UTA FNP 2 - Midterm, Module 2 -
Resp/Lower Airway
Acute bronchitis, General
-Cough is foremost symptom lasting up to a few weeks.
-Antitussive medication now not indicated in sufferers < 6 years old.
-follow up in 7 days if not improving or if worsening, or sooner if coexisting disease.
-refer to pulmonologist if not improving after 4 weeks.
Acute bronchitis, assessment
- Onset of cough for > 5 days with out proof of pneumonia, asthma, exacerbation of COPD
- Cough starts offevolved nonproductive and becomes effective.
- Dyspnea, wheezing and fatigue.
- Fever may also propose pneumonia or flu.
Acute bronchitis, pharm
- Antibiotics not advocated
# abx only if bacterial source recognized.
- decongestants if observed by way of sinus situation
- honey, cough suppressants, guaifenesin with codeine or dextromethorphan for pts >6yo
- mucolytics no longer encouraged
- Inhaled beta-agonist in combination with excessive dose ICS for cough with bronchospasm
in those with airflow obstruction.
Bronchiolitis, General
- Inflammation and obstruction of the small airlines and reactive airlines usually affecting
infants and younger.
- Predominant age: new child-2 years (peak age < 6 months). Neonates are not protected
despite transfer of maternal antibody.
- Predominant sex male > girl.
- Usually viral, usually RSV (70-85%).
- F/u and need to enhance in three to five days with complete restoration and 5 to ten days,
however this depends on underlying disease and affected person age.
Bronchiolitis, patho
- Infection consequences in necrosis and lysis of epithelial cells and launch of inflammatory
mediators.
- Edema and mucus secretion and loss of cilia clearance result in airflow obstruction.
- Hypoxia.
, - Air trapping because of airlines narrowing throughout expiration.
Bronchiolitis, pharmacology
- Nebulized hypertonic saline 5% for moderately sick ambulatory patients or hospitalized
infants- should no longer be administered to babies inside the ED.
- Bronchodilators have to NOT be routinely used.
- Albuterol must NOT be administered to babies and youngsters with bronchiolitis: danger of
damage outweighs benefits.
- Steroids ought to NOT be automatically used-can be considered if lower airway infection is
present.
-- Administration of palivizumab (Synagis) IM 15 mg/kg/dose (Max: 5 doses) to at chance
patients ONLY, as prevention.
- antivirals no longer routinely used.
- epinephrine is not advocated for babies and youngsters with bronchiolitis.
- antibiotics most effective if secondary bacterial infection is present.
Croup, fashionable
- Subacute viral illness, top airway signs, seal-like barking cough, inspiratory strider, fever.
- most common purpose of upper Airway obstruction or Strider in kids.
- commonly influenza virus, 75%, type A maximum common; tho bacterial infx also
mentioned.
- infx will infect OP then migrate inferiorly.
- spazmatic croup, non-infectious, afebrile, surprising resolution.
Supraglottic region with everyday look
Symptoms normally remedy in 48 hours.
Symptoms worse at night time.
Follow up - normally 24-forty eight hours
Croup, Diagnostics
- X-ray will display "steeple" signal due to subglottic swelling.
- "Thumb signal" is the time period used to explain swelling of the epiglottis visible on X-ray.
- Pulse oximetry
Croup, pharmacology
Basically, steroids -
Oral dexamethasone - 0.6 mg/kg/PO x 1 dose
OR zero.15-0.6 mg/kg/day PO in unmarried or divided doses for five days (solution zero.Five
mg/5mL)
Budesonide (Pulmicort Respules) - zero.25-0.5mg/day in 1 or 2 divided doses inhaled
Racemic epinephrine is used for intense cases with stridor at rest (hospitalized patients)
Resp/Lower Airway
Acute bronchitis, General
-Cough is foremost symptom lasting up to a few weeks.
-Antitussive medication now not indicated in sufferers < 6 years old.
-follow up in 7 days if not improving or if worsening, or sooner if coexisting disease.
-refer to pulmonologist if not improving after 4 weeks.
Acute bronchitis, assessment
- Onset of cough for > 5 days with out proof of pneumonia, asthma, exacerbation of COPD
- Cough starts offevolved nonproductive and becomes effective.
- Dyspnea, wheezing and fatigue.
- Fever may also propose pneumonia or flu.
Acute bronchitis, pharm
- Antibiotics not advocated
# abx only if bacterial source recognized.
- decongestants if observed by way of sinus situation
- honey, cough suppressants, guaifenesin with codeine or dextromethorphan for pts >6yo
- mucolytics no longer encouraged
- Inhaled beta-agonist in combination with excessive dose ICS for cough with bronchospasm
in those with airflow obstruction.
Bronchiolitis, General
- Inflammation and obstruction of the small airlines and reactive airlines usually affecting
infants and younger.
- Predominant age: new child-2 years (peak age < 6 months). Neonates are not protected
despite transfer of maternal antibody.
- Predominant sex male > girl.
- Usually viral, usually RSV (70-85%).
- F/u and need to enhance in three to five days with complete restoration and 5 to ten days,
however this depends on underlying disease and affected person age.
Bronchiolitis, patho
- Infection consequences in necrosis and lysis of epithelial cells and launch of inflammatory
mediators.
- Edema and mucus secretion and loss of cilia clearance result in airflow obstruction.
- Hypoxia.
, - Air trapping because of airlines narrowing throughout expiration.
Bronchiolitis, pharmacology
- Nebulized hypertonic saline 5% for moderately sick ambulatory patients or hospitalized
infants- should no longer be administered to babies inside the ED.
- Bronchodilators have to NOT be routinely used.
- Albuterol must NOT be administered to babies and youngsters with bronchiolitis: danger of
damage outweighs benefits.
- Steroids ought to NOT be automatically used-can be considered if lower airway infection is
present.
-- Administration of palivizumab (Synagis) IM 15 mg/kg/dose (Max: 5 doses) to at chance
patients ONLY, as prevention.
- antivirals no longer routinely used.
- epinephrine is not advocated for babies and youngsters with bronchiolitis.
- antibiotics most effective if secondary bacterial infection is present.
Croup, fashionable
- Subacute viral illness, top airway signs, seal-like barking cough, inspiratory strider, fever.
- most common purpose of upper Airway obstruction or Strider in kids.
- commonly influenza virus, 75%, type A maximum common; tho bacterial infx also
mentioned.
- infx will infect OP then migrate inferiorly.
- spazmatic croup, non-infectious, afebrile, surprising resolution.
Supraglottic region with everyday look
Symptoms normally remedy in 48 hours.
Symptoms worse at night time.
Follow up - normally 24-forty eight hours
Croup, Diagnostics
- X-ray will display "steeple" signal due to subglottic swelling.
- "Thumb signal" is the time period used to explain swelling of the epiglottis visible on X-ray.
- Pulse oximetry
Croup, pharmacology
Basically, steroids -
Oral dexamethasone - 0.6 mg/kg/PO x 1 dose
OR zero.15-0.6 mg/kg/day PO in unmarried or divided doses for five days (solution zero.Five
mg/5mL)
Budesonide (Pulmicort Respules) - zero.25-0.5mg/day in 1 or 2 divided doses inhaled
Racemic epinephrine is used for intense cases with stridor at rest (hospitalized patients)
