive OM (thickening of mucous membranes) nursing care: relieve pain, drainage, prevent complications, education, emotional support Croup Syndrome - - Types: Laryngotracheobronchitis (LTB), epiglottitis, laryngitis, tracheitis LTB Symptoms: hoarseness, barking cough, inspiratory stridor, varying degrees of resp. distress, URI, hypoxia ATects children <5 years of age (3 months-3 years), croup syndrome aTects larynx, trachea, + bronchi o Epiglottis, laryngitis, laryngotracheobronchitis (LTB), c/b H. influenzae type B o RSV, parainfluenza virus, M. pneumoniae, influenza A + B, pneumococci, Mgmnt: o Maintain airway, humidified oxygen, hydration o Nebulized mist with supplemental O2, epinephrine, corticosteroids o Advise family to seek medical attention if breathing becomes diTicult, severe abd pain develops, resp. stridor, sore throat pain so severe child can’t eat/drink Influenza “flu” - Causes: orthomyxoviruses (Types A, B, C), flu vaccine given >6mo Symptoms: fever, chills, sore throat, myalgia, photophobia, dry cough, hyperesthesia Mgmnt: symptomatic tx, oseltamivir all ages start within 2 days of onset Infectious Mononucleosis Cause: herpes-like Epstein-Barr virus (EBV) Diagnostic: increase in leukocytes, positive heterophil agglutination test, spot test Prognosis: self-limiting, 7-10 days, 2-4 weeks fatigue Therapeutic mgmnt: no specific tx, mild analgesia for ha + fever, rest, gargles, lozenges for sore throat, corticosteroids Nursing care: avoid contact sports for 4-6 weeks Acute Epiglottis - Medical emergency, DO NOT attempt to visualize epiglottis (r/f spasm + airway obstruction) Manifestations: sore throat, tripod position, pain, drooling, inspiratory stridor, mild hypoxia, diTiculty swallowing Mgmnt: prevention of progressive resp. obstruction, intubation or tracheostomy Signs of impending airway obstruction: increased RR + HR, substernal, suprasternal, intercostal retractions, nasal flaring, increased restlessness Lower Respiratory Tract Infections Lower airways considered “reactive” portion, bronchi + bronchioles, cartilaginous support not developed until adolescents, constriction of airways Bronchitis (Tracheobronchitis) - Symptoms: persistent cough, mild, self-limiting disease Causative agents: Tx: fluids, rest, cough suppressants RSV + Bronchiolitis - Common in winter + early spring Symptoms: cough, wheezing, diTiculty breathing Tx: supportive care, oxygen, RSV prophylaxis for high-risk infants Pneumonia Causative agents: inhaled organisms, bloodstream infections Causes: bacterial, viral, mycoplasma, pneumococcal Supportive + symptomatic care Pneumonitis: localized inflammation of lung w/o toxemia associated w/ lobar pneumonia Pertussis (Whooping cough) - Cause: Bordetella pertussis, occurs in children who aren’t immunized Highly contagious, r/f young infants, highest in spring/summer Prevention: DTaP/Tdap vaccine Foreign Body Aspiration + Aspiration Pneumonia - Common in children 1-3 years old, c/b small objects in the nose (peanuts, hotdogs, marbles, balloons), prevention: careful supervision, avoid high-risk foods Manifestations: choking, gagging, wheezing, coughing, half could be asymptomatic LT obstruction causes dyspnea, cough, stridor, hoarseness, cyanosis Severe distress à can’t speak, cyanotic, collapses Aspiration pneumonia - R/f child with feeding diTiculties, main nursing care is preventing aspiration, head elevated during feeds + 30 mins after, avoidance of aspiration risks (hydrocarbon lipids, solvents, talcum powder) Asthma - Chronic inflammatory airway disorder: airway obstruction, bronchial hyperresponsiveness, recurring symptoms r/f: atopy, heredity, gender, smoking exposure (maternal), ethnicity, LBW, overweight diagnosis: pulmonary function tests, skin testing for allergens Mgmnt: goal is to maintain normal activity levels, prevention of exacerbations, meds: albuterol, terbutaline, salmeterol, leukotriene modifiers Asthma interventions: exercise, breathing exercises, CPT, hypo sensitization o Peak flow rate: maximum flow rate that can be generated during forced expiratory maneuver, green: 80-100%, avoid things that make it worse, yellow: 50-80%, take meds to relieve episodes, red zone: <50% call MD Classifications of asthma: - Symptom frequency day, nighttime symptoms (waking), PEF, use of rescue inhaler, interference w/ normal activity Status Asthmaticus (medical emergency) - Severe asthma attack unresponsive to tx Can lead to respiratory failure + death Tx: oxygen, aggressive bronchodilator + steroid therapy, improving ventilation Goals of asthma management: - Prevent exacerbations à avoid allergens/triggers, provide acute asthma care, relieve bronchospasm, monitor function w PFM, master self-management Chronic allergy symptoms à post nasal drip, dark circles, allergic salute (transverse crease on upper nose) Cystic fibrosis - Multisystem genetic disorder aTecting respiratory, GI, endocrine + reproductive Autosomal recessive trait: defective gene inherited by both parents (1:4 chance) - Primary defect: dysfunctional CFTR protein à thick, sticky mucus à mechanical obstruction in organs Increased sweat electrolytes, increased viscosity of mucus gland, predominantly aTects respiratory tract + pancreas Clinical manifestations: Respiratory: Early signs à wheezing, dry nonproductive cough Progression à generalized obstructive emphysema, patchy atelectasis, chronic infections (bronchial wall destruction), clubbing fingers + toes, hemoptysis, pneumothorax, pulmonary HTN, cor pulmonale GI à meconium ileus (neonates), distal intestinal obstruction syndrome (DIOS), excretion of undigested food in stool (increased bulk, frothiness, foul odor), wasting of tissues, prolapse of rectum, r/f DM d/t pancreatic fibrosis Other manifestations à delayed puberty in girls, sterility in males, salty-tasting skin (d/t sweat gland dysfunction), dehydration, hyponatremic/hypochloremic alkalosis Diagnosis: sweat chloride test (>60 mEq/L), newborn screening, DNA of CTFR mutant, nasal potential diTerence testing Complications + Prognosis: - - - Respiratory progression: o Gradual: bronchial epithelium destroyed, infection spreads to peribranchial tissues, peribranchial fibrosis, impaired O2/CO2 exchange o Chronic: pulmonary HTN, cor pulmonale, pneumothorax, hemoptysis, contraction/hypertrophy of muscle fibers GI complications: o Thick secretions block ducts + cause cystic dilation, prevent pancreatic enzymes from reaching duodenum, impaired digestion of fat + protein, endocrine function of pancreas stays unchanged, eventually pancreatic fibrosis occurs (DM), pancreatic enzyme def, sweat gland dysfunction, FTT, increased weight loss despite increased appetite Prognosis: progressive, incurable disease, life expectancy: 44 yo, lung transplant can improve survival but has risks Management + Tx: Respiratory care: airway clearance therapies (chest physiotherapy, postural drainage, vibration therapy), bronchodilator meds, aerosolized abx (home IV therapy for infections), physical exercise Nutritional support: ADEK, tx for GERD, high-protein high-calorie diet (150% RDA), pancreatic enzyme replacement therapy Family support + considerations: - Emotional + psychological burden on families, freq. hospitalizations + lifelong tx, home care + infection control measures, genetic counseling for families