Summary NSG 101 DISORDERS OF THE RESPIRATORY SYSTEM NOTES 2021

DISORDERS OF RESPIRATORY SYSTEM 1. BRONCHIECTASIS • A condition characterized by chronic permanent dilatation and destruction of bronchi due to destructive changes in the elastic and muscular layers of bronchial walls. Congenital a. Cystic Fibrosis (most common cause) b. Primary hypogammaglobinemia leading to a recurrent infection c. Ciliary dysfunction syndrome -Acquired (in children) -Secondary to pneumonia which occurs often as complication of whooping cough and measles. -Aftermath of aspiration of foreign body unremoved o The most common thread in the pathogenesis of bronchiectasis consists of difficulty cleaning secretions and recurrent infections with a “vicious circle” of infection and inflammation resulting in airway injury and remodeling. CLINICAL FEATURES: • COUGH: -Chronic productive cough usually worse in the morning and often brought on by change in posture. -Cough occurs due to accumulationof pus in dilated bronchi • SPUTUM: copious & purulent • FEVER • HEMOPTYSIS • ANOREXIA AND POOR WEIGHT GAIN may occur as time passes. • CRAKLES localized to the affected area • WHEEZING STRIDOR NSG 101 DISORDERS OF THE RESPIRATORY SYSTEM NOTES 2021GKGG • CHRONIC LUNG DISEASE SYMPTOMS (digital clubbing, easyfatigability) DIAGNOSIS: • Thin section HRCT scanning- is the gold standard, because it has excellent sensitivityand specificity • CT- provides further information on diseaselocation, presence of mediastinal lesions, and the extent of segmental involvement. • Chest x-ray- increase in size and loss of lungvolume. Severe case: Honeycombing • SPUTUM CULTURETREATMENT: o Aims at decreasing airway obstruction andcontrolling infection o Postural drainage and control infection o 2 to 4 weeks of parenteral antibiotics isoften necessary to manage acute exacerbations adequately. o Amoxicillin/Clavulanic acid (22.5 mg/kg/dose twice daily) has been successfultreating the exacerbations. o Long term prophylactic oral (macrolide) ornebulized antibiotics (e.g. tobramycin, colistin, aztreonam) may be beneficial. o Airway hydration (inhaled hypertonic saline or mannitol) also improves quality of life in adults with bronchiectasis. o Any underlying disorder (immunodeficiencyrespirations) that may be contributing mustbe addresses. 2. PNEUMONIA • An acute infection of the pulmonaryparenchyma • Infection and inflammation of aleveoli TYPES: A. HOSPITAL ACQUIREDGKGG B. COMMUMITY ACQUIRED Most common pulmonary cause of death in infants younger than 48 hours of age. More prone in NB born 24 hrs. after rupture of membrane and those who aspirated amniotic fluid or meconium (SEPTIC WORKUP & PROPHYLACTIC ANTIBIOTIC) BASIC PATHOPHYSIOLOGY Most cases of pneumonia are caused by the aspiration of infective particles into the lower respiratory tract. Organisms that colonize child’s upper airway can cause pneumonia. Pneumonia can be caused by person to person transmission via airborne droplets. I. PNEUMOCOCCAL PNEUMONIA • Abrupt following an URTI • Infants; bronchopneumonia with poor consolidation • Older children; localized in single lobe and full consolidation= blood tinge sputum II. VIRAL PNEUMONIA • Virus from URTI (RSV’S, myxoviruses, adenoviruses) • Chest x-rays shows diffuse infiltrated areas • Antibiotic therapy is not effective • Rest, antipyretic and IVF III. CHLAMYDIAL PNEUMONIA • Often seen in NB up to 12 weeks of age • Contracted from the mother’s vagina during birth • Elevated IgG and IgM antibodies, peripheral eosinophilia and specific antibody of causative agent • Macrolide antibiotic (erythromycin) IV. MYCOPLASMAL PNEUMONIA • Similar but larger than viruses • Occurs more frequently in over 5 years’ old • Persistent rhinitis • Erythromycin- younger than 8 years’ old • Tetracycline- stains teeth brown and stunts long bone growth V. LIPID PNEUMONI