Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide

Nursing assessment for RSV: • Head to toe general assessment o Assess breath sounds o Check temperature o Check pulse oximetry • Review laboratory and radiology reports o Look for inter-costal retractions o

Nasal washes may be done to test for the virus o x-rays o CBC with differential Nursing diagnosis for RSV: • Risk for impaired gas exchange related to increased respiratory secretions • Risk for altered body temperature related to infectious process • Risk for ineffective infant feeding pattern related to increased breathing efforts Nursing interventions for RSV: • Assess breath sounds often for rhonchi and wheezes; look for retractions • Check temperature and administer antipyretics • Monitor pulse oximetry • Keep head elevated for respiratory comfort • Keep nose clear of mucous with bulb syringe • Offer small feedings and clear liquids • Provide humidified air • Oxygen per MD orders • Give breathing treatments as ordered byMD • Administer antiviral medications if ordered: o Ribavirin: This drug is an antiviral that is used to treat Hepatitis C. In nebulizer form, it has been found to be helpful in severe respiratory viral infections. o Albuterol: Breathing treatments with Albuterol via nebulizer have been found to be helpful. o Epinephrine: This drug is used when there is extreme respiratory distress and can either be taken via injection or in a breathing treatment. • Teach about isolation, hand washing, and thorough cleaning of surfaces.

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