11/6/14

Chapter 40 Module 2

Infection – Invasion of pathogen Effect – Body response (Raise in temperature, WBCs)

Pathogens enter through skin and mucous membrane and orifices(even urethra – UTI)

Mechanisms of expulsion

1) changing PH were organism to invade 2) Hair 3) Coughing(silia) 4) Inflammation

Colds most common form or respiration infection – dehydration, tachycardia

Yellowish discharge from nose, dry mouth, unable to breathe, drinking less or not at all

Dehydration – no tears, lower weight, timid and weak movements, no crying

Treatment – oral hydration, IV

Epiglotittis – infection is serious -

Epiglottitis is a medical emergency that may result in death if not treated quickly. The epiglottis is a

flap of tissue that sits at the base of the tongue that keeps food from going into the trachea

(windpipe) during swallowing. When it becomes infected and inflamed, it can swell and obstruct or

close off the windpipe, which may be fatal unless promptly treated. -

http://www.emedicinehealth.com/epiglottitis/article_em.htm

makes groaning sound –may need innervation

cool air, aerosol therapy, anti-biotics

Checking for level of consciousness

Babies like eyeglasses, toys and stethoscopes – helps with interaction

Interaction – social interaction is very important, lack of changing diaper – dehydration

S&S – be vigilant

breathing, restlessness, dehydration, tachycardia(can go above 150 in children)

Thermometer in mouth when they cannot breathe through nose – limits airway

babies are familiar with their surroundings and atmosphere, especially when they receive painful

procedures

Fluid volume overload – 50cc is 1/10th of bodyweight, 200-300cc can be lost when dehydrated, ask

mother about weight, weigh diapers

Upper Resp Infection

stop spread of infection; separate from healthy children, proper general precaution, keep records of

temp.; follow up with labs – check sodium and potassium levels for dehydration

Chlamydia can cause pneumonia in children

Be vigilant – check temperature regularly, lips should be rosy and moist looking, keep in mind

children’s milestone, weigh baby daily

Study Common Cold, Flu, pharyngitis, bronchial problems

Children loose fluids

frequent urination, diarrhea(most common), fever, tonsillitis(drink less – dehydration), fontanelle

depressed, sunken eyes

Reactive portion of lungs where exchange happens

Children are prone to resp. issues b/c of their anatomical structure is shorter and under-developed,

bronchi and trachea are collapsible in children, prone to narrowing and constriction

*keep sanitizer handy

Innervation and tracheotomy may be necessary at some point and the only option

Spasmodic Laryngitis in infants – 3 yrs., limited to children, horseness, fever, chill, stridor

*symptoms remain the same throughout all resp. infections

Bacterial Tracheitis – spitum is thick and hard to bring up, horseness reduces

Treatments are the same but you still need to differentiate

Bronchitis – poor perfusion, pupillary reaction diminished, limited consciousness, pale lips, culture

the spitum – use mist to help hydrate lungs

Pneumonia – whatever can pass through resp, passage can cause pneumonia, especially in winter,

evidence by restlessness, altered mental status – poor perfusion

reduce pain, postural drainage

Peds

Prioritize nursing intervention w/ infant – urine collection and catherization

catheter is evasive, do least evasive

Scenario -

7 mos. Vet. M lethargic, difficulty breathing, nutrition

treated for dehydration, social services(blanket of services), removal of catheter by mother

Focus not just on patient and care-giver

urine specimen, non-compliance, assess root of non-compliance, get translator find out what is the

perception of the mother, ask open ended questions

remember infants communicate through crying

nutrition is a limited resource in this situation, look at impact of finances

99.2 F 182/43 resp. 36 96% pain 2 – no recent pain med.

24ml an hour; similac, dehydration – labs

Assessment – check fontanels, check eyes, check for tenting, tachycardia, check pulse

assessment for adult and infant are similar for hydration except for fontanel

Elderly and peds are very sensitive to heat and water retention, heart works twice as hard to

compensate for decrease in blood volume of fluid

The focuses are: Dehydration, Psychosocial, socioeconomic, urine sample

get translator – assess signs of abuse, assess interaction between mother and child

*place them in a position to be complaint and educated

*do not assume noncompliance is a form of abuse

*Secondary Care

Foly Catheter does not need written consent but can be refused