Nursing 211

N211: Health Differences Across the Lifespan I Ineffective breathing related to inflammatory process Fatigue related to increased work of breathing • Fear related to respiratory distress and unfamiliar hospital environment and procedures • Fluid volume deficit related to dysphagia, dyspnea, and NPO status • Parental role conflict related to hospitalization of child Nursing Interventions Include maintaining child in upright position, encourage prevention with Hib vaccine, prepare for intubation or tracheostomy, administer IV antibiotics as prescribed, and employ measures to decrease agitation and crying. If intubation occurs it is usually for 24 hours; restraints may be needed to prevent tube dislodgement, because of swelling of epiglottis may prevent reintubation. Provide support for client and family; explain all procedures clearly and calmly. Keep child NPO, fluids provide hydration; administer antipyretics. After extubating, monitor child closely in intensive care unit to ensure immediate observation of respiratory effort. Antibiotics treat the bacterial infection, usually given for 7 to 10 days; child is discharged in about 3 days. Antipyretics treat fever andmanage pain of sore throat. Corticosteroids may be given for 24 hours before extubating to decrease edema. 2.16 Bronchiolitis Bronchiolitis (Respiratory Syncytial Virus) is a viral infection of the bronchioles that is characterized by thick secretions. This virus is prominent in young infants. RSV is highly contagious. Nursing Assessment Includes history of upper respiratory symptoms, irritable, distressed infant, paroxysmal coughing, poor eating, nasal congestion, nasal flaring, prolonged expiratory phase of respiration, wheezing and rales are auscultated. Condition deteriorates to rapid and shallow respirations. Diagnostic Include viral cultures via nasal swabs confirm the diagnosis of RSV. Nursing Diagnosis • Impaired gas exchange related to… • Ineffective airway clearance related to… Nursing Int rvent ons Include contact isolation; assign nurses to clients with RSV who have no other clients to prevent transmission of the virus. Monitor respiratory status and monitor for hypoxia. Clear airway secretions using a bulb syringe for suctioning. Provide care in a mist tent and administer oxygen as prescribed. Maintain oral and IV hydration. Monitor antiviral agent, ribavirin aerosol is prescribed. Evaluate response to respiratory therapy treatments. Administer palivizumab (Synagis) to provide • •

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