Bronchitis in children.ppt
- 1. ACUTE BRONCHITIS, ACUTE BRONCHIOLITIS NRSG 328: PEDIATRICS AND CHILD HEALTH NURSING
- 3. DEFINITION Acute bronchitis is acute infection of the bronchial mucosa, without obstruction ETIOLOGY: Respiratory viruses – parainfluenza, adenoviruses, Rarely pneumococci, H.influenzae, staphylococi and streptococi may be isolated from the sputum
- 4. CLINICAL MANIFESTATION Dry, hacking, unproductive cough within 4-5 days the cough becomes productive often preceded by an upper respiratory tract infection afebrile patient or low grade fever auscultation – rough high pitched rhonchi
- 5. MANAGEMENT Infants - pulmonary drainage is facilitated by frequent shifts in position Keep well hydrated, humidified air if possible Nasopharyngeal lavage with isotonic solution (normal saline or Ringer lactate) Treat fever: Paracetamol in t°> 38, 5 30 mg/kg/d: 4 doses No antibiotics, antihistamines Expectorants in irritating and paroxysmal coughing: Bromhexin (suspension, tabl.) , Ambroxol, Stoptussin (drops)
- 6. EVALUATION OF PATIENTS Onset of dyspnea: stridor, wheezing Onset of general danger signs: convulsions or abnormally sleepy Not able to drink, stopped feeding, Patient don’t improve after 5 days
- 7. REFER TO HOSPITAL Presence of general danger signs Fever > 39°C resistant to antipyretic treatment Acute respiratory distress and cardiac failure Chronic cough > 30 days duration Hemoptysis
- 9. ACUTE BRONCHIOLITIS Definition: acute viral infection, characterized by inflammation of bronchioles, causing severe dyspnea and wheezing. more common in infants a peak incidence at 6 mo of age
- 10. ETIOLOGY: The respiratory syncytial virus (50%) Adenovirus, parainfluenza virus Mycolplasma pneumoniae
- 11. RISK FACTORS Artificial feeding Age between 3-6 mo Passive tobacco smoking – smoking parents in the home
- 12. PATHOPHYSIOLOGY Bronchiolar edema Hyper secretion and accumulation of mucus and cellular debris Bronchiolar obstruction during expiration Air trapping and over inflation Hypoxemia hypercapnia (CO2 retention, PaCO2>45mmHg, PaO2 <90mmHg)
- 13. CLINICAL MANIFESTATIONS Respiratory signs Disease starting with signs of acute viral nasopharyngitis. Severe tachypnea >70-80 breaths/min Spasmoid cough Chest in drawing, intercostal, subcostal and xyphoid retractions Expiratory dyspnea, gasping, emphysematous chest, on percussion – hyperresonance, very loud intensity Diminished breath sound Crepitations, rhonchi, wheezing Respiratory distress – dyspnea cyanosis, flaring of the alae nasi
- 14. GENERAL SIGNS Fever (38-39°C) Febrile convulsions Vomiting, less appetite, dehydration Cyanosis, acrocyanosis Tachycardia, toxic myocard Diver and spleen below the costal margins – result of depression of diaphragm in over inflation of lungs
- 15. DIAGNOSIS Blood gas analysis – respiratory or mixt acidosis White blood cell usually normal, rarely eosinophilia, ↑ESR X- ray – hyperinflation of the lungs Small atelectasis secondary to obstruction or to alveoli inflammation Pneumothorax Pleural reaction without fluid
- 16. TREATMENT Refer urgently to hospital Keep young infant to intensive care unite Humidified oxygen relieve hypoxemia Bronchodilating drugs – Salbutamol, Atrovent, Terbutalin Oral intake and parenteral fluids to combat dehydration
- 17. ANTIVIRAL DRUGS Ribavirin (virazole) – continuons inhalation of a small particle mist for 12-20 hr/24 hr for 3-5 days. It is contraindicated for ventilators patients (blockage of expiration) Antibiotics in secondary bacterial pneumonia
- 18. CORTICOSTEROIDS in severe sequel i/v; i/m 3-5 mg/kg local corticosteroids: Beclometazon, Budesonid, fluticazon Electrolyte balance and pH monitoring