N427: Final

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N427: Final by Mind Map: N427: Final

1. N427: Test 3

1.1. Skin Integrity

1.1.1. Pediatric differences 40-60% thinner skin More susceptible to drug reactions Epidermis loosely bound to dermis More susceptible to bacterial infection Blisters easy during inflammation Preterm infants may blister easily Low melanin production Sun damage UV damage Non-functional apocrine glands Maceration common around mouth

1.1.2. Overview of skin lesions Etiology Contact with agent Physical trauma Hereditary factors External factors >> Reaction Systemic disease Age of child Time of year Anxiety issues Types Primary Secondary

1.1.3. Skin assessment Previous history Changes in pigment Moles, bruises, rashes, lesions Excessive dryness or moisture Medications Changes in soaps, etc. Hair loss Sick contacts Physical exam Skin character Inspect and palpate

1.1.4. Skin alterations Pruritis Cool compresses Alkaline bath Soft, lightweight clothing Short, clean nails Mittens Antihistamines Topical treatment Wet dressings Dermatitis Most common skin alterations (+50%) Acute (temporary) or chronic (permanent) Types Candida (Thrush) White plaques on roof of mouth, buccal mucosa, tongue Impedes proper eating Treated with Nystatin (swish and spit OR paint) Impetigo Most common bacterial skin infection Red papule >> vesicle >> rupture >> erosion >> honey-colored crust Extends peripherally with sharp, irregular margins Treatment Bullous impetigo Bullous eruptions on intact skin Face, buttocks/perineum, trunk Same treatment as regular impetigo (PO/parenteral antibiotics) CA-MRSA Found on skin, mucous membranes, nares of healthy people May develop furuncle after exposure >> cultured for d Treatment Folliculitis Superficial inflammation Caused by staph aureus (**) and pseudonoma aeruginosa (hot tub) Treated with antibacterial cleansure; benzyol peroxide (drying) May require cipro for infection >1 week Cellulitis Acute bacterial infection (skin + SQ) Follows infection or impaired integrity Strep and staph (MRSA) Treatment Complications Molluscum Contagiosum Direct/sexual contact or fomite Pearl-like, flesh colored papules Usually 1-20 lesions Can last 1-2 years Tx: destroy lesions Warts Caused by HPV Skin-colored, rough, scaly papule/nodule Can occur on feet Capillary thrombosis visible (black spots) Can be treated w/duct tape Fungal infections Dermatophytoses (Tinea) Tinea capitis Tinea corporis Tinea cruris Tinea pedis

1.1.5. Other skin alterations Atopic dermatitis Eczema 3 types Treatment Infestations Pediculosis capitis Pediculosis pubis Scabies Drug reactions Erythema multiforme Red man syndrome Steven-Johnson syndrome Toxic epidermal necrolysis Birth marks Mongolian spot Cafe au lait spots Vascular birthmarks NF-1 Autosomal dom Cafe-au-lait spots or freckles in infancy Slow-growing neurofibromas on peripheral nerve later May have Lisch nodules (dome-shaped, clear/yellow/brown on iris) Elephantiasis may occur Associated dx

1.1.6. Communicable diseases Fever >= 100.4 Dangerous @ 105.9F In >2-3 months - emergency! (septic!) Treat w/tylenol, motrin, alternate Sepsis Perinatal period most at risk Group B strep, E. coli, H. flu or staph Manifestations Locate infection Chickenpox (varicella) Chickenbox F/M/A Itchy rash - MPV >> Crust All 3 (PVC) at same time for DX Trunk, face, proximal Don't treat w/aspirin Short nails S/A/C precautions Contagious until V dried up Shingles Varicella on nerve route Itching, neuropathic pain Treat symptoms, isolate, antivirals Complications Erythema infectiosum Fifth Disease (Parvo B19) Fever, irritability 3-part rash Treatment Roseola (exanthem subitum) Herpes T6 High fever for 3-4 days in well child Measles (rubeola) Viral infection Fever, malaise >> 3 Cs Koplik spots on face >> down Progressive SX until 2 days after rash appears Treat bedrest, skin, antipyretics Isolation until day 5 Rubella (german measles) Rubella virus Prodrome phase possible Rash on face >> neck, trunk, limbs Treatment Scarlet fever Group A hemolytic strep Prodrome period Enathema Exathema Treatment Complications Stomatitis Oral mucosa Contagious or non- Treat the symptoms Erythema toxicum neonatorum Newborn, flea-bite dermatitis Benign and self-limiting Within first 2 days Never on palms or soles May worsen with crying Lasts up to a week

1.2. Quality in Nursing Care

1.2.1. Overview 22% of Americans affected by medical error 8th leading COD in USA

1.2.2. Blame culture Unwillingness to take risks or accept responsibility for fear of criticism Breeds distrust and fear Protect yourself Silence in both directions

1.2.3. Just culture Open, fair and just culture Learning culture Foundation of patient safety Hungry for knowledge Seeks to see risks at individual, org level Dialogue Must move away from overly-punitive reactions Must recognize own fallibility Two key areas Designing safe systems Managing behavioral choices

1.2.4. Duties To produce an outcome for system On time Badge Don't steal Don't snoop To follow procedural rules 2 identifiers Hand hygiene Med admin To avoid causing unjustifiable risk/harm Right thing for patient ...coworkers ...family/visitors ...organization

1.2.5. Behaviors Human error Inadvertant Slip, lapse, mistake Console At-risk Increases risk (unrecognized) Mistakenly believed to be warranted Coach Reckless Choice to disregard major risk Punish

1.3. Cardiovascular Alterations

1.3.1. Fetal circulation Movement through BC squeezes out fluid from lungs Clamp the chord >> Wharton's jelly solidifies and clamps umb vessels Chemoreceptors (CA) respond to changes Pressure on chest released at birth >> Recoil Temp change and skin sensors stimulate respiratory effort Surfactant keeps alveoli open Crying >> Increased P >> Keeps alveoli open Shunts close due to increase oxygen >> Reversed heart pressures Dcutosis venosis constricts when chord clamped Foramen ovale closes too >> Increased SVR (LA > RA) 1st breaths > DA constricts (closes in 15-hrs) Pulmonary BVs dilate w/first breaths r/t oxygen

1.3.2. Acquired heart disease Pulmonary HTN CHD >> Increased PA pressure or pulm disease Chronic excess pulm flow >> Pulmonary VC Hypoxemia >> VC >> R-L shunt >> RHF Patho Manifestations Treatment Infective endocarditis Uncommon Manifestations Treatment Kawasaki disease Acute, febrile, systemic inflammation Leading cause of AHD in kids Most common in Asians Three stages Treatment

1.3.3. Congenital heart disease Defect or persistant fetal circulation Four broad types Increased pulm Decreased pulm Obstructed systemic Mixed defects Manifestations Murmur Struggle (after birth; within days; school)

1.3.4. Nursing care Assessment RR status Perfusion CV status Activity/behavior Growth chart Goals Interventions Post-cardiac cath Baseline data prior Bleeding, hematoma, infection VS Bed rest, straight limb, supine for 6-8 hrs No HOB elevation w/o orders No hip flexion Check dressing q15min Check under buttocks for bleeding I&O Emergency Home care for cath S/S complications Rest and quiet play When to call MD

1.3.5. Discharge Pad baby seat restraints Don't lift under arms Healthy diet with protein S/S complications Medications Digoxin (contractility, slow HR) Furosemide (loop, blocks salt/water, lose K) Thiazide (maintain diureisis, decreased absorption) Spironolactone (maintain diuresis, K-sparing) ACEI (vascular relaxation, reduced PR, no fluid retention) Propanolol (contractility, slow HR) Carvedilol (LV fxn, VD of SC)

1.3.6. CHD in pediatrics Inadequate CO Overwhelming blood vol >> PHTN >> Reduced CO Appears as above + high metabolic rate Worsened by body's own stress response Manifestations Tachypnea Wheezing, etc Muscle use Tiring easily Hepatomegaly, acites Fluid retention, edema, etc Tachycardia, weak pulses, hTN Delayed refill, pallor, cool Failure to thrive Diaphoresis

2. N427: Test 2

2.1. Chronic Illness

2.1.1. Overview Interferes with functioning for +3 months May also cause hospitalization for +1 month in a year Effects the patient and their family Limiting in three categories Diagnostic Functional Social Causes of chronicity Genetic conditions Congenital abnormalities Injury in utero or at birth Complications after birth Serious infection Major injury Over 10 million CSHCNs in USA Have or at risk for a condition Also require additional health or other services Disability = limitation Disability >> Developmental delay Need to have hope

2.1.2. Informing of Chronicity Parents Varied reactions Grieve the loss of perfect child Experiences Strain on marriages Children Response effected by age, developmental level Many concerns Sibling Response highly variable and influenced by age May benefit from support groups if older Nurse should help parent promote normal G/D

2.1.3. Normalization Definition Process of promoting +++ self-image Minimizes feeling of alienation Coping mechanism by sick child to redefine normal Promotion Child Siblings Parents Strategies Preparation Participation Sharing Control Expectations Positive attitude Threats Worsening condition Changes in management routines Additions to the family Situational changes or stressors

2.1.4. Transition Must plan based on needs Collaborate with family Involve the child Can assist planning with healthy/ready-to-work services Chronically ill person may have to assume responsibility for own care Multi-factoral process to determine readiness Want a smooth, undisruptive process

2.1.5. The Role of the Nurse Promoting G/D Trust vs. mistrust Autonomy vs. shame/doubt Initiative vs. guilt Industry vs. inferiority Identity vs. role confusion Early intervention services IWDA of 1973 State and local education Reasonable accomodations to lower cost of ed Mainstreaming Emergency preparedness To prepare for needs Shelter, generator, fx member, DPOA

2.1.6. Death & Dying Stages of grief Denial Anger Bargaining Sadness/Depression Acceptance Chronic grief Not the same as chronic sorrow Mourning after death that is excessive & impedes functioning Differences by age Infants and toddlers Preschoolers School age Adolescent Compassion fatigue After caring for chronically ill for long time Weariness & lack of energy >> Impedes function

2.2. Child Maltreatment

2.2.1. Overview Three areas Physical abuse/neglect Emotional abuse/neglect Sexual abuse Omission OR commission Legal area: CAPTA 1996

2.2.2. Specific situations MSBP SBS Hallmark symptoms Suspect abuse with symptoms Hazing Domestic violence Dating violence International issues Abuse occurs in many ways Declaration of Rights of Children (UNGA) Abuse and mutilation of women and children Child soldiers, routine executions, honor killings

2.2.3. Nursing responsibilities Assessment Most critical element High index of suspicion No typical profile of victim Detailed and thorough history Protect child from abuse Provide support to child Don't try to be their parent Continue to be an advocate Encourage parental relationship* Also support the family genuinely Documentation Accurate, factual, concise, legible Describe behaviors (don't interpret) Verbatim conversations if possible Be prepared to testify Prevention Difficult goal Identify and intervene appropriately Collaborative

2.3. Genetic Abnormalities

2.3.1. Overview Thousands of known inherited disorders May have same manifestations but different MOI At least one minor anomaly in 50% of all infants 3+ >> 20-50% have serious defect Genes Specific sequence of bases Protein blueprints >> Body structure and fxn Occupy a position on a chromosome (locus) Variable forms at each site (alleles) Can be mutated (inherited alteration) DNA analysis Karyotypic analysis Inheritance variability Penetrance Reduced or incomplete penetrance Variable expressivity

2.3.2. MOIs for single-gene disorders Autosomal dominant Disorders Pattern Autosomal recessive Disorders Characteristics X-linked dominant Characteristics Disorders X-linked recessive Characteristics Disorders

2.3.3. Specific genetic disorders Down Syndrome Most common 1:800 - 1:1000 births Unknown etiology - many factors Transmission patterns Widely variable phenotypes Therapeutic management Hemophilia Hereditary bleeding disorder Clotting factor deficiency X-linked recessive Three types

2.3.4. Genetic testing Diagnosis and screening For diagnosis Cytogenic (karyotype, enhanced res) Molecular (DNA methylation analysis) Only screen kids for medical benefit Social issues Personal Private Powerful Potentially predictive Pedigree sensitive Permanent Prejudicial Must provide only the facts (not a course of action)

2.3.5. Assessment and management Hypotonia = Neuro problem In infants, there IS a problem! Have to identify the mutation Check for tone by measuring Include a pedigree Phenotypic modification Surgical Diet (PKU) Metabolic (THY) Avoiding carcinogens (ASA in hemolytic anemia) Immunologic prevention (Rh- moms get IGB) Transplants (PKD) Genetic manipulation Gene product replacement therapy Recombinant DNA Gene transfer Enzyme repression Competitive inhibition

3. N427: Test 4

3.1. N427: Immunology

3.1.1. Overview Recognize foreign bodies Several types Natural Acquired Cell-mediated Humoral Components B-lymphocytes T-lymphocytes Complement Cytokines (messengers) Pediatric variations Influenced by several factors Variable amount of Ig in infants Undeveloped humoral immunity until age 7 Cell-mediated immunity fully developed earlier

3.1.2. SCID No humoral or cell-mediated immunity Susceptibility to infection Failure to recover fully Frequent reinfection Genetic abnormality X-linked Autosomal receissive Confirmed by lab tests Very low t-cell count Very low immunoglobulins Treatment Antibiotics IVIG HSCT Nursing care S/S infection Skin, RR, G/D assessment Skin integrity Medications Parent education

3.1.3. HIV/AIDS Alters body's ability to fight off infection Destroys CD4+ t-cells Often perinatal transmission May result from unsafe sex Manifestations Chronic, frequent or unusual infections Poor growth, weight loss, FTT Hepato- or splenomegaly Lymphoid interstitial pneumonia Burkitt lymphoma Developmental delay Diagnostics Serologic testing HIV DNA PCR Retesting to confirm Management Preventing vertical transmission Testing Prophylaxis Antibiotics HAART Nursing care Assessing & identifying at-risk patients Preventing vertical transmission Pediatric assessment Prevent infection Support Education Medications Nutrition

3.1.4. SLE Systemic lupus erythematosus Autoimmune disease May be genetic and triggered Pediatric variation Demographics Females > males Ages 10-19 More common in non-Caucasians Manifestations Cutaneous GI MSKT Neuro CV Renal Diagnostic criteria (4+) Butterfly or discoid rash Photosensitivity Oral ulcers Arthritis Serositis ANA Systemic disorders Therapeutic management Reverse or minimize disease Medications Education Diet Rest Exercise Nursing care Minimize exacerbations Compliance issues Body image concerns

3.1.5. JRA Juvenile RA Idiopathic, chronic Inflammatory diseases Joints and tissues Autoimmune cause Prognosis No cure Eventually inactivates (70%) Earlier onset >> better prognosis? Can progress to uveitis >> permanent vision loss* Courses Oligoarthritis Polyarthritis Systemic Manifestations Stiffness Swelling LOM in affected joints Warm to touch NO erythema Tenderness* Exacerbated by stress Growth retardation Diagnosis No definitive tests Supportive tests Criteria Therapy Goals Medications PT Surgery Nursing care Pain management Nutrition Exercise Rest Patient, family ed

3.1.6. Allergic Reactions Response to allergens Four types Type 1: anaphylaxis Type 2: tissue-specific Type 3: immune-complex Type 4: delayed Treatment Avoidance Desensitization Antihistamines Epi-pen Nursing care Assessment Skin testing Education

3.2. N427: Hematology

3.2.1. Review Types of cells RBC WBC Platelets Lab tests CBC Clotting indices Iron indices RBC indices WBC differential

3.2.2. Anemia Alterations Decreased #s of RBCs Decreased quantity of HgB Decreased volume of packed RBCs Causes Loss/destruction of RBCs Impaired RBC production Types Iron deficiency Sickle cell disease Thalassemia Aplastic

3.2.3. Transfusion Reactions Types Allergic reaction Hemolytic reaction Febrile/septic reaction Circulatory overload Prevention Check blood w/another RN 1st 20 mL slow infusion while monitoring Frequent assessment

3.2.4. Hemosiderosis Overload of iron in tissues Causes Frequent transfusions Excessive RBC breakdown Treat with Fe-chelating agents Deferasirox Deferoxamine

3.2.5. Bleeding Disorders Hemophilia Hereditary Types Manifestations Diagnostics Medical care Nursing care Von Willebrand disease Most common genetic bleeding disorder Autosomal dominant Manifestations Diagnosis Treatment DIC Acquired, abnormal clotting activation Commonly caused by sepsis Manifestations Management ITP Increased splenic destruction of platelets Autoimmune disorder May occur after MMR vaccine Manifestations Diagnostics Treatment

3.2.6. HSCT Found mainly in bone marrow May grow into new body cells Autologous (self) or allogenic (donor) Donar needs compatible MLA Three phase process Pre-transplant Transplant Post-transplant

3.3. N427: Oncology

3.3.1. Overview Leading COD (disease) for <15 yo Cells are warped Don't divide normally Don't die Etiology External stimuli Immune system Gene abnormalities Chromosomal abnormalities Manifestations Pain Excessive, rapid weight loss Unusual mass/swelling Pallor & loss of energy Sudden bruising Prolonged illness or fever Frequent headaches Vision changes Diagnostics H&P CBC with diff BM aspiration LP Imaging Biopsy Treatment Chemo Surgery Radiotherapy BM/SC transplant Biologic response modifiers Complementary therapy

3.3.2. Oncologic Emergencies Metabolic emergency Tumor lysis syndrome Septic shock Hypercalcemia Hematologic emergency Thrombocytopenia DIC Space-occupying lesions SVC syndrome Spinal cord compression

3.3.3. Solid Tumors CNS tumors Incidence Etiology Types Presentation Treatment Nursing care Neuroblastoma Malignant; "SILENT TUMOR" Most common ECST in children NOT a brain tumor Presentation Diagnosis Staging/prognosis Treatment Nephroblastoma AKA Wilms tumor Large, rapidly growing Vascular abdominal tumor NEVER PALPATE ABDOMEN Presentation Diagnosed via imaging Treatment 90% overall cure rate Osteosarcoma Malignant bone tumor Most common bone tumor (peds) Often metastasizes to lungs by diagnosis (20%) Presentation Treatment Prognosis Ewing sarcoma Tumor of bone and soft tissue Presentation Treated w/SCR Nursing care Rhabdomyosarcoma Striated muscle (SM) Common site: head/neck/orbital Rapid metastasis Manifestation Treatment Prognosis Retinoblastoma Most common intraocular peds tumor Manifestations Treatment Prognosis Nursing care

3.3.4. Leukemias ALL Most common cancer (peds) Lymphoid cell lineage Presentation Diagnosis Prognostic factors Treatment AML Less common than ALL Myeloid cell lineage Treatment aspects Relapse info Reinduction therapy BMT to replace diseased marrow Unable to control prolif >> death Nursing care Patient/family education Emotional support ADRs for treatment (assess!!)

3.3.5. Lymphoma Hodgkin's Lymphoid system Common presentation Treated w/ chemo and/or radiation Survival rates Diagnosis Non-hodgkin's Majority of peds lymphomas 10-15% of all peds cancer Characteristics Staging Treated w/chemo & radiation Good survival rate (80%) w/multiagent chemo

3.3.6. Nursing Care CVAD Broviac/hickman Groshong PICC Ports Supportive therapy Nutrition Medication Side effects Infection Pain management Psychosocial support Overall effect 80% cancer survival rate :) Research effects

3.3.7. Cancer Survival Radiation after-effects Growth retardation Endocrine dysfunction Cardiac toxicity Secondary malignancies Chemo after-effects Cardiomyopathy Neuropsychological deficits Social/behavioral problems

4. N427: Test 5

4.1. Gastrointestinal

4.1.1. General Concepts Immature at birth Common consequences Malabsorption Fluid/electrolyte imbalances Malnutrition Poor growth Adversely affect g/d & health Nursing care I&O Height and weight Abdominal exam Urine, stool tests Diagnostics X-ray Barium swallow Barium enema Ultrasound/CT Colonscopy 24-hr pH probe UGI

4.1.2. Structural Defects Cleft lip/cleft palate Failure of fusion Unilateral or bilateral Multifactorial etiology Assessment Manifestations Medical care Nursing care Esophageal atresia/TEF Doesn't form continuous tube Symptoms Assessment Diagnosis Management Pyloric stenosis Opening b/w lower stomach & duodenum Diagnostics Manifestations Management GERD Usually normal Disease if symptomatic May be caused by P in LES Manifestations Diagnostics Management Omphalocele/Gastroschisis Congenital herniation of stomach contents Diagnostics Nursing care Intussuception Invagination of two portions in intestine Surgical emergency Manifestations Diagnostics Treatment Nursing care Hirschsprung disease Absence of ganglionic nerves Acute or chronic Manifestations Diagnosis Management Complication: Enterocolitis Nursing care Anorectal malformations Diagnostic Management Nursing care DC planning Hernias Protrusion of organ through muscle wall Congenital diaphragmatic hernia Umbilical hernia

4.1.3. Ostomies Surgical opening Temporary or permanent Risk for disturbed body image, G/D Nursing care Education Pain Stoma care Functioning Skin care Support groups

4.1.4. Inflammatory Disorders Appendicitis Surgical emergency Hard to diagnose R/T obstruction Manifestations Diagnostics Management Nurse's role Inflammatory bowel disease Ulcerative colitis Crohn's disease Diagnostics Management Nursing care Peptic ulcer Erosion of mucosa Primary or secondary R/T h. pylori Symptoms Diagnosis Medical care

4.1.5. Motility Disorders Gastroenteritis Acute diarrhea Inflammation of stomach, intestines Major cause of infant mortality in 3rd world Viruses, bacteria or parasites Mild form Severe form Constipation Infrequent, hard stools For at least 2 weeks >2x/week School-age children Get description from parents DD Treatment

4.1.6. Pinworms Pinworms PO ingestion Eggs hatch in upper intestines Mature in 2-4 wks Migrate to cecal area Migrate to anus Itch during movement Scratching >> hand-to-mouth Can last for a week+ Diagnostics Tape test Early in AM Penlight Microscopic exam Meds All family members Treat once, then repeat in 1-2 wks Vermox, Pinex, Antiminth Nursing Tape test directions S/S Cleaning practices Showers instead of baths

4.1.7. Diseases of Malabsorption Celiac disease Permanent gluten intolerance Lack of peptidase for digestion Four characteristics Usually appears 9-12 months (dx in pre-school) Diagnosis Therapeutic management Nursing care Short bowel syndrome Decreased SA r/t SI resection Causes Problems M/WL/D Nursing care

4.2. Musculoskeletal

4.2.1. Feet & Legs Metatarsus adductus "In-toeing" Most common congenital FD Diagnosis Treatment Nursing care Clubfoot Talipes equinovarus Boys > girls Etiology Treatment Genu varum Bow legs Normal until 2-3 Combined info Genu valgum Knock knees Normal until 4-5

4.2.2. Hips DDH Females > males Unknown causes Manifestations Screen until 1 yo or walking Diagnosis Therapeutic care Nursing care LCPD Self-limiting, idiopathic, ages 2-12 White males > other groups Suspect if boy age 2-12 CC hip pain + limp Stages Treatment SCFE Displacement of femoral head from neck Before or during growth spurts Idiopathic, multifactorial Manifestations Therapeutic management

4.2.3. Spine Torticollis Tilt of head r/t rotated C-spine Injury to SCM or C-spine abnormality Treated with stretching Kyphosis Abnormal convex angle of thoracic spine Usually postural TB, arthritis, OD, compression fx Lordosis Accentuation of lumbar curve Secondary or idiopathic Obesity Scoliosis Most common Lateral curve >10 degrees Congenital, compensatory (leg length), idiopathic (10-13yo) Medical care Nursing care

4.2.4. Misc. Bone Disorders Osteomyelitis Inflammation/infection Abrupt onset Marked leukocytosis Increased ESR/CRP* Medical treatment Marfan syndrome Autosomal dominant CT Various symptoms Present w/murmur No cure Osteogenesis imperfecta BBD Autosomal dominant Classifications Medications Nursing care

4.2.5. Injuries Sports injuries Types RICE Stretch before activity Fractures Nursing assessment Traction Immobility Many negative effects RN first to ambulate PT r/t orthostatic hTN Braces/orthoses Variety of types Frequent readjustments Skin checks q1-2 hrs for few days Protective clothing NVCs

4.2.6. Muscular Dystrophies General Largest group Inherited Increased disability, deformity Terminal DMD Most severe, common X-linked inheritence Abnormal coding for dystrophin Characteristics Diagnoses Nursing care

4.3. Respiratory

4.3.1. Distress vs. Failure Distress Any onset Abnormal resp effort Failure Inability to maintain gas exchange

4.3.2. Apnea Periodic breathing Irregular Up to 20 sec b/w breaths Apnea Cessation of RR for >20sec Any pause associated w/ Prematurity ALTE OSAS SIDS

4.3.3. Croup Syndromes LTB Parainfluenza; flu A; MP; RSV Post-URI Seal-like barking cough/stridor Self-limiting Treated with NEB and O2 Spasmodic croup Similar symptoms, less serious croup Sudden, at night, no viral illness Resolves quickly Acute epiglottis Severe, life-threatening Flu B, Strep or Staph Manifestations No visual inspection Medications Bacterial tracheitis Pertussis On the rise in older kids/adults Direct contact Persistent URI Treat family

4.3.4. Lower Airway Disorders Bronchitis Usually non-isolated Coarse, hacking cough Woarse hS Palliative treatment Bronchiolitis Usually RSV Higher risk populations Progression Pneumonia Acute inflammation of lung parenchyma Involves small airways, alveoli Many causes TB Increases US incidence Mycobacterium

4.3.5. Chronic Disorders Asthma Chronic inflammation Reversible hyperactivity Triggered Manifestations Complications BPD R/T acute neonatal RD Related to prematurity Manifestations Reduced prevalence CF Exocrine gland dysfunction Chromosome 7 ARD Median life span of 37 years Associated infections Nursing care