NR 602 Respiratory Infections Guide

NR 602 Respiratory Infections Guide

NR 602 Respiratory Infections Guide

Respiratory Infections

• Leading cause of morbidity and mortality in children
• Respiratory failure can develop rapidly with ominous symptoms
• Be able to recognize key respiratory sounds
  • Croup cough vs. other coughs *Sound bit croup cough: see link under Croup*
  • Inspiratory stridor *Sound bit: (https://www.easyauscultation.com/heart-lung-sounds-details/140/Stridor)
  • Wheezing * Sound bit: (https://www.easyauscultation.com/heart-lung-sounds-details/71/Wheeze)
• Critical Sign: Tachypnea!
  • Respiratory Rates:
    • Infants (birth to 12 months): 30-53 bpm (RR > 60 requires further evaluation)
    • Toddlers (1-2 yrs): 22-37 bpm (RR > 40 requires further evaluation)
    • Preschool (3-5 yrs): 20-28 bpm
    • School Age (6-9 yrs): 18-25 bpm
    • Pre-Adolescent (10-11 yrs): 18-25 bpm
    • Adolescent (12yrs and older): 12-20 bpm
  • Red Flags: Tachypnea +
    • grunting,
    • nasal flaring,
    • use of accessory muscles
  • Upper Respiratory Infections are the most common (common cold)
    • Most often Viral
      • Rhinovirus, Parainfluenza, RSV, Coronavirus, human metapneumovirus
      • Self-limiting lasting 7-10days
    • Peak: Spring and Winter
    • Common Sxs: (gradual onset)
      • Low grade fever
      • Nasal Congestion
      • Sore throat, hoarseness
      • *Hallmark: Rhinorrhea (clear at first, progresses to purulent)
      • Cough/Sneezing
    • Clinical Findings:
      • Conjunctiva: mild injection
      • Erythematous nasal mucosa with mucus
      • Erythematous posterior oropharynx
      • Anterior cervical lymphadenopathy
    • Diagnostics:
      • ONLY if in doubt of URI: sore throat without drainage or cough
        • Rapid antigen detection test (RADT): rapid strep
        • Throat culture if RADT negative
      • Treatment: Supportive Care
        • Hydration
        • OTC antipyretics as directed (weight dose)
        • Normal saline nasal rinse
        • Topical menthol
        • NO Antibiotics prophylactically
      • Complications: secondary infection
        • Bacterial infection
        • Otitis media
        • Sinusitis
        • Asthma exacerbation
      • Pharyngitis, Tonsillitis, and Tonsillopharyngitis
        • Inflammation of mucosal lining of the throat structures
        • Infectious or noninfectious causes
          • Viral or bacterial
            • Viral (most common): adenovirus (pharyngitis primary sx), Epstein-Barr (EBV), herpes simplex (HSV), cytomegalovirus (CMV), enterovirus, parainfluenza, HIV
              • Upper nasal symptoms, cough and rhinorrhea, hoarseness, conjunctivitis, rash, diarrhea
              • Occur year round, except adenovirus which is predominantly summer (contaminated swimming pools)
            • Bacterial: GABHS (most common in 5-13 year olds), gonococcal (15-19 year olds), Corynebacterium diphtheria (RARE), Arcanobacterium haemolyticum, Neisseria gonorrheae(adolescents), Chlamydia trachomatis (adolescents), Francisella tularensis, Mycoplasma pneumonia, Group C & G Strep
              • GABHS: typically late winter and early spring
              • Acute abrupt onset: sore throat, headache, nausea, vomiting, abdominal pain, myalgia, arthralgia, malaise
            • Respiratory irritants (smoke)
          • Clinical Findings:
            • Erythematous tonsils and pharynx
            • EBV: exudates on tonsils, petechiae on soft palate, diffuse adenopathy
            • Adenovirus: follicular pattern on pharynx
            • Enterovirus: vesicles or ulcers on tonsillar pillars, coryza, vomiting, diarrhea
            • Herpes: anterior ulcers, adenopathy
            • Parainfluenza and RSV: lower respiratory sx, stridor, rales, and wheezing
            • Influenza: cough, fever, systemic sxs
            • pneumo & Chlamydophila pneumo: cough, pharyngitis
            • GABHS: exudative Erythematous pharyngitis with follicular pattern without presence of cough or nasal symptoms, swollen beefy red uvula, enlarged tonsillopharyngeal tissue, anterior cervical lymphadenopathy, bad breath, scarlatiniform rash, strawberry tongue
            • A. haemolyticum: exudative pharyngitis, marked erythema and pruritic, fine scarlatiniform rash
          • Diagnostics:
            • RADT and/or throat culture if >3 years old with pharyngitis or if someone in household is + Strep
            • Culture if RADT negative, or suspect haemolyticum, N. gonorrhea or C. diphtheria
            • If suspect Mononucleosis: CBC
          • Treatment:
            • Supportive care: ibuprofen, acetaminophen
            • Hydration
            • GABHS with + RADT or + culture: antibiotics
              • PCN V potassium – 1^st choice
              • Amoxicillin suspension
              • Benzathine pcn G IM
              • Allergy to PCN:
                • Cephalexin
                • Cefadroxil
                • Clindamycin (1^st choice if chronic symptomatic carriage of GABHS)
                • Azithromycin
                • clarithromycin
              • If CMV or EBV: beta-lactam antibiotic causes diffuse morbilliform skin eruption
              • Discard/Clean: bathroom cups, toothbrush, orthodontic devices
              • Return to school when afebrile or on antibiotic for 24 hours
              • Tonsillectomy/adenoidectomy:
                • if > 7 throat infections in past year, >5 throat infections in past 2 years, >3 throat infections per year x 3 years
                • sleep apnea
                • adenoid hypertrophy
                • unresponsive rhinosinusitis
                • chronic otitis media (post tympanostomy tube placement)

NR 602 Respiratory Infections Guide

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