NR 602 Sinusitis/Rhinosinusitis Quiz Guide

NR 602 Sinusitis/Rhinosinusitis Quiz Guide

NR 602 Sinusitis/Rhinosinusitis Quiz Guide

Sinusitis/Rhinosinusitis

• URI lasting 10 to 14 days with no symptoms improvement or worsening symptoms
  • Acute (ARS): lasting as long as 4 weeks
  • Chronic (CRS): persist 12 weeks or more
• Inflammation and edema of mucous membranes lining the sinuses
• Bacterial: Strep pneumo., H. influenza, Moraxella catarrhalis, Staph. Aureus (less often)
• Risk factors:
  • Preceding infection
  • Environmental irritants/allergies
  • Anatomic problems (septal deviation, nasal polyps, facial trauma)
  • GERD
  • CF, ciliary dyskinesia
  • Immunodeficiency
• Clinical Findings:
  • Thick, yellow discharge
  • Worsening symptoms after initial improvement from URI
  • Sx: headache, fatigue, decreased appetite
  • Bad breath (halitosis)
  • Facial pain*
  • Facial/nasal congestion and fullness*
  • Purulent postnasal drainage and nasal discharge
  • Cough
  • Ear pain/fullness/pressure
• Treatment:
  • Watchful waiting: do not over use antibiotics
    • Symptom management: ibuprofen, acetaminophen
    • Rest
    • Reassess after 72 hours
  • Chronic: referral to ENT
  • Antibiotics Criteria per AAP Guidelines:
    • URI with persistent nasal discharge, daytime cough, lasting >10 days without improvement
    • URI with worsening symptoms, new onset of fever, nasal discharge, or daytime cough after initial improvement
    • Fever > 102.2 F (39 C) with purulent nasal discharge for at least 3 days and sinusitis
    • Amoxicillin – 1^st line x10-28 days or 7 days past symptom resolution
      • 45 mg/kg divided into 2 doses/day
      • pneumo: 80-90 mg/kg/day (max: 1000 mg/dose)
    • Child < 2 yrs, daycare attendee, recent antibiotic use, or severe illness: Augmentin 80-90 mg/kg/day of amoxicillin part (max: 2 grams/dose)
    • Vomiting: ceftriaxone 50 mg/kg IV or IM
    • PCN allergy type I: 3^rd generation cephalosporin (cefdinir, cefpodoxime, cefuroxime)

NR 602 Sinusitis/Rhinosinusitis Quiz Guide

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Bronchitis/ Bronchiolitis/ Respiratory Syncytial Virus (RSV)

• inflammatory process of the bronchus, or bronchioles (small airways)
• most commonly caused by a Virus
  • MOST Common: Respiratory Syncytial Virus (RSV)
  • Others: influenza, parainfluenza, adenovirus, enterovirus, bocavirus, and rhinovirus
  • Rarely: can have rare bacterial cause: Mycoplasma pneumonia
• Highly CONTAGIOUS
• Direct Contact and Droplet Transmission
  • Incubation period before symptoms start
• High Risk: children with
  • Prematurity
  • Chronic lung disease
  • Immunocompromised
  • Participating in Day Care
• Symptoms:
  • Starts as URI
  • Worsening cough
  • Rhinorrhea
  • *HALLMARK: Wheezing
• Exam Findings:
  • Increased work of breathing
  • Prolonged expiration
  • Intercostals retraction
  • Grunting
  • Nasal flaring
  • Wheezes and crackles *Sound bit: polyphonic wheeze found in RSV: (https://www.easyauscultation.com/heart-lung-sounds-details/144/Wheeze-Polyphonic), crackles (https://www.easyauscultation.com/heart-lung-sounds-details/72/Crackles-Fine-(Rales))
  • Abdominal distention, palpable liver and spleen
  • Chest X-ray (not typically done): hyperinflation, atelectasis, flattening diaphragm
• Complications: may progress to
  • Pneumonia
  • Respiratory distress and hypoxia
  • Respiratory acidosis
• Treatment:
  • Supportive Care
    • Monitory pulse oximetry and respiratory status
    • Supplemental Oxygen
    • Hydration (oral, NG, IV)
    • Nutrition
    • Suction
  • Hospitalization
    • Age < 2 months
    • Respiratory distress
    • Progressive stridor or stridor at rest
    • Apnea
    • RR > 50-60 bpm (sleeping)
    • Cyanosis, hypoxia
    • Inability to tolerate oral feeding
    • Depressed sensorium
    • Presence of chronic cardiovascular or immunodeficiency disease