Intervention: HOB elevated at all times, pneumonia risk, NPO, Ng or G tube, hydration, surgical repair Laryngomalacia: congenital cartilage abnormality (floppy), causes upper airway obstruction, crowing noise with respirations, stridor increases when child is supine (laying down), small frequent feedings may ensure adequate intake (hard time with reflex, grow out of this with time) Cleft lip & Cleft palate: abnormal opening in the roof of the mouth (hard & or soft palate) & or lipRisk: family hx, exposure to alcohol & cigarettes in utero, males, CaucasianTx: cleft lip- surgery done first 6-12 wks of life, cleft palate- surgery done at 12-18 mo, nares & airway is big enough then, infants nose breath until 2 mo, orthodontia (teeth effected), extensive & complicating factors, more likely to have hearing loss, speech impediments, infection Nutrition: haberman nipple (squeeze & create pressure tongue normally would), Ng/G tube feeds, restraints so pt cant touch their mouth, accurate I&O, pain control, post op supine or side lying (not on belly!) Broncholitis: bacteria or virus, RSV, highly contagious, increases mucus production, hydration, pulmonary hygiene, peak age 3-6 mo, <3 mo question immunity, >5 yrs viral cause decreases RSV: October-march, younger the child the more severe, mild cold like to respiratory failure, symptoms can last up to 1 mo, 3-7d, 5thday is the worst, virus can live on surfaces for over 6 hrs, isolation (contact & droplet), Risk for complications: <24 mo, hx of chronic lung disease, congenital heart disease, premature birth S&S: fever, cough, wheeze, course, irritability, loss of appetiteDx: NP culture, nasopharyngeal swab, CXR
Tx: ease respiratory efforts, suction, NT, NC O2, rest, hydration, nutrition, prevention, albuterol, abx, corticosteroids, vaccine- synegis for high risk babies, given every monthPneumonia: inflamm or inf of the bronchioles & alveolar spaces of lungs, viral, bacterial, aspirationS&S: fever, cough, abd pain, coarse lung sounds Tx: O2, humidification, hydration, abx, antipyretics, bronchodilators, pulmonary toileting (tiny IS machine, blow bubbles,pinwheel), preventionPertussis: whooping cough, Bordetella pertussis, resistant strains developing in unvaccinated kids, narrowing of airway, severe coughing spells, respiratory distress, apnea, starts with 1-2 wks of mild cold symptoms followed by 4 wks severe coughing, can lead to pneumoniaTx: O2, respiratory support, IVF or tube feeding (post pyloric), azithromycinVaccination in moms 27thweek of pregnancy- as early as 2 mo Foreign Body Aspiration:children ages 6 mo to 5 yrs, asymptomatic for days or weeks stridor or increased drool, common small toy, grape, peanut, hot dog, coin, latex balloonRemoval: evaluate for laryngeal edema, cool mist, steroid admin, education safetyAsthma: reactive airway disease, chronic obstructive inflam disorder, bronchospasm from constriction of smooth muscleTriggers: col air, pets, dander, smoke, infections, stress, exerciseAssess: cough worse at night, nasal flaring, retractions, chest tightness, prolonged expiration, wheezing, pulmonary function test, spirometry, FVC, FEV, test before & after meds
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- Spring '17
- cough, fine motor skills, yrs, 1-3 yrs