Nursing BRONCHOPULMONARY dysplasia
INTRODUCTION
Bronchopulmonary dysplasi (BPD) is a chronic disease, are progressive and have an unknown cause characterized by pulmonary edema, bronchial and alveolar hypertrophy, and needs oxygen all the time ..
BPD typically occurs in premature infants with respiratory syndrome, respiratory problems who had endotracheal intubation, oxygen delivery with a high concentration, high positive-pressure ventilation in a long period. There is a 25% mortality over the age of 1 year.
Without treatment performed, support treatment, usually focused on treatment of symptoms. Possible complications include pernafasdan a chronic disease, frequent respiratory infections, pneumothorax, heart failure, pulmonary hypertension, and sudden infant death syndrome.
ASSESSMENT
Breathing
Respiratory Disorders
Retraction
Dyspnea
Crackle
Ronchi
Wheezing
Atelectasis
Cardiovascular
Elongated capillary filling time
Right heart failure
Gastrointestinal
Difficulty eating
Weight loss
Musculoskeletal
Fatigue
Delayed growth
Integumentary
Pale
Cyanosis around the lips
Psychosocial
Pending development.
Nursing Diagnosis
Impaired gas exchange in relation to atelectasis
Expected results
Children will improve gas exchange marked reduction in wheezing, chest retraction decreased, pink skin color. And capillary filling time of 3 to 5 seconds.
Intervention
Assess the child's respiratory status and fluid status, note the skin color, breathing effort, retraction, capillary filling time, the sound of the breath, secretions, vital signs, and edema every hour to 4 hours. Report various deviations from baseline data.
Perform chest physiotherapy every 4 hours as far as can be tolerated and do suksion 4 times per day or, if necessary.
Give oxygen if necessary. Monitor the condition of the skin surface oxygen if needed (levels as high as 90s)
Give bronchodilators, according to the instructions
Monitor fluid intake and output in children carefully
Give a diuretic, according to the instructions
Monitor electrolyte levels
Increase fluid intake in children if no contraindications
Rational
monitoring is necessary because children with BPD susceptible to lower respiratory infections, hypertension, and respiratory failure.
Chest physiotherapy helps remove mucus in the lungs and help to remove it. Suctioning mucus will issue from the airway mucus.
BPD can cause hypoxia by intermittent or persistent, give oxygen therapy
Bronchodilators may be considered for treatment of acute respiratory infection or increasing air flow in alveoli.
Monitoring fluid intake and output in order to help maintain adequate hydration, if required to help thin mucus.
Diuretics help to improve respiratory function by reducing the risk of fluid retention and pulmonary edema.
Required monitoring, especially in the provision of diuretics; can occur hypokalemia.
Increase your intake of fluids will help thin mucus.
Nursing Diagnosis
Nutritional deficiencies: lack of demand associated with increased metabolism and the high caloric needs.
Expected results
Children will get the calories marked with weight gain.
Intervention
Weigh the body weight every day at the same time (usually before breakfast), without clothes and with the same scales.
consultation to the dietitian at the child's diet plan, especially when children need a high calorie formula given or provided.
Using the extra time with children during meals, as needed to enable to burp and break
Feeding through a nasogastric (NG) tube, as needed at night
Check placement of NG tube before meals (air aspiration).
Rational
weigh weight every day as a basis for determining the weight gain or weight loss.
Dietitian can help determine the nutritional needs of children based on age-appropriate development data. Increase calorie intake of children, dietitian will provide advice to eat little but often with supplements and a high calorie formula, such as oil from the middle trigleserida chain in the formula to increase the total volume consumed
Children with BPD often experience fatigue during eating and needed additional time to finish his food.
If the child is not enough to consume enough calories during the meal, eating through the NG tube to help maintain weight
It is known that the NG tube in the stomach to help prevent aspiration.
Nursing Diagnosis
Barriers to growth and development associated with chronic illness, premature, or a long hospital stay
Expected results
Children will increase its development with good although he prematurely or with chronic illness.
Intervention
Review the status of child development using standard development tools, such as Washington or Denver Guide Delopmental Screening Test II. Consult your child's development to the experts, if available.
If possible, assign specific personnel to care for children
Plan individual development, including stimulation of sight, hearing, touching, and sosial.Setelah tailored development plan, all state child care provider to see the plan.
Assess the child's response to sounds and colors and shapes in a variety of distances to determine if the child has trouble hearing or seeing. Report of assessment such as an interruption occurs suddenly.
Rational
Children with BPD had a risk of resistance development due to a long hospital stay and decreased intake of oxygen; examine carefully to identify the barriers that occur. Child development experts to help assess the barriers that occur in children and create a treatment plan.
Children are treated by the same officer would be better to follow its development.
Specific plan to find the unique developmental needs of children. Listing of the plan will ensure all officers are in contact with children can provide consistent stimulation.
Barriers to development can be a barrier to hear or see, therefore, need to be detected early.
Nursing Diagnosis
Risk of disruption associated with the role of parental chronic illness.
Expected results
Parents will give effective attention to their children is marked by express feelings effectively and demonstrate a positive interaction behaviors, such as touching, stroking, holding, and eye contact directly.
Intervention
Encourage parents to participate in child care
Give encouragement behavior supports, such as touch and hold the child.
Discuss with parents to treat the child as an individual. Give a chance to express concern about his sick son.
Helps parents Identify stressors (such as providing care is constantly on anaknnya) and solve the problem. Refer to the appropriate social service agency or the support group, if needed.
Rational
Direct participation in the nursing child will increase the bonding
Reinforcement will encourage parents to repeat the behavior in question.
Looking at children as individuals will help improve the bonding between parent and child. Expressing concern will help parents to open their feelings and adjust to the situation.
Because stressors can be overwhelming, parents may need help dealing with the pressure that is felt because anank sick. Social service agencies and support groups will provide emotional and financial support.
Nursing Diagnosis
Risks of damage to the integrity of the skin associated with irritation by NG tube.
Expected results
Children will maintain the integrity of the skin characterized by pink skin color, skin around the nostrils and cheeks remain intact.
Intervention
Apply a skin protector as Stomahesive, on both cheeks and secure pleister from the area in dioles and cannula.
Review and clean the skin to remove dirt, if necessary
Robah child lying position every 2 hours.
Rational
Smear of the skin will help pleister of irritation to the skin of children
Review regularly and skin care helps prevent skin damage.
Changing the child's body position to help prevent skin damage.
Nursing Diagnosis
Anxiety (parents) are associated with lack of knowledge about the sick children.
Expected results
Parents will express that anxiety is reduced in relation to the child's condition and reduced fears related to procedure.
Intervenasi
Assess understanding of the condition of children of parents - including chronic conditions and treatment.
Explain all treatments, procedures and equipment.
Provide emotional support to parents during the child-patient stay.
Rational
The assessment will provide the basis to start teaching and makes it possible to start teaching.
The explanation given before and during the hospital will provide knowledge and understanding to help clarify the error, reduce anxiety.
Emotional support to help parents adjust to the crisis of hospitalization.
Nursing Diagnosis
Lack of knowledge related to home care
Expected results
The parents will express pemahamannnya about home care instructions and demonstrate procedures for home care.
Intervention
Explain to parents the importance of children exposed to cold air, humidified air.
Teach parents to the signs and symptoms of respiratory disorders, including dyspnea, Tachypnoea, cyanosis, and retraction.
Teach parents how to provide safe okdigen; including descriptions of the instruction speed and frequency.
Teach parents how and when given the drug, including information about dosage and reaction information.
Convince parents to attend classes cardiopulmonary resuscitation before the child returns
Teach parents how to provide food to the NG tube if the child had gone home. Include specific information about the placement of tubes, liquid food, and an indication of aspirations.
Rational
Humidity will thin mucus and allow it to breathe easily. Humidity cold air from a humidifier or nebulizer is safer warm air from evaporation could memyebabkan fire or grow fungus.
Knowing some of the signs and symptoms parents can quickly contact a doctor for help.
Children with BPD are usually given continuous oxygen. Parents need to previously know how to secure, and maintain appropriate.
Parents need to know how to provide consistent and safe drug. Knowledge also helps give a boost following the treatment program.
For children with BPD increased risk of respiratory problems, parents need to know how membewrikan fast service in case of emergency.
For children with BPD cederung have aspirations because it is often given food through NG or gastrostomy tube in some cases. Parents need to know how to feed and monitor the progress and what was done in case of aspiration.
Documentation checklist
Over at the hospital, notes:
The status of children and assessments have been made during hospitalization
Changes in the child's condition
Associated with pemeiksaan laboratory and diagnostic tests performed
Fluid intake and output
Nutrition
Child treatment response
The reaction of children and parents to disease and hospitalization
Guidelines for teaching patients and families
Guidelines for home plans
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