Nursing Epiglottitis
INTRODUCTION
Epiglottitis is infection of the airway obstruction is characterized by the acute respiratory disorders are rapidly dividing and inflammation of the epiglottis. The infection is caused by Haemophilus influenzae type b, with the start quickly. In particular, the child showed no signs of sleep and when I woke up with difficulty swallowing and sore throat. Fever and lethargy lasts quickly, followed by dyspnea.
This condition usually affects children between ages 2 and 5 years and can be life threatening if not immediately addressed. Handling including support mechanical ventilator or tracheostomy. Antibiotics are also used. Prognosis is generally good if the child is immediately received treatment.
ASSESSMENT
Breathing
History of injury to the throat with breathing problems start suddenly (dyspnea, Tachypnoea, retraction, wheezing)
Breathing through the mouth
Breath stridor
hypoxia
Cardiovascular
Tachycardia
The pulse is small
Gastrointestinal
Salivate
The inability to swallow
Musculoskeletal
Erect, chin-thrust posturing
Nervous
Integumentary
Increased temperature
Psychosocial
Worry
Fear
Nursing Diagnosis
Ineffective breathing patterns associated with upper airway edema
Expected results
Children will remain free to maintain the airway characterized by the absence of signs of acute respiratory disorders.
Intervention
Assess signs and symptoms of respiratory disorders of children, including dyspnea, Tachypnoea, cyanosis, pengeluaan saliva, and wheezing.
Prepare emergency means of intubation and tracheostomy child's bed side at all times.
avoid direct stimulation of the airway by pressing the tongue, culture swabs, suction catheter, or laryngoscope.
Let the child in a position comfortable as possible from the horizontal position (head higher above the bed).
Monitor continuously run private child's skin color, respiratory status, and heart rate to ensure free airway.
Rational
Assessment is needed to determine the child's condition and prevent respiratory failure perfectly.
Emergency equipment that is required intubation and tracheostomy beside the bed when there is a case obnstruksi airway completely.
different handling of the epiglottis that can cause laryngeal spasm and swelling, is likely to cause obstruction perfect. Direct examination can be performed during surgery or an emergency section.
Allow the child to obtain a pleasant psosisi will help alleviate anxiety and reduce the risk of increased respiratory problems. Penempatkan children in horizontal position can cause rapid deterioration of the network.
Continuous monitoring allows to detect the occurrence of a perfect obstruction, which can occur at any time.
Nursing Diagnosis
Ineffective airway clearance is associated with inflammation and edema.
Expected results
Children will mempertahankankan free and secure airway is characterized by the absence of respiratory problems.
Intervention
Assess the respiratory edekuat children, specifically note the signs of respiratory frequency pengingkatan
Pengingkatan children with soft ties at the wrist and the elbow.
Keep the endotracheal tube in place by using a safety ribbon tube on the upper jaw of children.
Keep the head and neck in neutral position (with head and neck in a straight position.)
Perform suctioning mucus caution in children through the endotracheal tube, if necessary, if secretion in the airway.
Give humidified oxygen using a face shield, nasal kanule, or ventilator, according to the instructions.
Rational
If there is a change of respiratory status is usually indicated respiratory problems.
Because reintubasi can make it difficult, traumatic and potentially life threatening, the binding required to prevent a child pulling out endothracheal tube.
Installation of the ribbon will guarantee to minimize movement and reduce indisiden due to extubation.
maintain minimal movement on the tube in the trachea, will menurnkan risk of trauma and subsequent stenosis occurred.
The child may need suctioning of mucus causes airway made affect the ability of mucus. Suction mucus done carefully to avoid trauma to the airway, which can increase the occurrence of hypoxia and atelectasis.
Humidified oxygen to prevent thick secretions become dry and in the airway.
Nursing Diagnosis
Risk reduction in fluid volume associated with decreased fluid intake.
Expected results
Children will maintain a balanced liquid tugor characterized by good skin, urine output of 1 to 2 ml / kg / hour, and capillary filling time of 3 to 5 seconds.
Intervention
Do not give children fluids by mouth prior to intubation.
Provide and monitor fluid I.V., as directed.
monitor children carefully in relation to fluid intake and output
Assess for signs of dehydration in children, including poor skin turgor, dry mucous membranes, and hollow crown and eyeballs.
Rational
Giving fluids by mouth before intubation can cause difficulty swallowing and increased risk of aspiration.
Per infusion fluid will maintain the child remains hydrated.
Reduced urine output is an early indicator of dehydration.
Dehydration berindsikasi that children require increased fluid intake.
Nursing Diagnosis
Hyperthermia associated with infection.
Expected results
Children will maintain body temperature less than 100 ˚ F (37.8 ˚ C)
Intervention
monitor the child's temperature every 2 to 4 hours in order to be evaluated.
give antipyretics (acetaminophen or ibuprofen, not aspirin), as directed.
Give a wet compress (98.6 ˚ F [37 ˚ C]) if treatment does not give the child the body temperature down.
Perform blood cultures, as directed.
Give antimicrobials, according to the instructions.
Rational
high temperature of 101.3 ˚ F (38.5 ˚ C) is usually associated with Haemophilus influenzae, the bacteria that most commonly cause epiglottitis.
Antipyretics help reduce fever and allows children berisitirahat more; of aspirin given to children under the age of 12 will be associated with Reye's syndrome.
konpres cold wet on the surface of the body, will enable blood vessels vasoconstriction, and the entire metabolism to be low, and the body temperature becomes lower.
culture is needed to identify and treat sepsis infection, which occurred over 70% of all children who suffer from epiglottitis.
Antimicrobials, such as cefuroxime (Ceftin), ampicillin (Omnipen), and chloramphenicol (chloromycetin), effective against H. influenzae.
Nursing Diagnosis
Anxiety and fear (of children) are associated with respiratory problems and stay patient in hospital.
Expected results
Children will decrease anxiety and fear characterized by a full rest and breathing is not difficult.
Intervention
Let the child in a pleasant position
delay all action to make sure the airway examination free.
Encourage parents to stay with their children and participate in treatment.
Explain all procedures and treatment of children within the limits that can be understood.
Give your child the familiar tools, such as dolls and blankets. If the child merima oxygen, then make sure the doll does not issue electrical spark.
Rational
put the child at a given position will increase the anxiety of children, which will cause an increase in respiratory problems.
Examination anxiety affects children, which can lead to increased respiratory problems.
Making children feel as comfortable as possible will reduce anxiety. The presence of parents and their involvement will give the children feel safe.
give an explanation before treatment can help reduce anxiety related to procedure and particular treatment.
Objects that are familiar to children will help children feel more secure in the hospital environment is alien to him. The game is out electric sparks can cause a fire of oxygen.
Nursing Diagnosis
Anxiety (parents) are associated with less knowledge of the attention the child's condition.
Expected results
Parents will be reduced his anxiety is characterized by the ability duikungan puts on children and explain the child's condition.
Intervention
Assess understanding parent to the child's condition and treatment yangdiberikan.
Describe the health conditions of children, various procedures and medications given.
pengutan provide behavioral support, such as speech and touch the child.
Provide emotional support to parents during their stay in hospital care.
Rational
Assessments conducted as a basis for planning teaching.
Provide an explanation before treatment and during the hospital stay will increase knowledge and understanding of eliminating errors, will reduce anxiety.
Reinforcement will encourage parents to continue the behaviors that support.
Listen to the attention of parents and their feelings will help address the crisis hospitalization.
Nursing Diagnosis
Lack of knowledge related to nursing home care
Expected results
The parents will express his understanding of home care instructions.
Intervention
Teach about antibiotic treatment, including information about such potential reaction occurs gastrointestinal disturbance, rash, and ganggua breathing (dyspnea, Tachypnoea, cyanosis, wheezing, and tachycardia). If the child has a fever, tell parents to use acetaminophen or ibuprofen instead of aspirin to reduce fever.
Explain pentinmgnya encouragement to children to drink two or four 8-oz (240 ml) glass of fluid every day.
Rational
Parents need knowledge of how and when the antibiotics are safe and consistent. Pengetahui possible reaction bantua treatment will eventually ask the doctor if necessary. Giving aspirin to children under the age of 12 will result in the occurrence of Reye's syndrome
Replacing fluids lost through expiration and difficulty in swallowing, inadequate fluid intake can increase the occurrence of dehydration and electrolyte imbalance even.
Documentation checklist
During his stay in hospital care, notes:
The situation of children and the assessment made during hospitalization
Changes in the situation of children
Associated with laboratory tests and diagnostic tests performed
Efforts intubation
Fluid intake and output
Response of children and treatment
The reaction of children and parents to the disease and stay patient in hospital.
Guidelines for teaching patients and their families
Guidelines for follow-up plan.
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