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ASTHMA NURSING
Asthma is a process of repeated respiratory obstruction, characterized by periods of sudden attacks and recurrent, which occurred bronchial spasms that cause airway obstruction. One of the main causes of chronic disease in children, this condition usually appears before age 5 years and sbebelum teens, more frequently in boys than women.
Although asthma attack is often caused by intrinsic factors (such as activity or allergy animal dander, pollen, cigarette smoke, or dust), intrinsic factors such as illness, stress, or fatigue factor is also the originator of the attack. Associated inflammation and edema that causes bronchial spasms. Mucosal cells produce thick secretions that are difficult to remove.
Treatment biasasnya form of steroids and bronchodilators, increased fluid intake, the handling associated with respiratory (such as coughing and breathing exercises in the event of a severe lung congestion or pneumonia, chest physiotherapy), and action nebulizer. In the event of infection, treatment may include antibiotics. Potential complications associated including pneumothorax, heart failure, respiratory infections, emotional disturbances, and can even die duna. In the same case, the child will develop the disease after adolescence or can be more progressive or emphysema as adults.
ASSESSMENT
Breathing
Shortness of breath
Wheezing respiratory long
Chest retraction
Tachypnoea
Cough dry, hacking cough (very frequent sign)
Ronchi
Nostril movement
Cardiovascular
Tachycardia
Neurological
Nervous
Anxious
Difficulty sleeping
Musculoskeletal
Not able to indulge
Integumentary
Cyanosis
Pale
Psychosocial
Non-compliant with treatment
Nursing Diagnosis
Impaired gas exchange related to bronchial constriction.
Expected results
Children will improve gas exchange is characterized by a reduction in wheezing and retraction, decreased cough, slightly reddish skin color, capillary filling time of 3 to 5 seconds, and reduced anxiety.
Intervention
Encourage the child to cough and deep breathing exercises every 2 hours. Instructed to breath in three to four times, then the rock in a sitting position.
If you need to do in order to suction mucus from the airway mucus
If the child has a severe lung congestion or pneumonia, perform chest physiotherapy three atu 4 times daily.
Assess the child's respiratory rate and auscultation of breath sounds.
Put children in high-Fowler's position or sitting position with his chest forward
Give bronchodilators such as albuterol, and steroids such as methylprednisolone (Solu-Medrol), or inhaled steroids.
Give oxygen humidifier, as directed
Monitor peak flow rate
Keep the possibility of allergen in the child's room.
Rational
Coughing helps clear mucus from the lungs, and breath in will improve oxygenation. Sitting up straight will ease a cough.
Suctioning mucus helps to remove secretions because the child can not remove itself.
Chest physiotherapy combined with postural drainage, chest percussion and vibration, cough and deep breathing exercises - to help eliminate and remove secretions, lung tissue development, and improve the efficiency of respiratory muscles.
This will provide data to assess changes in breathing before and after treatment.
This position will increase the chest expansion
Bronchodilators to relax bronchial smooth muscle; steroids will reduce inflammation.
Humidified oxygen will improve oxygenation and help remove secretions.
Peak flow rate is an indication of the level of pulmonary function disorder.
Allergens can induce asthma attacks.
Nursing Diagnosis
Fatigue related to hypoxic
Expected results
Children will show a reduction of anxiety and fatigue is characterized by a decrease in agitation, periods of undisturbed sleep, no sign of difficulty breathing, and increased ability to perform activities.
Intervention
examine the signs of hypoxia or hiperkapnea, including anxiety, agitation, cyanosis, increased heart frequency, and increased respiratory frequency.
Place the child in supine position with head elevated 54 degrees.
provide adequate rest and time cukup.Lakukan intervention as directed.
Rational
Early detection and prompt treatment of hypoxia and hiperkapnea and prevent anxiety and excessive fatigue.
Placing a child in that position will enhance the ability of the lungs to expand and improve oxygenation, and therefore will reduce the anxiety.
Rest in sufficient time will reduce the level of child activities, which would reduce the excessive urge to breathe and reduce fatigue.
Nursing Diagnosis
Less than the needs of nutritional deficiencies associated with gastrointestinal disorders.
Expected results
Children will be reduced gastrointestinal disorder characterized by reduced nausea and vomiting and increased intake of nutrients (over 80% of food spend on each meal).
Intervention
Give the child with food portions are small, but frequent (five or six per day) gave a preferred food.
Give soft foods, low in fat. Use color as directed; white foods - such as toast, potatoes, and pudding made from low-fat milk tends to be softened.
Avoid foods that can cause allergic responses, such as eggs, flour, and brown.
Rational
Foods that little, but often will reduce the energy to digest and does not cause excessive stomach filled, which can decrease lung expansion. Giving the children liked the food will assist an adequate dietary intake
Food is spicy and high in fat cause indigestion and not easily digested.
These foods can stimulate the allergy attacks in children who are sensitive to the food in question.
Flow clinic
Asthma
DRG: 98 (Pediatric asthma, ages 6 to 17)
The expected length of stay: 3 days
Planning
Laboratory tests
Test
Treatment / I.V.
Respiratory Handling
Osteopathic manipulative medicine (OMM)
Nutrition
Elimination
Activities
Patient education
Follow-up plan
Before the entrance / emergency section
Laboratory tests of blood chemistry
Pulse oximetry
Base line peak flow meter
Treatment cool aerosol
Giving oxygen
Day 1
Complete blood count and blood chemistry, if not done in the emergency
Weight loss
Maintaining I.V.
I.V.steroid
Treatment cool aerosol
Continuous oximetry
Pulse oximetry is stopped if the oxygen saturation by pulse oksimetry ateri (SpO2) above 93% air space
Oxygen therapy
Oxygen therapy is stopped when the SpO2 above or equal to 93% and the clinical condition is stable.
Check peak flow and oxygen saturation levels before treatment
Development of rib
Visible T4
The reduced diaphragm
OMM treatment every day
Noting that the more severe disease (asthma score)
Age-appropriate Diet
Give fluids / beverages
Normal age-appropriate
Intake and output (I & O)
Whenever possible
Peak flow meter with a record of asthma
Providing asthma education guidelines and discuss
patient instructions
Consider the handling of cases to arrange home visits if necessary.
Day 2
Replace infusion with NaCl
I. V. Steroids
Reevaluate cool aerosol treatment on each professional service
Check peak flow and oxygen saturation before action OMM
OMM actions performed stu times a day
Age-appropriate Diet
Note the fluid needs
Normal age-appropriate
I & O
That can be tolerated
Assessing activity tolerance
Use the inhaler to taste and according to the distance of time
The disease process
Stimulating environment
Brochures asthma
Assess the need for a nebulizer at home
Day 3
Check peak flow and oxygen saturation before handling OMM
Began to give oral steroids
Steroid / bronchodilator / salt cromolyn (through medication or cool aerosol metered-dose inhaler)
Follow the appropriate treatment protocol.
Diabetes management
Expenditure urine and feces within normal limits
Acceptable
Review
Physical therapy: a family demonstrating the appropriate use of inhalers and kuantititas required.
Teach using the pamphlet "Asthma Resources"
Gazette treatment appointment
-Albuterol
-Intal
Note asthma
Growth after 3 days
Advise patients to always carry a record of asthma in all doctor visits.
Objectives achieved
Respiratory frequency appropriate to their age
Objec stable on further treatment in 12 hours
Peak flow: an estimated 80%
Pulse oximetry above 97% in room air in 24 hours
Regular diet and acceptable
Output of urine and stool normally by age
Maintain a normal level without shortness of breath akitiftas
Patient / family revealed:
- Signs and symptoms of the disease process and complications
- Treatment (name, dosage, the influence of information, objectives, rules, interaction of food / medicine
- Understanding asthma peak flow meter zone and it works
- Environmental monitoring plan
- Asthma diary
Nursing Diagnosis
Risk reduction in fluid volume associated with fluid loss through the respiratory system
Expected results
Children will maintain adequate hydration is characterized by good skin turgor and urine output of 1 to 2 ml / kg / hour.
Intervention
Assess the child's skin turgor, and monitor urine output every 4 hours
Encourage children to drink three 8-oz (240-ml) glasses of fluid per day, depending on age.
Rational
Through pengakjian and monitoring will help determine the level of hydration and the need for additional fluids
Children need enough liquid to mepertahankan hydration and acid-base balance and prevent shock.
Nursing Diagnosis
Non-compliance associated with loss of self control
Expected results
Children will follow the medical and nursing care that is characterized by utilizing all the best action and participate in routine action.
Intervention
Precisely, let the children participate in the decision routine actions, such as chest physiotherapy activities and meals.
Explain to the children of all procedures, such as laboratory tests, and chest physiotherapy, and the reason that action is needed. Explain that laboratory tests allow doctors and nurses evaluate the effectiveness of chest physiotherapy pengeobatan and that can help remove secretions with cough effectively to facilitate breathing easily.
Rational
Give the child to control tindaklan very simple routines that will increase the feeling to control himself and enhance the fulfillment of all the action.
The explanation will help to reduce feelings of fear and losing control.
Nursing Diagnosis
Lack of knowledge related to home care
Expected results
Children and parents will mengekespresikan knowledge of nursing home care instructions.
Intervention
Explain the physiology of disease to children and their parents.
Based on the history of the child, teach about the factors that can increase asthma attacks, such as allergens, infection, activities, weather changes, and stress.
Teach children and parents in relation to the signs and symptoms of respiratory infection, including fever, respiratory problems, wheezing, and Tachypnoea.
Teach children and their families in relation to the importance of using all treatment measures and possible influence. Explain:
Metaproterenol (Alupent), is a bronchodilator that can cause gastrointestinal disturbances
Albuterol (Proventil), is a bronchodilator that can cause far-reaching implications.
Corticosteroids (anti inflmasi) that can cause barriers to development, gastrointestinal disorders, impaired immune response, and fluid retention (if given orally or IV)
Teach the child how to inhale drugs through regulatory dose inhaler inhalation, spacer devices, or both, if necessary
Explain to parents and children to avoid antihistamines during the attacks took place
Teach the importance of maintaining the level of activity appropriate to the child's condition.
Teach parents and if necessary how to monitor peak flow rate of children and report any changes. the doctor
Rational
An understanding of the disease helps to help children and parents follow the treatment program
Teaching such as this can help reduce the number of attacks in the future
Early detection and treatment of respiratory infections can prevent or reduce respiratory distress associated with asthma attacks.
Following the treatment program will ensure blood levels remain stable, and can control excessive asthma attacks.
This tool will improve the delivery of treatment with full doses, for children who are not easier to use a metered dose inhaler through a spacer device to use with an inhaler to help mempertanhankan the appropriate dose.
Antihistamines cause secretion becomes thick and difficult to be issued and may increase the occurrence of cough.
Maintain physical fitness it is important for normal development of children. Unless experiencing an acute asthma attack, the child will maintain the level of activity as usual.
Droplets on the peak flow rate indicates a change of treatment and dosage required.
Check the documentation
During his stay in the hospital, notes:
- The situation of children and the assessment when admitted to hospital
- Change the status of children
- Related to the findings of laboratory and diagnostic tests
- The ability of children and parents in dealing with acute asthma attack
- Intake and output fluid
- Intake of nutrients
- The response of children to treatment
- Reaction of children and the elderly to chronic illness and hospitalization
- Guidelines for teaching patients and their families
- Guidelines for follow-up plan.
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