Nursing 211

N211: Health Differences Across the Lifespan I Includes tachypnea, inspiratory stridor, and a seal like barking cough. Noisy breathing and use of accessory muscles increase. Child may be agitates, restless and frightened. Client has a sore throat and rhinorrhea. Diagnostics Pulse oximetry will show hypoxia; chest x-ray shows narrowed airways. N rsing Interventions Include monitoring respiratory effort continuously to ensure a patent airway; observe for diminished breath sounds, circumoral cyanosis, diminished noisy breathing and drooling. Quiet respiratory effort is a sign of physical exhaustion and impending respiratory failure. Provide humidity and supplemental oxygen; IV fluids prevent dehydration and help liquefy secretions. Assist child to an upright position or any position of comfort; promote a calm, quiet environment; keep parent nearby to reduce child’s stress/crying. Keep emergency intubation equipment at the bedside. Monitor child’s anxiety level and provide emotional support. Medications Bronchodilators are used to decrease mucosal constriction and laryngeal edema; nebulized racemic epinephrine has a rapid onset with improvement of symptoms, although relapse may occur within 2 hours. Corticosteroids decrease inflammation and edema. Reinforce client and family teaching that symptoms are usually worse at night; instruct parents that the child is able to be cared for at home if able to take fluids by mouth and has no stridor at rest. Instruct parents on cool mist humidification and to seek medical attention immediately if breathing becomes labored, child seems exhausted or very agitated, or if symptoms do not improve after cool air humidity treatment. Epiglottitis (Supraglottitis) is a severe life-threatening infection of the epiglottis. Epiglottitis progresses rapidly, causing acute airway obstruction. Age groups affected are 1 year to 8 years. The organism usually responsible if Haemophilus influenzae. The epiglottis will become cherry red, swollen and so edematous that it obstructs the airway; secretions pool in the pharynx and larynx above the epiglottis; child has a sore throat and is unable to swallow; complete airway obstruction can occur within 2 to 6 hours. Onset is sudden in a previously healthy child; Hib vaccine has reduced its incidence of epiglottitis. Nursing Assessment Includes sudden onset, restlessness, high fever (102°F), sore throat, drooling, dysphonia (muffled voice), child assuming an upright sitting position with the chin out and tongue protruding (tripod position). Examination of the throat is contraindicated, because of risk of spasm and complete obstruction. Nursing Diagnosis

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