pedia ntbk
TRANSCRIPT
-
7/29/2019 Pedia Ntbk
1/5
A . M a t e r n a l a n d B i r t h H i s t o r y Date of birth: July 18, 2008Birth weight: 6 lbs. (as recalled by the
mother)Type of delivery: normal deliveryCondition after birth: normal, nocomplications afterbirthHospital: mother gave birth at their house by a
hilot
B . M o t h e r Complications of delivery: there were no complications asrecalled by themotherAnesthesia: no anesthesiaExposure to teratogens: none
TreatmentI f t h e c a u s e i s b a c t e r i a l , t h e g o a l i s t
o c u r e t h e infection with antibiotics. If the cause is viral,antibioticsw i l l n o t b e e f f e c t i v e . I n s o m e c a s e s ,i t i s d i f f i c u l t t o d i s t i n g u i s h b e t w e e n v i r
a l a n d b a c t e r i a l p n e u m o n i a , s o antibiotics
may be prescribed.Many people treated at home with antibiotics. Ifthere isan underlying chronic disease, severe symptoms, or lowoxygenlevels, it will likely require hospitalization forintravenousantibiotics and oxygen therapy. Infants and the
el de rl y ar emore commonly admitted for treatment of pneumonia.
If at home:
D r i n k p l e n t y o f f l u i d s t o h e l p l o o s e n s e c r et i o n s a n d bring up phlegm
Get lots of rest. Have someone else do household chores
Control your fever with aspirin or acetaminophen. Donot give aspirin to children.When in the ho spi tal , r esp ira tor y
tre at me nt s to remo vesecretions mat be necessary. Occasionally,steroid medicationsmay be use d to re duce wh ee zi ng if th er eis a n un derlyin g l ungdisease.
IX.LIST OF IDENTIFIED PROBLEMS
ACCORDING TO PRIORITY (P + E) A . I n e f f e c t i v e a i r w a y c l e a r a n c e r e l a t e dt o i n c r e a s e d s p u t u m production in response to
respiratory infectionB . I m p a i r e d g a s e x c h a n g e r e l a t e d t o
c o l l e c t i o n o f m u c u s i n airwaysC . I n f e c t i o n r e l a t e d t o i n v a d i n g b a c t e r i a l o r g a n i s m s
D . D i s c o m f o r t r e l a t e d t o r e s p i r a t o r y di s t r e s s E . H i g h r i s k f o r a l t er e d n u t r i t i o n ( l e s s t h a n
b o d y requirements) related to lack of appetite
XIII.DISCHARGE PLAN (HEALTH TEACHINGS)
-
7/29/2019 Pedia Ntbk
2/5
Take the entire course of any prescribed medications.Af te r
ap a t i e n t s t e m p e r a t u r e r e t u r n s t o n o r m a l , m e d i c a
t i o n m u s t b e c o n t i n u e d a c c o r d i n g t o t h e d o c t o r s in st ru ct io n s , o th er wi s ethe pneumonia may recur. Relapsescan be far more serious thanthe first attack.
Ge t p l en ty o f r e s t . A d e q u a t e r e s t i s i m p o r t a n t t o m a i n t a i n progresstoward full recovery and to avoid relapse.
Dr ink l o t s o f f l u i d s , e spe c i a l l y wa te r . L i q u i d s w i l l k e e p pat ie nt fr om becomi ng deh yd ra te dand help loosen mucus in thelungs.
Keep all of follow-up appointments. E v e n t h o u g h t h e p a t i e n t fe el s bet te r, hi s lu ngs ma yst il l be in fe ct ed . It s importantto have the doctor monitor hisprogress.
Encourage the guardians to wash patients hands. T he h an ds c o m e i n d a i l y c o n t a c t w i t h g e r m s t h a t c a n c a u s e p n e u m o n i a . These germs enter ones
body when he touch his eyes or rub hisno se. Washin g ha nd sthoroughly and often can help reduce therisk.
Tell guardians to avoid exposing the patient to anenvironmentwith too much pollution (e.g. smoke). Smoking damages oneslungsnatural defenses againstrespiratory infections.
Give supportive treatment.Pr op er die t an d oxy gen to incr ea se oxygen in the blood when
needed.
Protect others from infection.T r y t o s t a y a w a y f r o m a n y o n e w it h a co mp ro mi se d
immune system. When that isnt possible,
ap e r s o n c a n h e l p p r o t e c t o t h e r s b y w e a r i n g a f a c e m a s k a n d always coughing into a tissue.
Nursing Interventions (Independent andDependent)RationaleIndependentDocument actual weight and height. IndependentPatientmother may be unaware of the actual height and weightloss of his child due to estimating weightObtain nutritional history Monitor or explore attitudestoward eating and food. Patient Mother perception ofactual intake may differ Proper assessment guidesinformationAdvice the mother to serve food and fluids those are
appealing to the client. To stimulate appetite and promoteinterest in eating.
Home Treatment
The following tips are suggested:
Drink plenty of liquids.
Do not suppress a cough. Coughing is animportant reflex for clearing the lungs. Some
doctors advise taking expectorants, such asguaifenesin (Breonesin, Glycotuss, Glytuss,Hytuss, Naldecon Senior EX, Robitussin) toloosen mucus. However, there is no proof thatany of these products make much difference ina patient's outcome.
Mild pain can be treated with aspirin (in adultsonly), acetaminophen (Tylenol), or ibuprofen(Advil, Motrin).
For severe pain, codeine or another stronger
pain reliever may be prescribed. It should benoted, however, that codeine and othernarcotics suppress coughing, so they should beused with care in pneumonia. Such painrelievers often require monitoring.
A laboratory study reported that aromatic oilscontaining oregano, thyme, and rosewooddestroyed S. pneumoniae. It is not knownwhether they have any effect on pneumonia inpeople.
Practice chest therapy.
Surgery:
Although most patients with pneumonia do not needinvasive therapy, it may be necessary in patients withabscesses, empyema, or certain other complications.
Thoracotomy
Thoracotomy is the standard surgery for pneumonia. Itrequires general anesthesia and an incision to open thechest and view the lungs. This procedure allows thesurgeon to remove dead or damaged lung tissue. Insevere cases, the entire lobe of the lung is removed.This is called a lobectomy. Remaining healthy lungtissue re-expands after surgery to make up for tissuethat has been removed.
Chest Tubes
Chest tubes are used to drain infected pleural fluid.Tubes are not typically required for pneumonia orabscesses. The tubes are inserted after the patient isgiven a local anesthetic. They remain in place for 2 - 4days, and are removed in one quick movement. Thiscan be very distressing, although some patientsexperience no discomfort. Complications of chest tubesinclude:
Accidental injury to the lung
Fluid build-up within the lung if the pleural fluidis removed too rapidly
Infection
Perforation of the diaphragm
Removing the chest tubes may cause the lung tocollapse. In this case, a chest tube may be needed toinflate the lung
-
7/29/2019 Pedia Ntbk
3/5
-
7/29/2019 Pedia Ntbk
4/5
XII. HEALTH TEACHINGThe best way to control this is prevention.Teach the family about the management required for the disorder.Keep your environment clear of potential allergens.Pay attention to the weather and take precautions when you know weather or air pollution conditions may affect you. You may need to stay indoors or limit your exercise toindoor activities.Be smart about exercise.Encour age s ignif icant other s to do che st ta pping to fac ilita te m obili zation of secretion.En co ur ag e t o c ha ng e p at i en t ' s p os i t io n r eg ul ar l y t o f ac i l i t at e d ra i na ge an dmobilization of secretion.
Encourage to provide well ventilated area.Instruct to give medications at the right route, dose, and time.Remind significant others to always assess to patient needs.Instruct significant others to keep child always clean and dry.
Advise to go to the physician if signs and symptoms of pneumonia and bronchialasthma are observed.Teach the folks the importance of monitoring the progress and compliance withthe treatment regimen.Patient needs health promotions activities and health screening.Emphasize to the significant others the importance of having regular check-up toknow her present condition.
-
7/29/2019 Pedia Ntbk
5/5