NR 602 Quiz Week 3

1 NR 602 Quiz Week 3 Quiz 3 Chap 13 (sports child and adolesents , 32 ( respiratory disorders, 35 ( GU) , 33 (GI), 38 ( Musculosketal) , 40( common injuries ) The following topics could potentially be tested on week ...

1 NR 602 Quiz Week 3 Quiz 3 Chap 13 (sports child and adolesents , 32 ( respiratory disorders, 35 ( GU) , 33 (GI), 38 ( Musculosketal) , 40( common injuries ) The following topics could potentially be tested on week 3 quiz. Respiratory infections URI- viral infection of rhinovirus or coronaviruses. Peak winter and spring. Sx- congestion, sore throat, rhinorrhea Tx- hydration, OTC anti pyretic, normal saline rinses of the nares Complications—OM and sinusitis 1. Foreign body aspiration- know sx; interpret scenario Hx- rapid onset of hoarseness, sudden episode of cough, unilateral wheeze and recurrent pneumonia. Dx- CXR- local emphysema- area that does not inflate or deflate, suspect FB aspiration. Bronchoscopy or direct laryngoscopy Refer to pulmon. 2. Restrictive airway disease- decreased lung compliance with relatively normal flow rates. Key findings are rapid RR and decreased tidal volume/capacity. 3. Sinusitis- cannot be dx until 10-14 days w/ lack of symptom improvement or dev or new sx such as facial pain. Severe onset of worsening course after 10 days w/o clinical improvement requires oral abx. Tx- watchful wait or amoxicillin w/ or w/o clauvunate 4. Bronchiolitis-pg 817- disease that causes inflamm, necrosis, and ededma of resp epithelial cells in lining of aiways. Most commonly caused by respiratory syncytial virus (RSV). Common in children < 2. Contagous, spread thu droplet. Sc- URI sx of cough coryza, rhinorrhea, progresses over 3-7 days, gradual resp distress noisy raspy breathing, audible exp wheeze, low grade to mod fever, decrease in appetite. Worsening fever with bacterial infection. Tachypnea, retractions, exp wheeze, fine/coarse crackeles Dx- CXR if needed. Tx- supportive care, supplemental O2 6. Pneumonia-pg 823- Sx -lower resp tract infect ass w/ fever and resp sx involving the parenchyma of the lung. Risk factors- male gender, low SES, poor nutrition, lack of breast feeding, smoke exposure, drug/alcohol use, GERD, tracheosophageal fistula, immunodeficiency. Sx- fever, cough, tachypnea,….60 breaths/min infant’s <2, 50 breaths/min in children 2 to 11 months, 40 breaths/min age 1-5increased work of breathing, hypoxia, nasal flaring, rales, retraction, rhonchus lung sounds Dx- CXR for 3 yrs and > who does not improve in 72 hrs on standard tx. Tx- azithromycin or amoxicillin 7. Asthma-chronic resp disease characterized by periods of coughing, wheezing, resp distress, and bronchospasm. Pathophys: result of immunohistopathologi responses that produce shedding of airway epithelium and collagen deposits beneath the basement membrane. Factors that precipitate- viral/bacterial infections, exposure to known irritants, GERD, tobacco smoke, environmental changes, exercise, AR/sinusitis, drugs, food, allergies- dust, mites2 Sx- wheezing, continuous/persistent cough, long expiratory phase, diminished breath sounds, signs of resp distress- tachypnea, retractions, nasal flaring, accessory muscles, apprehension, drowsiness, tachycardia, cyanosis of lips Dx- o2 sat, PFT- spirometry FEV1- amount of air expelled in 1 sec FVC >75%- normal 80-120%- normal 60-75 mild obstruct 70-79%- mild 50-59% moderate obstruct 50-69%- moderate <49% severe obstruct <50%- severe Levels of Severity pg 567 Mild -Wheezing @ end of expiration or no wheezing -No or minimal intercostal retraction along posterior axillary line -slight prolongation of expiratory phase -normal aeration in al lung fields -can talk in sentences Moderate -Wheezing throughout expiration -Intercostal retractions -Prolonged expiratory phase -Decreased breath sounds at the base Severe -Use of accessory muscles plus lower rib and suprasternal retractions, nasal flaring -inspir and expir wheezing or no wheezing heard w/ poor air exchange -suprasternal retractions w/ abd breathing -decreased breath sounds throughout base Impending resp arrest -Diminished breath sounds over entire lung field -tiring, inability to maintain resp -severely prolonged expiration if breath sounds are heard -drowsy, confused See pg 572/573 for table and stepwise treatment. 8. Rotavirus-viral gastroenteritis Transmit- fecal-oral, inanimate objects Dx-enzyme immunoassay and latex agglutination Duration- 3-8 days Sx- acute-onset of fever vomiting and watery diarrhea occur 2-4 days later in children older than 5 and those 3-24 mo. Tx- supportive, replace electrolytes Rotavirus vaccine, hygiene and diapering 9. SalmonellaTransmit- contaminated eggs, poultry, unpasteurized milk, juice, cheese, raw fruits, veggies, fecal contam of water Dx-stool cultures- + leukocytes gross blood Duration-1-3 days Sx- diarrhea, fever, abd cramps, rebound tenderness, vomiting Tx- supportive care- Abx for infants < 3 mo. Use ampicillin, amoxicillin, azithromycin or bactrim 10. Clostridium difficile -Transmission- environment or stool of other colonized or infected ppl by fecal-oral route. Sx- mild to explosive diarrhea, bloody stools, abd pain, fever, N/V, watery diarrhea low grade fever/abd pain Dx- stool cultures, enzyme immunoassay for toxin a, or A and B, gross blood, leukocytes3 Tx- D/c current Abx, Fluid and electrolyte replacement, supplement w/ probiotics Complications- pseudomembranous colitis, toxic megacolon, colonic perf, relapse, intractable proctitis 10. Cryptosporidium- illness caused by protozoan parasaite cryptosporidium Sx- watery diarrhea, abd cramps, loss of appetite, low-grade fever, N/V. Sx can last for up to 2 wks sometimes 4. Tx- supportive 12. Pyloric stenosis- pg 1102 *hungry after vomiting -narrowed pyloric sphincter r/t hypertrophied pyloric muscle -first born Caucasian males, familial in nature Hx- regurg and non-projectile vomit in first few wks of life, 2-3 wks old then projectile, insatiable appetite w/ wt loss, dehydration, and constipation -May feel olive mass in the epigastrium, right of midline Dx-US Tx- surgical intervention 13. Pinworms- pg 884 Know Sx Transmission-Fecal-oral contact w/ eggs or cytsts excreted from the initial vector via ingestion of contaminated food or water Sx- perirectal/vaginal pruritus, nervous irritability, yperactivity, insominia, urthritis, vaginitis, salpingitis, pelvic peritonitis Can cause chronic health and nutritional problems that impair physical and mental growth Tx- mebendazole, pyrantel pamoate repeat in 2 wks, morning baths, change bedding, hand hygiene, clip fingernail,s avoid scratching 14. GERD- pg 845- Sx, Education, Tx -passage of gastric contents into esophagus from stomach through LES. Sx-esophagitis, irritability, arching, choking, gagging, feeding aversion, FTT sx, stridor lower airway disease, sinusitis, hoarseness, dysphagia, odoynophagia, halitosis DX- endoscopy, barium upper GI, radionuclide scan Tx- PPIs- promote mucosal healing HR2 Thickening agents, avoid eating 2 hrs before bed, weight management Surgery- fundoplication EDU- usually self-limiting and sx improve as child grows, may temporarily worsen during illness 15. UTI pg 915 -asymptomatic bacteruria- bacteria in urine w/o other sx, benign, no renal injury -cystitis- infection of the bladder that produces lower tract sx but does not cause fever or renal injury -pyelonephritis- most severe, involving renal parenchyma or kidney, must be tx to prevent irreversible renal damage Physical exam- flank pain/CVA tenderness, suprapubic tenderness, bladder distendtion, mass from fecal impaction, vaginal erythema, edema, irritation, labial adhesion, uncircumcised male, urethral ballooning Sx- fever, irritability, vomiting Dx-sterile bag, straight cath or CC UA, > 100,000 colonies of single pathogen via CC, >50,000 in a cath spec then + Tx- Bactrim > 2 mos Amoxicillin [Show More]