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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
, 2
▪ 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)
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
, 2
▪ 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)
