Exam 1 Study Guide KEY TERMS FROM EVOLVE

It would be helpul to !"ow the p#e$e"tatio" % $i&"$'$ymptom$ (what would the !id loo!
li!e)* dia&"o$ti+ $tudie$* a"d t#eatme"t o# ea+h di$o#de# li$ted below,
-.//LI0.TIO1 23ESTIO1S !"ow what i$ ab"o#mal a"d what to do with ab"o#mal
1, Re$p
3ppe# #e$pi#ato#y t#a+t4 o#o"a$opha#y"x* pha#y"x* la#y"x* a"d uppe# pa#t o the
t#a+hea
Lowe# #e$pi#ato#y t#a+t4 lowe# t#a+hea* mai"$tem b#o"+hi* $e&me"tal b#o"+hi*
$ub$e&me"tal b#o"+hiole$* te#mi"al b#o"+hiole$* al5eoli
I"e+tio"$ o epi&lotti$ % la#y"x 0#oup di$o#de#$
Respiratory tract infections
.++ou"t o# ma6o#ity o a+ute ill"e$$e$ i" +hild#e"
Etiolo&y a"d +ou#$e i"lue"+ed by4
o .&e
You"&e# tha" 7 mo"th$ p#e$umed to ha5e a lowe# i"e+tio" #ate
be+au$e o mate#"al a"tibodie$8 howe5e# may be $u$+eptible to
pe#tu$$i$ du#i"& thi$ pe#iod,
I"e+tio" #ate i"+#ea$e$ #om 7-9 mo"th$ o a&e* whe"
di$appea#a"+e o mate#"al a"tibodie$ a"d i"a"t$ ow" a"tibody
p#odu+tio",
Vi#al i"e+tio" hi&h i" toddle# a"d p#e$+hool yea#$
:y a&e o ; 5i#al #e$pi#ato#y t#a+t i"e+tio"$ le$ #e<ue"t but
i"+ide"+e o my+opla$ma pe"umo"iae a"d G.:=S i"e+tio"$
i"+#ea$e$
Lymphoid ti$$ue i"+#ea$e$ a$ a&e* a"d #epeated expo$u#e to
o#&a"i$m$ i"+#ea$e$ immu"ity
o Si>e
o Re$i$ta"+e
0o"ditio"$ that wea!e" the dee"$e o #e$pi#ato#y t#a+t4 alle#&ie$*
p#ete#m bi#th* b#o"+hopulmo"a#y dy$pla$ia* a$thma* hi$to#y o
RSV* +a#dia+ a"omalie$ that +au$e pulmo"a#y +o"&e$tio"* a"d
+y$ti+ ib#o$i$
o Sea$o"
Mo$t +ommo" #e$pi#ato#y patho&e"$ du#i"& wi"te# a"d $p#i"&
mo"th$
My+opla$mal i"e+tio"$- autum" a"d ea#ly wi"te#
I"e+tio" #elated a$thma- +old weathe#
RSV $ea$o"- wi"te# a"d ea#ly $p#i"&
o Li5i"& +o"ditio"$
o /#eexi$ti"& medi+al p#oblem
a. Respiratory Assessment
i, 0olo# (+ya"o$i$)* LO0 !"ow ba$eli"e* #e$pi#ato#y eo#t'patte#"*
po$itio" be"di"& o5e#'t#ipod* b#eath $ou"d$* e5aluatio" o
oxy&e" (?@AB)* tal!i"&'+#yi"&C* "a$al la#i"&* &#u"ti"&*
#et#a+tio"$* metaboli+ a+ido$i$ (p=DE,7;* =0O7DFF mE<'L)*
alte#atio"$ i" pe#u$io" (de+#ea$ed +apilla#y #etu#")* =R* SO:*
#e$pi#atio"$'mi"* i"&e# +lubbi"&*
ii, .$$e$$me"t $hould i"+lude #e$pi#ato#y #ate* depth* a"d #hythm*
hea#t #ate* oxy&e"atio"* hyd#atio" $tatu$* body tempe#atu#e*
a+ti5ity le5el* a"d le5el o +omo#t,
iii, . "o"i"5a$i5e pul$e oximete# (oxy&e" $atu#atio") mea$u#eme"t to
be pe#o#med o# .LL +hild#e" a$ apa#t o a #outi"e phy$i+al
a$$e$$me"t,
Normal ranges for vital signs
Vital Sign Infant Child Pre-Teen/Teen
0 to 12 months 1 to 11 years 12 and up
Heart Rate

100 to 160 beats per
minute (bpm)
70 to 120 bpm 60 to 100 bpmdrin
Respiration
(breaths)
0 to 6 months
30 to 60 breaths per minute
(bpm)
6 to 12 months
24 to 30 bpm
1 to 5 years
20 to 30 (bpm)
6 to 11 years
12 to 20 bpm
12 to 18 bpm
1

Temperature
All ages
98.6 F
(normal range is 97.4 F to
99.6 F)
All ages
98.6 F
(normal range is 97.4 F to
99.6 F)
All ages
98.6 F
(normal range is 97.4 F to
99.6 F)
Gate# o# +ool mi$t i$ +ommo" the#apeuti+ mea$u#e o# #e$pi#ato#y di$+omo#t
o Saety p#e+autio"$
Time ho"o#ed method (albeit "ot e5ide"+e ba$edH) o p#odu+i"& $team i$ the
$howe#
o Keepi"& +hild i" thi$ e"5i#o"me"t o# app#oximately 1I-1;
mi"ute$ humidiie$ i"$pi#ed ai# a"d +a" help #elie5e $ymptom$
Sali"e "o$e d#op$ may be admi"i$te#ed 1;-FI mi"ute$ beo#e eedi"& a"d at a
bedtime, Two d#op$ a#e i"$tilled a"d be+au$e thi$ $h#i"!$ o"ly the a"te#io#
mu+ou$ memb#a"e$* two mo#e d#op$ a#e i"$tilled ;-1I mi"ute$ late#
o /he"yleph#i"e I,F;B (o# i"a"t$ a"d +hild#e" olde# tha" 9 mo"th$
o a&e)
o Ephed#i"e 1B (o# +hild#e" olde# tha" 9 yea#$ o a&e)
o Oxymeta>oli"e I,IAB (+hild#e" olde# tha" 9 yea#$ o a&e)
o 1a$al $p#ay$ (olde# +hild#e")
Tau&ht to +omp#e$$ the pla$ti+ +o"tai"e# at the mome"t o
i"$pi#atio" while o++ludi"& the othe# "o$t#il
Should "ot be admi"i$te#ed o# mo#e tha" 7 day$ due to
ea$y +o"tami"atio"
To p#e5e"t +#o$$ +o"tami"atio" with "o$e d#op$* d#aw the
"o$e $p#ay $olutio" i"to the +hildJ$ "o$t#il$ u$i"& the blu"t
$y#i"&e
=ot o# +old appli+atio"$ p#o5ide #elie o# +hild#e" with pai"ul +e#5i+al
ade"iti$
Redu+i"& body tempe#atu#e
o .+etami"ophe" o# ibup#oe" (o# i"a"t$ a"d +hild#e" 9 mo"th$
a"d olde#)
o 0ool li<uid$
Kehyd#atio" i$ a pote"tial +ompli+atio" i" #e$pi#ato#y i"e+tio"$* a"d a#e
eb#ile o# a"o#e+ti+* e$pe+ially whe" 5omiti"& o# dia##hea i$ p#e$e"t
o I"a"t$ e$pe+ially p#o"e to luid a"d ele+t#olyte dei+it$ due to
#apid RR
o .de<uate luid i"ta!e e"+ou#a&ed by oe#i"& $mall amou"t$ o
a5o#ite luid$ (+lea# li<uid$ i 5omiti"& at #e<ue"t i"te#5al$)
o O#al #ehyd#atio" $olutio"$4 I"alyte o# /edialite (i"a"t$) % wate#
o# a low +a#b la5o#ed d#i"! (olde# +hild#e")
o Fluid$ $hould "ot be o#+ed* &e"tle pe#$ua$io" mo#e $u++e$$ul
o To a$$e$$ le5el o hyd#atio"
Ob$e#5e 5oidi"& #e<ue"+y
0ou"ti"& L o wet diape#$ i" FA hou#$
I" ho$pital* diape#$ wei&hed to a$$e$$ output* whi+h $hould
be at lea$t 1 ml,!&,h# up to 7I !& i" wei&ht
The" it $hould be at lea$t 7I ml pe# hou# i" patie"t$
wei&hi"& mo#e tha" 7I !&
b. Upper Respiratory Infections
i. Acute Laryngotracheobronchitis (Croup)
1, Vi#al* +au$e - RSV o# pa#ai"lue">a* 5a#ied de&#ee$ o
$ub&lotti+ ob$t#u+tio"* p#io# hx o 3RI 7-A day$ a&o
F, S'S la#y"&eal $pa$m (Ke+#ea$e$ with +ool temp)* ba#!i"&
+ou&h* i"$pi#ato#y $t#ido# ($<uea!y)* hoa#$e"e$$ $ou"d$
wo#$e tha" it i$* 7mo-;yea#
7, Kia&"o$i$ ba$ed o" $ymptom$* po$$ible +he$t x-#ay
A, T#eatme"t +ool mi$t* luid$* #e+emi+ epi"eph#i"e ope"
uppe# ai#way* $te#oid$ de+#ea$e i"lammatio"* "o
a"tibioti+$ (VIR.L)* at home !eep +alm a"d +omo#table
e"+ou#a&e +lea# luid$ a"d $te#oid$, May be ad5i$ed to &o
i" to ER8 howe5e# i d#i5e du#i"& +old weathe# with
wi"dow$ ope" $ymptom$ may $ub$ide,
ii. Epiglottitis
1, .+ute i"lammatio" o $up#a&lottal $t#u+tu#e$ p#e+ipitati"&
me+ha"i+al ob$t#u+tio" lie th#eate"i"&* +omplete ai#way
ob$t#u+tio" +a" de5elop ate# o"$et with ma"ipulatio" o
"e+! o# ai#way
F, 0au$e =, lu* i"+ide"+e de+#ea$e with 5a++i"atio"
7, /#e$e"tatio" a+ute $udde" o"$et* hi&h e5e#* $oa# th#oat*
dy$pha&ia (dii+ulty $wallowi"&)* muled 5oi+e* d#ooli"&*
t#ipod po$itio"* p#o&#e$$e$ to #e$pi#ato#y di$t#e$$*
i"$pi#ato#y $t#ido#* #et#a+tio"$* 7-Myea#$
A, Kia&"o$i$ pul$e ox* th#oat exami"atio"* +he$t o# "e+! x-
#ay* th#oat +ultu#e a"d =ib, :lood +ultu#e$
;, Ma"a&eme"t medi+al eme#&e"+y* t#a+h e<uipme"t
"ea#by* !eep +hild +alm* a"tibioti+$* $welli"& will de+#ea$e
by FAh#$
iii. LTB s Epiglottis
!. LTB
a. 0ou&h* "o dy$pha&ia* "o o# low e5e#* p#io# 3RI*
$ou"d$ wo#$e tha" loo!$* u$ually 5i#al* po$itio" o
+omo#t* 7 mo"th$-; yea#$
". Epiglottis
a. 1o +ou&h* d#ooli"&* hi&h e5e#* N'- 3RI* loo!$
wo#$e tha" $ou"d$* u$ually h, lu* t#ipod po$itio"* 7-
M yea#$
i. URI (iral) # C$L%&
1, F#e<ue"t i" +hild#e" you"&e# tha" 7
F, Rea$$u#e that thi$ i$ a "o#mal pa#t o +hildhood a"d that by
; yea#$ o a&e immu"ity will be mo#e u#the# de5eloped
7, S'S- #hi"iti$ ("a$al +o"&e$tio")* +ou&h* e5e#* i##itability*
a"o#exia* 5omiti"&* dia##hea* i##itability
A, Kia&"o$i$ ba$ed o" $ymptom$
;, T#eatme"t i$olatio"* ele5ate =O:* $ali"e "o$e d#op$ o#
wa#m wate#'bulb $u+tio" (D1 yea# 1 d#op ea+h "o$t#il til
+lea#)* mo"ito# e5e#* SO:* +ou&h* e"+ou#a&e luid$*
medi+atio" to +o"t#ol e5e#* a"tahi$tami"e (?;y#)
a. Fe5e# O ?1IA F* e5e# i$ a $ymptom "ot di$ea$e,
3$ual e5e#$ 7E,M-AI 0 a#e "ot ha#mul, Mo$t
+au$ed by 5i#al ill"e$$e$, may la$t F-7day$*
a+etami"ophe" OR ibup#ophe" (../ doe$"Jt
#e+omme"ed p#e$+#ibi"& both at the $ame time o#
e5e#$ a$ the#e i$ a hi&h #i$! o# li5e#'!id"ey
p#oblem #'t o5e#do$e)("o a$pi#i")* #e+he+! temp*
#emo5e +lothi"&* a"* i+e pa+!$ u"de# a#m$'&#oi"*
$po"&e bath i =FI T,AI 0 (1IA F)* a"
i, 0all =0/ i D 7 mo, Old* T ? A1,; 0 (1I;F)*
loo!$ $i+!* letha#&i+
ii, Re$et $et poi"t (a"tipy#eti+ med$) beo#e
u$i"& e"5i#o"me"tal i$$ue$
b. 0a""ot u$e de+o"&e$ta"t$ o# +hild#e" you"&e# tha"
; yea#$ old, .lte#"ati5e$4 "o#mal $ali"e'humidiie#
c. ."tihi$tami"e$ +a" be u$ed o# othe# $ituatio"$
howe5e# whe" $upp#e$$i"& +ou&h a"d +lea#i"&
ai#way may lead to death
c. Lo'er Respiratory Infections
i. R&(
1, Mo$t impo#ta"t #e$pi#ato#y di$ea$e o i"a"+y a"d ea#ly
+hildhood
F, T#a"$mitted4 di#e+t +o"ta+t with #e$pi#ato#y $e+#etio"* di#e+t
i"o+ulatio" #om ae#o$oli>ed pa#ti+le$* di$ta"t ae#oli>ed
i"o+ulatio" u"li!ely* +a" li5e o# hou#$ i" d#y e"5i#o"me"t
7, Vi#u$* i"lammatio" o #e$pi#ato#y t#a+t mu+o$a*
b#o"+hiola# mu+o$a $well* epithelial +ell$ lo$e +ilia* lumi"a
illed with exudate* mu+u$* +ell$ $hed i"to b#o"+hiole$
+au$i"& pa#tial ob$t#u+tio"* hype#i"latio"* atela+ta$i$* ai#
t#appi"&* ai#bo#"e p#e+autio"$* #e+o5e# F-7w!$ i healthy
A, I"+#ea$ed #i$! o de5elopi"& a$thma ate# RSV
b#o"+hioliti$ (due to $+a##i"&)
;, S'S- i"itialO #hi"o##hea ("a$al +o"&e$tio")* +ou&h* low
&#ade e5e#* otiti$ (ea# pai")* +o"6u"+ti5iti$ (pi"! eye)*
pha#y"&iti$* whee>e$* i" wi"te# o# $p#i"&* le$$ tha" Fy#
pea#! F-; mo"th$* Late#O i"+#ea$e whee>e* +ou&h* ai#
hu"&e#* ta+hyp"ea (P#e$p)* #et#a+tio"$* +ya"o$i$* +#a+!le$*
de+#ea$ed b#eath $ou"d$ SERIO3SO li$tle$$* poo# luid
i"ta!e* #e$pi#ato#y +omp#omi$e* ta+hyp"ei+* #et#a+tio"$*
hypoxi+* OF $tat le$$ tha" @AB
9, 0au$e b#o"+hioliti$ (i"lammatio" o the b#o"+hiole$)
a. I" the b#o"+hioliti$* the ai#way be+ome$ ob$t#u+ted
#om $welli"& o the b#o"+hiole wall$8 Ea$ie# o#
patho&e"$ to &et i"to +hild#e"J$ b#o"+hiole$ a$ they
ha5e le$$ dee"$e i" lowe# amou"t$ o lymphati+
ti$$ue a"d $ho#te# di$ta"+e to b#o"+hiole$
E, Ma"a&eme"t dia&"o$i$ by "a$al 1/ $wab #apid #e$ult$*
@IB a++u#ate* humidity* luid (IV)* #e$t* ele5ate =O:*
$ali"e to +lea# "a#e$* oxy&e"* #iba5i#i" #a#e* a"ti5i#al
a&e"t* Sy"a&i$ immu"i>atio" mo"thly IM* &i5e" DFy#
with +h#o"i+ lu"& di$ea$e* p#ete#m i"a"t$* 0=K
(mo"o+lo"al a"tibody)
M, Ghe" to ho$pitali>e- li$tle$$* poo# luid i"ta!e* #e$pi#ato#y
+omp#omi$e* ta+hyp"ea* #et#a+tio"$* hypoxi+
@, T#eatme"t- $ymptomati+ a"d $uppo#ti5e +a#e (IV luid$*
"ut#itio"* oxy&e"* t#eat b#o"+ho$pa$m)8 Riba5i#i"
+o"t#o5e#$ial (a"ti5i#al a&e"t* ae#oli>ed 5ia hood* ma$!*
5e"tilato#* +o"t#o5e#$y)
a. ../ #e+omme"datio"$ o# Riba5i#i" u$e
i, =i&h #i$! i"a"t$ w' RSV
1, 0omplex 0=K
F, Lu"& di$ea$e
7, /#ete#m i"a"t (D7E wee!$)
ii, =o$pitali>ed* $e5e#ely ill i"a"t$ w' RSV
b#o"+hioliti$
iii, Immu"o+omp#omi$ed i"a"t$ w' RSV
1, Se5e#e +ombi"ed immu"odei+ie"+y
(S0IK)
F, =IV
7, T#a"$pla"t patie"t$
). Respiratory Emergencies
i. Cho*ing+foreign bo)y aspiration
1, 3ppe# ai#way i$ $malle# with i"$pi#atio"$ a"d la#&e# with
expi#atio"$* lowe# i$ oppo$ite* Type$ pa#tial* la#&e#*
+omplete ("o OF)
F, 0au$e$ hot do&$* #ou"d +a"dy* "ea"ut$* &#ape$* latex
balloo"$* butto"* +oi"* e+t,
7, S'S #apid o"$et* $udde" o"$et +ou&hi"&'+ho!i"&*
i"pi#ato#y $t#ido#* SO:* hoa#$e +#y'5oi+e* $up#a$te#"al
#et#a+tio"$* apho"ia (+a"t $pea!)* p"eumo"ia* whee>i"&*
+ya"o$i$* dy$p"ea
A, T#eatme"t #emo5al o o#ei&" ob6e+t depe"di"& o" $i>e*
#i$!
ii. $bstruction
1, I"a"t ai#way i$ Amm 5$ adult 1Imm
F, Fi#$t de&#ee ob$t#u+tio"4 ob$t#u+tio" allow$ pa$$a&e o ai#
i" both di#e+tio"$
7, Se+o"d de&#ee ob$t#u+tio"4 ai# able to mo5e pa$t the
ob$t#u+tio" i" o"e di#e+tio" o"ly, .i# pa$$a&e$ e"la#&e
du#i"& i"$pi#atio" a"d dimi"i$h du#i"& expi#atio",
A, 0omplete ob$t#u+tio"4 .i# u"able to mo5e i" eithe#
di#etio", F: a"d edematou$ mu+o$a oblite#ate pa$$a&e,
iii. Epiglottitis
1, lie th#eate"i"&* +omplete ai#way ob$t#u+tio" +a" de5elop
ate# o"$et with ma"ipulatio" o "e+! o# ai#way
F, .+ute i"lammatio" o $up#a&lottal $t#u+tu#e$ p#e+ipitati"&
me+ha"i+al ob$t#u+tio"
7, =, lu i$ mo$t +ommo" +au$e8 =i&h mo#tality
A, Mo#tality #ate$ de+#ea$ed 7F-EB $i"+e 1@EI$--Si&"ii+a"tly
de+#ea$e with the i"t#odu+tio" o =ib 5a++i"e i" 1@@1* al$o
= lu i$ #e$po"$ible o# ba+te#ial me"i"&iti$ a"d ha$ &#eatly
de+#ea$ed with the 5a++i"atio",
;, 0li"i+al Ma"ie$tatio"$4 a+ute* $udde" o"$et8 hi&h e5e#8
$e5e#e $o#e th#oat* dy$pha&ia8 muled 5oi+e8 d#ooli"&8
t#ipod po$itio"8 p#o&#e$$e$ to #e$pi#ato#y di$t#e$$8
i"$pi#ato#y $t#ido# #et#a+tio"$
9, MEKI0.L EMERGE10Y- do 1OT i"$t#ume"t th#oat*
!eep +hild +alm i" pa#e"t$ lap* a"tibioti+$* $welli"& u$ually
dow" by FA hou#$,
e. Asthma
i, Relea$e o i"lammato#y mediato#$ #om b#o"+hial ma$t +ell$*
alte#ed .1S +o"t#ol o ai#way to"e* i"+#ea$e $mooth mu$+le
#eati5ity* a++umulatio" o thi+! $e+#etio"$ o mu$+u$*
b#o"+ho$pa$m* imlammatio"'edema o mu+u$ memb#a"e$* $pa$m
o $mooth mu$+le o b#o"+hi
1, Ea#ly #e$po"$e a"ti&e" ? hi$tami"e #elea$e ?
b#o"+ho$pa$m* #e$ol5e$ 1-7h#$
F, Late #e$po"$e o"$et o ai#way ob$t#u+tio" A-9h#$ late#*
pe#$i$te"t i"lammato#y #e$po"$e
ii, $'$ epi$odi+ whee>i"& i" #e$po"$e to t#i&&e#$* +ou&h at "i&ht
without +old* i"lammatio"* b#o"+hial hype#-#e$po"$i5e"e$$* a&e o
o"$et i$ olde#* dimi"i$hed lu"& u"+tio"* #elated to alle#&i+
#ea+tio"* hype#-#e$o"a"+e* +oa#$e b#eath $ou"d$* lo"& expi#ato#y
pha$e* I%E whee>e$* ab$e"+e o whee>e$ may be omi"ou$ $i&"
iii, Kia&"o$i$ The mo$t +e#tai" way to dia&"o$e a$thma i$ with a
lu"& u"+tio" te$t ($pi#omet#y* alle#&y te$t$* b#o"+hop#o5o+atio"
te$t)* a medi+al hi$to#y* a"d a phy$i+al exam (alle#&y te$t$),
=owe5e#* itQ$ ha#d to do lu"& u"+tio" te$t$ i" +hild#e" you"&e#
tha" ; yea#$, Thu$* do+to#$ mu$t #ely o" +hild#e"Q$ medi+al
hi$to#ie$* $i&"$ a"d $ymptom$* a"d phy$i+al exam$ to ma!e a
dia&"o$i$,
i5, T#eatme"t i"a"t t#eat +au$e* $uppo#ti5e +a#e* po$$ible
b#o"+hodilato#$* +la$$i+ alle#&i" +o"t#ol(du$t* a"imal$)* Med$ :
a&o"i$t$ (albute#ol)* a"ti+holi"e#&i+$ (at#o5e"t)* +o#ti+o$te#oid$
(i"hale$ o# $y$temi+)* +#omoly" (p#e5e"t$ hi$tami"e* leu!ot#ie"e
#elea$e)
5, Ma"a&eme"t Edu+atio"H !"ow t#i&&e#$* alle#&i" +o"t#ol*
#e+o&"i>e ea#ly $i&"$* u$e o MKI a"d $pa+e#* u$e o /EFM (a$$e$$
$tatu$ o a$thma)* p#omote a+ti5ity* p#omote health* team app#oa+h
to ma"a&eme"t a"d pla"* i"5ol5e $+hool
f. $titis
i. ,e)ia
1, O"e o mo$t p#e5ale"t di$ea$e$ i" ea#ly +hidhood8
i"+ide"+e hi&he$t i" wi"te# mo"th$
F, Two 5i#u$e$ mo$t li!ely to +au$e- RSV % I"lue">a
7, Mo$t +ommo"* #' $mo!e# i" hou$e* day+a#e* bottle
eedi"&(mu$t bottlep#op) (bottle eedi"& +a" allow o#
pooli"& o o#mula i" po$te#io# a#ea o o#al +a5ity a"d wo#!
it$ way to ea#$ a"d $i"u$e$8 o#mula &#eat medium o#
ba+te#ial &#owth)* +hild#e" at &#eate# #i$! due to $ho#te# a"d
$t#ai&hte# eu$ta+hia" tube* +au$ed by alle#&ie$ o# uppe# ai#
way i"e+tio" (i"lue">a* $t#epp* +ata##hali$)
A, S'S 9mo-Fy#* e5e#* pai"* de+#ea$ed hea#i"&* dia##hea*
i##itability* e5e#* pai"* a"o#exia* 3RI $ymptom$
(+o"&e$tio"* +o"6u"+ti5iti$* $o#e th#oat'pha#y"&iti$*
$i"u$iti$* dia##hea (you"& +hild#e" will be $ee" pulli"& at
thei# ea#$)
;, Kia&"o$i$ p"eumati+ oto$+ope (#edde"ed)* mu$t pull
KOG1 ea#
9, T#eatme"t mo"ito# temp* $'$* dehyd#atio"* mo"ito# SI o
medi+atio"$* a+etami"ophe" o# pai" a"d i"lammatio"*
#ea$$u#e pa#e"t$* a"tibioti+$ $ho#te" +ou#$e o i"e+tio"*
mu$t ha5e ?7 i"e+tio"$'yea#* ?7day$ o i"e+tio"* N+ultu#e*
immu"o$up#e$$io"* day+a#e* $mo!e# i" the home,
a. .moxi+illi" -$* MI-@Im&'!&'day
i, 1
$t
li"e o t#eatme"t (0K0)
b. 0eu#oxime -$* 7Im&'!&'day
c. .u&me"ti" -$* MI-@Im&'!&'day
i, /a#e"t$ alway$ wa"t8 6u$t +au$e they &ot o#
la$t ea# i"e+tio" doe$"Jt mea" they $hould
&et it e5e#ytime
). 0et#iaxo"e I, x7 day$
i, O"ly o# SEVERE
e. .u#ala&e" )rops pai"
i, ."tiba+te#ial* a"al&e$ia* a"d a"e$theti+
+ombi"atio"
f. 0o#ti$po#i" )rops otiti$ exte#"a
g. Keb#ox )rops +e#ume" #emo5al
E, 1u#$i"& +a#e
a. Mo"ito# e5e#* $ymptom$ o ill"e$$* dehyd#atio"
b. ."tibioti+$ o# 1I day$
c. .+etami"ophe"
). Rea$$u#e pa#e"t$ o t#eatme"t pla"
ii. E.terna
1, ." i"lammatio" o# i"e+tio" o the exte#"al audito#y +a"al
(E.0)* the au#i+le* o# both
F, S'S otal&ia (ea# pai")* hea#i"& lo$$* ea# ull"e$$ o#
p#e$$u#e* ti""itu$* e5e#* it+hi"&* $e5e#e deep pai"*
di$+ha#&e
7, Kia&"o$i$ hi$to#y a"d phy$i+al exam* #a#e- &#am $tai"i"&*
di$+ha#&e +ultu#e* $!i" exam $howi"& i"lammatio" with
exudate
A, T#eatme"t ma"a&eme"t o pai"* #emo5al o deb#i$*
topi+al medi+atio"$ to +o"t#ol edema a"d i"e+tio"* a+eti+
a+id d#op$ (+ha"&e p=)* a"tiba+te#ial d#op$
iii. Effusion
1, thi+! o# $ti+!y luid behi"d the ea#d#um i" the middle ea#*
but the#e i$ "o ea# i"e+tio"* +au$e$ alle#&ie$* i##ita"t$
($mo!e)* #e$p i"e+tio"$* i"+#ea$e$ i" ai# p#e$$u#e
(ai#pla"e)* d#i"!i"& lyi"& dow"* mo#e +ommo" i" wi"te# o#
ea#ly $p#i"&* mo$tly DFy#$*
F, S'S a$ymptomati+ i" you"& +hild#e"* olde# +hild#e"
muled hea#i"&* $e"$e o ull"e$$ i" the ea#* tu#"i"& up the
TV to loud
7, Kia&"o$i$ ollow up ate# t#eated ea# i"e+tio"* ai#bubble$
o" the $u#a+e o the ea#d#um* dull"e$$ o the ea#d#um
whe" lit* "o mo5eme"t with pu$ o ai#* luid ob$e#5ed
behi"d the ea#d#um* tympa"omet#y te$t (amou"t a"d
thi+!"e$$ o luid)* a+ou$ti+ oto$+ope o# #ele+tomete#
(p#e$e"+e o luid)* audiomete# (hea#i"& te$t)
A, T#eatme"t - 3"le$$ the#e a#e al$o $i&"$ o a" i"e+tio"*
mo$t health +a#e p#o5ide#$ will "ot t#eat OME at i#$t,
I"$tead* they will #e+he+! the p#oblem i" F - 7 mo"th$, I
OME pe#$i$t$ a"tibioti+$ o# ea# tube$
g. Cystic /ibrosis
i, Mo$t +ommo" lie th#eate"i"& #e+e$$i5e &e"eti+ di$ea$e i"
0au+a$ia"$* i"he#ited a$ a" auto$omal #e+e$$i5e di$ea$e* exo+#i"e
&la"d dy$u"+tio" (i"+#ea$ed 5i$+o$ity o mu+ou$ &la"d $e+#etio")
that p#odu+e$ multi$y$tem i"5ol5eme"t #e$ult$ i" me+ha"i+al
ob$t#u+tio"* #e$pi#ato#y t#a+t a"d pa"+#ea$e a#e p#edomi"a"tly
ae+ted* +olle+tio" o mu+u$ a"d ba+te#ial +olo"i>atio" #e$ult i"
de$t#u+tio" o lu"& ti$$ue * MIB +a$e$ dia&"o$ed by a&e 7 i" pa$t*
"ewbo#" $+#ee"i"& lead$ to dia&"o$i$ at bi#th a"d i$ impleme"ted
i" ma"y +ou"t#ie$ a#ou"d the wo#ld8 almo$t 1IB dia&"o$ed ?1M
yea#$
1, Kee+ti5e &e"e o# the p#otei" +y$ti+ ib#o$i$
t#a"$memb#a"e +o"du+ta"+e #e&ulato# (0FTR) that +o"t#ol$
$odium a"d +hlo#ide t#a"$e# i" a"d out o the epithelial
+ell$ withi" the body body
ii, /#e$e"tatio" 5a#iable o"$et a"d exte"t* de+#ea$ed OF-0OF
ex+ha"&e* hypoxia* hype#+ap"ia (too mu+h 0OF i" blood)*
a+ido$i$* pulmo"a#y hype#te"$io"* +o# pulmo"ale (R 5e"t#i+le
ailu#e)* #e$pi#ato#y ailu#e* death* impai#ed di&e$tio" a"d
ab$o#ptio" o at ($teato##hea) a"d p#otei" (a>oto##hea)* pa"+#eati+
ib#o$i$ (diabete$ mellitu$)* multitilobula# bilia#y +i##ho$i$*
impai#ed $ali5atio"* pa"+#eati+ e">yme dei+ie"+y ( 1o#mal $e#um
amyla$e #e$ult$4 F; to 19I 3'L* lipa$e ;9 to F7@ 3'L)* 0O/K*
$weat &la"d dy$u"+tio"* ailu#e to th#i5e* de+#ea$ed wei&ht de$pite
i"+#ea$ed appetite* &#adual #e$pi#ato#y dete#io#atio"* whee>i"&* d#y
"o"p#odu+ti5e +ou&h* &e"e#ali>ed ob$t#u+ti5e emphy$ema* pat+hy
atele+ta$i$* +ya"o$i$* +lubbi"& o i"&e#$ a"d toe$* #epeated
b#o"+hiti$* p"eumo"ia* ta$te $alty* mu+o"ium ileu$ (1
$t
$i&")* di$tal
i"te$ti"al ob$t#u+ti5e $y"d#ome* ex+#etio" o u"di&e$ted ood a"d
$tool
iii, Kia&"o$i$ .ll State$ $+#ee" "ewbo#"$ o# 0F u$i"& a &e"eti+ te$t
o# a blood te$t, The &e"eti+ te$t $how$ whethe# a "ewbo#" ha$
aulty 0FTR &e"e$, The blood te$t $how$ whethe# a "ewbo#"Q$
pa"+#ea$ i$ wo#!i"& p#ope#ly, I a &e"eti+ te$t o# blood te$t
$u&&e$t$ 0F* a do+to# will +o"i#m the dia&"o$i$ u$i"& a $weat te$t,
Thi$ te$t i$ the mo$t u$eul te$t o# dia&"o$i"& 0F, . $weat te$t
mea$u#e$ the amou"t o $alt i" $weat,
i5, T#eatme"t e"+ou#a&e ai#way +lea#a"+e* i"haled b#o"+hodilato#*
+he$t /T* /ulmo$yme* a"tibioti+$ (luo#o<ui"olo"e$)* pa"+#eati+
e">yme $uppleme"t$* multi5itami"$* mu+olyti+$* a"tibioti+$* a"ti-
i"lammato#y
F, 0U !"ow how $y$tem wo#!$ o# appli+atio" <ue$tio"$HHHHH K"ow ab"o#mal
5alue$ a"d what to do about it* health hi$to#y will p#o5ide a lot o i"o#matio"
a. Renal Tests 1 ariances in morning
i. BU2+creatinine
ii. Urine culture an) sensitiity
iii. Urinalysis
b, I"e+tio"$
i. UTI
1, Kei"itio"4 E, 0OLI diape#i"&* wipi"&*
F, /#e$e"tatio" % $i&"$'$ymptom$ -M.Y SEE 1OT=I1G .T
.LL (dehyd#atio"$)
7, Kia&"o$ti+ $tudie$ loo! at +ha#t i" boo!
A, T#eatme"t
ii. -yelonephritis
1, Kei"itio"4 loo! at +la$$ii+atio" o 3TI
F, /#e$e"tatio" % $i&"$'$ymptom$
7, Kia&"o$ti+ $tudie$
A, T#eatme"t
c. %isor)ers of the bla))er
). 2ephrotic &yn)rome
i, Kei"itio"4
ii, /#e$e"tatio" % $i&"$'$ymptom$
iii, Kia&"o$ti+ $tudie$
i5, T#eatme"t
e. Acute 0lomerularnephritis
i, Kei"itio"4 1O1I1FE0TIO3S RE1.L KISE.SE po$ti"e+tio"
#om b-hymolyti+ $t#epto+o++i i"e+tio"$
ii, /#e$e"tatio" % $i&"$'$ymptom$ - hematu#ia #e$ulti"& i" $mo!y tea
loo!i"& u#i"e* p#otei"u#ia* low p#otei" i" blood* daily wei&ht$
edema* low p#otei" dama&e to !id"ey$ a$ p#otei" blow$ th#ou&h*
iii, Kia&"o$ti+ $tudie$
i5, T#eatme"t
f. 3ilm4s Tumor
i, Kei"itio"4
ii, /#e$e"tatio" % $i&"$'$ymptom$
iii, Kia&"o$ti+ $tudie$
i5, T#eatme"t #adiatio" to $h#i"! beo#e $u#&i+al #emo5al
g. Renal /ailure
i. Acute
ii. Chronic
h. %ialysis
i. -eritoneal
ii. 5emo)ialysis
i. Transplantation
6. 0I
a. %iarrhea+0astro
i, Types a+ute (a"tibioti+ a$$o+iated au&me"ti")* a+ute
i"e+tiou$* +h#o"i+* (I:S o diabete$) i"t#a+table dia##hea o
i"a"+y (mal"ut#itio")* +h#o"i+ "o"$pe+ii+ dia##hea (01SK)
toilet t#ai"i"& will ix
ii, Causes ab"o#mal i"te$ti"al wate#* ele+t#olyte t#a"$po#t*
i"e+tiou$ o#&a"i$m$4 E, +oli* #ota5i#u$* 1o#wal!-li!e o#&a"i$m$*
+ampolyba+te# 6e6u"i* +lo$t#idium* $amo"ella* $hi&ella $t#ai"$*
ye#$i"ia* &ia#dia* +#ypto$po#idium
iii, .$$o+iated di$o#de#$ &a$t#oe"te#iti$* +oliti$* e"te#o+oliti$*
a"tibioti+-a$$o+iated
b. %ehy)ration
i, Types i$oto"i+ (1a'=FO lo$t)* hypoto"i+ (hypo"ate#mia)*
hype#to"i+ (hype#"ate#mia) +ha#t o" $lide$
ii, $ral Rehy)ration wei&ht i" !&* 1IIml'!& i#$t 1I* ;Iml'!&
$e+o"d 1I* FIml'!& o# #emai"i"&
1, E;-@ImE< 1a'L
F, maita"a"+e AI-9ImE< Ma'L
7, D1;Iml'!&'day
c. /eer
i, Kei"itio"4
ii, /#e$e"tatio" % $i&"$'$ymptom$
iii, Kia&"o$ti+ $tudie$
i5, T#eatme"t
). 0ER+%
i, Kei"itio"4 patholo&i+ e"t#y o &a$t#i+ +o"te"t$ i"to the e$opha&u$
ii, /#e$e"tatio" % $i&"$'$ymptom$4 with o# without 5omiti"&* +a"
happe" at a"y time "ot "e+e$$a#ily #elated to eedi"&$* ailu#e to
th#i5e* bleedi"&* dy$pha&ia* p"eumo"ia* b#o"+ho$pa$m* pe#$i$ta"t
pa$$i5e #e&u#&itatio" o# 5omiti"&* poo# wei&ht &ai" a"d &#owth*
FTT* i"+o"$olable* $e5e# +#yi"&* i##itability* dii+ult to eed*
+ho!i"& with eedi"&$* +ou&h* #e<ue"t #e$pi#ato#y i"e+tio"$*
a$thma* po$iti5e hemo++ult with a$pi#ate* a"emia* b#ady+a#dia i"
p#emie$
iii, Kia&"o$ti+ $tudie$4 0:0* o++ult blood i" a$pi#ate* $tool*
ele+t#olyte$* /h p#obe dei"iti5e te$t w' FA h# ob$e#5atio"
("o#mal /h i$ ;-E* with #elux DA)* ba#ium $wallow e5ide"+e o
#elux a"d a"atomi+ de5iatio"$* e"do$+opy i"lammatio" o#
ul+e#atio"
i5, T#eatme"t4 #e$ol5e$ by 1M mo with out $u#&e#y* diaph#a&mati+
+o"t#ol i$ de5eloped* $u#&e#y 1i$$e" Fu"dopli+atio" o"ly
$e5e#e la$t optio" (ap"ea) &-tube po$t-op* Thal p#o+edu#e* Toupet
p#o+edu#e* po$t-op"o la#&e bolu$ eed$* 1/O 1-F day$* VS* 1GT
low i"te#mitte"t $u+tio" (p#io#ity)* #e$p a"d GI a$$e$$me"t* IV
luid$* pai" med$* po$itio" +ha"&e$ p#o"e ate# eedi"& a"d
du#i"& $leep* lat o# head o bed ele5ated 7I de&#ee$ o# at lea$t 7I
mi" * 5e"t GT tube* Feedi"&- thi+!e" o#mula with #i+e +e#eal*
$low eedi"&$* #e<ue"t bu#pi"&* Medi+atio"$ - p#ilo$e+ OT0*
maylox (olde#)
e. -yloric &tenosis
i, Kei"itio"4 a" elo"&atio" o# "a##owi"& o the pylo#i+ +ha""el
whi+h +au$e$ ob$t#u+tio" a"d +ompe"$ato#y dilatio"* hype#t#ophy
a"d hype#pe#i$tal$i$ o the $toma+h* thi+!e"i"& o the +i#+ula#
mu$+le o the pylo#i+ $phi"+te# #om a" i"+#ea$ed $i>e o# ma$$
po$$ibly &e"eti+* ull-te#m white male$
ii, /#e$e"tatio" % $i&"$'$ymptom$ - p#o6e+tile "o"biliou$ 5omiti"&*
dehyd#atio"* hypo+hlo#emi+ al!alo$i$* hypo!alemia* metaboli+
al!alo$i$* &#owth ailu#e* hu"&e#* i##itability* +o"$tipatio"$* uppe#
abdomi"al di$te"tio"* pe#i$tal$i$ wa5e$ 5i$ible o" abdome"* oli5e
$i>e ma$$ o++a$io"ally palpable i" let epi&a$t#i+ #e&io"*
hype#t#ophy o pylo#u$* low +hlo#ide a"d pota$$ium
iii, Kia&"o$ti+ $tudie$ abdomi"al ult#a$ou"d* $e#um ele+t#olyte$
(de+#ea$ed +hlo#ide* $odium* pota$$ium* I"+#ea$ed :31* =0O7*
ph)* u#i"e $pe+ii+ &#a5ity (i"+#ea$ed)
i5, T#eatme"t $u#&i+al pylo#omyotomy lap i"to pylo#i+ mu$+le
f. Intussesception
i, Kei"itio"4 tele$+opi"& o o"e po#tio" o the i"te$ti"e i"to a"othe#
- "o appa#e"t +au$e
ii, /#e$e"tatio" % $i&"$'$ymptom$ - $udde" pe#iodi+ mode#ate to
$e5e#e abdomi"al pai"* $+#eami"& +hild with !"ee$ d#aw" to +he$t*
5omiti"& $oo" ollow$ the pai"* +u##a"t 6elly-li!e $tool withi" 1F
hou#$* e5e"tual e5e# $e+o"da#y pe#ito"iti$* p#o$t#atio"* alte#ed
+o"$+iou$"e$$* letha#&y* po$$ible $ei>u#e$
iii, Kia&"o$ti+ $tudie$ abdomi"al x-#ay (ai# bowel pe#o#atio")*
ult#a $ou"d* abdomi"al exam (palpatio" o a $au$a&e $haped
ma$$'LR2 empty)
i5, T#eatme"t p"eumati+-e"ema with Shield Kit* ba#ium e"ema ("ot
with pe#)* $u#&e#y i i" $ho+!* pe#* o# pe#ito"iti$ bowel #e$e+tio"
g. Crohn4s %isease (chart in sli)es)
i, Kei"itio"4 a +h#o"i+ di$o#de# o the GI t#a+t +ha#a+te#i>ed by
i"lammatio" o the i"te$ti"e a"d #e$ulti"& i" abdomi"al +#ampi"&
a"d pe#$i$te"t dia##hea
ii, /#e$e"tatio" % $i&"$'$ymptom$
iii, Kia&"o$ti+ $tudie$
i5, T#eatme"t
h. Ulceratie Colitis (chart in sli)es)
i, Kei"itio"4 a +h#o"i+ di$o#de# o the GI t#a+t +ha#a+te#i>ed by
i"lammatio" o the i"te$ti"e a"d #e$ulti"& i" abdomi"al +#ampi"&
a"d pe#$i$te"t dia##hea
ii, /#e$e"tatio" % $i&"$'$ymptom$
iii, Kia&"o$ti+ $tudie$
i5, T#eatme"t
i. Cleft lip+palate
i, Kei"itio"4 LI/ i"+omplete u$io" o emb#yo"i+ o#al +a5ity* may
be u"i o# bilate#al* +omplete o# i"+omplete* /.L.TE i"+omplete
u$io" o the ha#d a"d'o# $ot palate4 may be u"i o bilate#al*
+omplete o# i"+omplete
ii, /#e$e"tatio" % $i&"$'$ymptom$ (pi+tu#e i" $lide$)
iii, Kia&"o$ti+ $tudie$ 5i$ual exam
i5, T#eatme"t4 LI/4 7-;mo o a&e at lea$t 1Iw!$* =&b 1I&m$'dl* o#
1Ilb$* out-patie"t optio"* u"#e$t#i+ted b#ea$t o# bottle eedi"& ate#
$u#&e#y* /.L.TE @-1Mmo* Fday$ i" ho$pital* to"&ue $utu#ed i"
pla+e u"til .M du#i"& 1
$t
day
1, /ai" a+etami"ophe" with lip* IV "a#+oti+$ o# palate
F, /o$t-op AMh#$ pla$ti+ medi+i"e +up w' ble"de#i>ed ood*
$ot ood Fw!$* u"#e$t#i+ted diet 1mo (palate)* mi$t te"t
(palate) 1-Fw!$ o# i"e+tio" a"d ai#way* AMh#$ o# bottle
ate# palate* 1O STR.GS
7. /ailure to Thrie
i, Kei"itio"4 a $i&" o i"ade<uate &#owth #e$ulti"& #om i"ability to
O:T.I1 o# 3SE +alo#ie$ #e<ui#ed o# &#owth wei&ht below ;
th

pe#+e"tile o# a&e o# d#a$ti+ +ha"&e* +au$e i"ade<uate +alo#i+
i"ta!e* i"ade<uate ab$o#ptio"* dee+ti5e utili>atio"* i"+#ea$ed
metaboli$m
ii, /#e$e"tatio" % $i&"$'$ymptom$ - &e"e#al appea#a"+e (#edu"da"t
$!i" old$* dou&hy eeli"& o la#&e mu$+le ma$$e$* li$tle$$)*
beha5io#al (p#ee#e"+e o# ob6e+t$ o5e# people* a5oida"+e po$tu#e*
wat+hul)* "ut#itio" (eedi"& $!ill$* beha5io# a"d de5elopme"t*
a"th#opomet#i+* dieta#y a"aly$i$* b#ea$t eedi"& 5$ bottle* alle#&ie$*
i"tole#a"+e$* ood #e$t#i+tio"$* pa#e"tal eati"& habit$'attitude$
iii, Kia&"o$ti+ $tudie$ =&b $mea#* u#i"aly$i$ (!eto"e$)* $tool
(o5a'pa#a$ite$)* $weat te$t (0F)* tube#+uli"
i5, T#eatme"t "ut#itio" the#apy (mai" &oal)* +alo#i+ $uppleme"tatio"*
beha5io#al (#outi"e meal$* plea$a"t a"d #elaxed atmo$phe#e*
mi"imi>e di$t#a+tio"$* 1;-FI'meal* ;-1;'$"a+!* a5oid &#a+i"& a"d
"ibbli"&* ute"$il u$e)