Respiratory Problems Flashcards
(95 cards)
1
Q
FUNCTIONS OF THE RESPIRATORY TRACT
A
- RESPIRATION
- ACID BASE
2
Q
FUNCTIONS OF THE RESPIRATORY TRACT: Respiration_Breathing Sequence
A
- Phrenic nerve stimulation
- diaphragm and muscles contract; thorax expands
- Intrathoracic and intrapulmonic pressures decrease
- INSPIRATION : air moves from (+) pressure outside to (-) pressure in alveoli; stretch receptors are stimulated
- EXPIRATION : passive expulsion of air as elastic tissue recoils
3
Q
Hering-Breuer reflex
A
inspiration stimulates alveolar stretch receptors, which send inhibitory impulses to brainstem to prevent overdistention
4
Q
Chemoreceptors (central & peripheral)
A
stimulate respiration in
response to lowered pH, increased PCO2 and decreased PO2
5
Q
Medulla oblongata and pons
A
control respiration rate and depth
6
Q
Compliance
A
capacity of chest wall and lung to distend
7
Q
Resistance
A
mostly dependent on airway size, as well as tissue resistance
8
Q
Respiratory Tract in Infants and Children
A
- Neonate: rapid RR (high metabolism); rate
steadily decreases with growth and maturity - During growth: amount of oxygen in expired air
decreases, replaced by more carbon dioxide - Newborn and Infant: higher compliance due to flexible rib cage; with growth, compliance
decreases
9
Q
pH
A
hydrogen ion concentration in solution; measure of
acidity and alkalosis
10
Q
Steady pH concentration in the body
A
homeostasis; balance between acidosis and alkalosis
11
Q
Respiration’s role
A
pH drops, respirations increase to exhale more carbon dioxide; when pH rises, respiratory center decreases rate of respiration
12
Q
Alterations in exhalation of carbon dioxide (CO2) alter normal concentrations of carbonic acid (H2CO3) in the body results to….
A
respiratory acidosis or alkalosis
13
Q
Acidosis
A
excess presence of H+ ions
14
Q
Alkalosis
A
deficiency of H+ ions
15
Q
Acid Base Balance in Infants and Children
A
- In many disorders, symptoms like fever, vomiting or diarrhea, cause acid-base disturbances that are
more hazardous to a child than the primary
disorder - Hydration, electrolyte replacements, etc. can often stabilize these disorders
16
Q
ASSESSMENT AND
GENERAL PHYSICAL
EXAMINATION: Physical Observations
A
- Chest rise-and-fall (child 7 and up)
- Abdominal rise-and-fall (infant and young child)
- Nasal Flaring : indicates respiratory distress
- Skin : mottled, pallor, cyanosis
- Clubbing at fingertips, usually with chronic hypoxia
17
Q
ASSESSMENT AND
GENERAL PHYSICAL
EXAMINATION: Counting Respirations
A
Counting Respirations
- Abdominal movements in infant to age 7
- Chest movements in age 7 and up
- Count when child is restful and unaware
- Tachypnea: rapid respiration often due to awareness, excitement, anxiety, fever, other disorders
18
Q
Hyperpnea
A
excessively deep breathing; seen in fever,
anemia, etc.
19
Q
Hypopnea
A
shallow breathing
20
Q
Dyspnea
A
difficulty breathing
21
Q
Hypoventilation
A
too-shallow, too-slow breathing that fails to
meet the body’s needs. Seen in preterm infants and children with neuromuscular disorders
22
Q
ASSESSMENT AND
GENERAL PHYSICAL
EXAMINATION: Auscultation
A
- Airway patency
- Wheezing: musical breathing, usually on
expiration from narrowed airway or foreign body obstruction - Stridor: loud, high-pitched breathing;
inspiratory or expiratory; usually from narrowed upper airway or foreign body obstruction - Cough: voluntary or involuntary reflex
- Whoop: inspiratory sound with cough
associated with pertussis in small children
23
Q
ASSESSMENT AND
GENERAL PHYSICAL
EXAMINATION: Palpation/ Percussion
A
- Chest and back palpation for movement
- Fremitus: voice sounds while breathing
- Percussion: can be used to loosen secretions
24
Q
DIAGNOSTIC TESTS: Chest Radiograph
A
- Use of x-rays passed through the body to record internal structures
- Protect gonads and thyroid with lead shield
25
DIAGNOSTIC TESTS: Computed Tomography (CT Scan)
Use of x-ray sequences to demonstrate
cross-sections of the lung to detect lesions, masses, other abnormalities
26
DIAGNOSTIC TESTS: Bronchoscopy
Use of bronchoscope to directly inspect trachea and bronchi under sedation
27
DIAGNOSTIC TESTS: Pulmonary Function Tests
- Use of spirometry or pneumotachography to evaluate treatment and course of a disease
- less useful diagnostically
- spirometer measures lung volume and inhalation capacity to ascertain amount of air exchanged in breathing
28
DIAGNOSTIC TESTS: Sputum Culture
to assess consistency, color and pathogens
in secretions
29
DIAGNOSTIC TESTS: Pulse Oximetry
- Uses a photo detecting sensor clipped to a finger, toe or other
small appendage
- continuously monitor oxyhemoglobin saturation
- helps determine child’s need for O2 administration
30
DIAGNOSTIC TESTS: Arterial Blood Gases
assess levels of oxygenation and
gas exchange by analyzing blood from an
artery or capillary
31
COMMON
RESPIRATORY DISORDERS
IN PEDIATRIC PATIENTS
1. PHARYNGITIS
2. TONSILLITIS
3. ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
4. ACUTE EPIGLOTTITIS
5. ACUTE LARYNGITIS
6. INFECTIOUS MONONUCLEOSIS
7. OTITIS MEDIA
8. RSV (RESPIRATORY SYNCYTIAL VIRUS)
BRONCHIOLITIS
9. ASTHMA
10. PNEUMONIA
11. CYSTIC FIBROSIS
32
PHARYNGITIS
Infection and inflammation of the throat
33
PHARYNGITIS TYPES
- Viral
- Streptococcal- caused by GABHS
34
PHARYNGITIS - Viral
FACTS
- sore throat, fever & general malaise
- enlarged regional lymph nodes; erythema at the back of the pharynx & palatine arch
MANAGEMENT
- acetaminophen, ibuprofen
- warm heat to the external neck area for comfort
- gargle with warm water
35
PHARYNGITIS - Streptococcal caused by GABHS
S/Sx:
- erythema at the back of the throat & palatine
tonsils
- enlarged tonsils, white exudates in tonsillar crypts
- petechiae on palate, high fever
- extreme sore throat, difficulty swallowing
- overall lethargy
- headache
36
PHARYNGITIS Management: Pen G or clindamycin
- antibiotic treatment for 10 days
- advise parents to strictly follow course of
treatment to prevent hypersensitivity or
autoimmune reaction to group A strep causing Rheumatic fever or
glomerulonephritis
37
TONSILLITIS
- Infection and inflammation of the palatine tonsils
- In < 3 y.o, cause is viral, in school age, GABHS
38
TONSILLITIS S/Sx
- drooling
- difficulty swallowing
- high fever
- lethargy
- increased ASO titer
- enlarged, bright red
palatine tonsils
39
TONSILLITIS Management
- Antipyretic, analgesic
- Full 10 days antibiotic treatment (Pen
G or Amoxicillin)
- Tonsillectomy for chronic tonsillitis;
done when organs aren’t infected
40
Tonsillectomy Management
- Avoid red fluids
- Bleeding signs check: increased pulse & RR, frequent swallowing (cardinal sign of bleeding post tonsillectomy), throat clearing, feeling of anxiety
- Restrict child’s activity until after 7th day
- Offer sips of clear liquid, popsicles or ice chips
- Avoid acid & carbonated drinks
- Do position in prone or side lying position with head lower than the chest
41
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB)
1. Upper respiratory infection (type of croup) usually affecting children
under age 5 years; with slow progressive onset
2. An inflammation of the mucosa lining the larynx and trachea causing a narrowing the airway
3. Typical patient is a toddler who develops the classic “barking” cough and acute stridor after several days of coryza
4. Causes: parainfluenza virus types 1,2,3, RSV (Respiratory Syncytial
Virus), Influenza type A &B, measles, Mycoplasma pneumoniae
42
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB) S/Sx
- barking (brassy) cough that usually happens at night
- dyspnea
- hoarseness
- inspiratory stridor (produced by the
struggle to inhale air past obstruction and
into the lungs)
- low-grade fever (gradual onset)
- moderate respiratory distress with mild wheezing
- persistent laryngospasm
- Retractions
- respiratory acidosis and respiratory failure due to
hypoxia and airway obstruction
43
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB) Therapeutic Management
❖ Major objective is the medical management of infectious process and
maintaining an airway for adequate respiratory exchange
1. mild croup without stridor are managed at home
2. cool mist with dexamethasone or racemic epinephrine
3. fluids (oral and intravenous)
4. run shower or hot water tap in bathroom; keep child in warm, moist environment
5. monitoring for signs of respiratory distress
44
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB) NURSING INTERVENTION: Assessment
✔ Vigilant and accurate assessment of respiratory status: difficulty breathing, low-grade fever, inadequate ventilation, fatigue from persistent cough
✔ Noninvasive cardiac, respiratory and blood gas monitoring
Planning and Implementation
✔ Treat fever
✔ Push fluids
✔ Provide comfort and soothing
45
ACUTE LARYNGOTRACHEOBRONCHITIS (LTB) NURSING INTERVENTION: Planning and Implementation
✔ Ice chips or physician’s approved agents for irritated throat from
brassy cough
✔ Ensure immediate accessibility of intubation equipment
✔ Medications: corticosteroids, heliox (moderate to severe),
nebulized epinephrine
✔ If mist tent is not tolerated, cool moist mist blowing directly toward
the patient can be done
✔ Allow parent or caregiver to lie next to the child in the mist tent
to lessen anxiety
✔ Patient/ family teaching
- monitor fever
- offer comfort and distraction from restlessness
- irritability is to be expected
- Teach caregivers to monitor intercostal retractions, tachypnea, nasal flaring, increasing restlessness and/or continuous stridor (signs of respiratory distress)
46
ACUTE EPIGLOTTITIS
1. Life-threatening supraglottic obstructive inflammation
requiring emergency medical attention
2. Results from bacterial infection of the epiglottis
3. Occurs in children between 2-5 years old
4. Causes/ Transmission: H. influenzae, pneumococci,
streptococci, staphylococci; intake of smoke, hot substances or crack cocaine
47
ACUTE EPIGLOTTITIS S/Sx
- A cherry red epiglottis & muffled voice
- Absence of spontaneous cough
- Apprehension & Aggitation
- Bacterial infection
- Causes respiratory Stridor
- Croaking inspiration
- Drooling, Dyspnea, Dysphagia
- Fever
- Hypercapnia
- Muffled voice
- Rapid onset and rapid
progression to distress
- Retractions (Suprasternal and
substernal)
48
ACUTE EPIGLOTTITIS S/Sx if there is obstruction
✔ Hypoxia
✔ Acidosis
✔ Reduced level of Consciousness
✔ Sudden Death
49
ACUTE EPIGLOTTITIS Test Results
✔ (+) for H. influenzae
✔ Chest films
✔ WBC with differential count
50
ACUTE EPIGLOTTITIS Therapeutic Management
1. Immediate airway clearance via nasotracheal tube or tracheostomy
2. Radiology as needed for rapid visualization
3. With airway opened, administer humdified oxygen
4. Bypass diagnostics and invasive procedures until airway is established
5. All invasive procedures should be performed in the operating room or areas equipped to initiate immediate intubation
6. Antibiotic therapy
51
HUMIDIFIED OXYGEN ADMINISTRATION
- Via O 2 hood
- Mist Tent
- Croupette
52
HUMIDIFIED OXYGEN ADMINISTRATION Considerations
✔ Avoid mobile toys- soft, non-flammable toys, non battery operated only
✔ Be sure to provide cotton clothes
✔ Change and check the clothes & linens if wet
✔ Determine if the linens are properly tucked
✔ Ensure to prevent the escape of O2
53
ACUTE EPIGLOTTITIS NURSING INTERVENTION: Planning and Implementation
✔ Keep calm but move rapidly
✔ Never attempt to visualize the epiglottis directly w/ a tongue blade or obtain a throat culture until airway is cleared by primary care
provider (to prevent gagging and obstruction of epiglottis)
✔ Ensure availability of resuscitation and suction equipment
✔ Reassure child and family to reduce anxiety
✔ Droplet isolation precautions for first 24 hours after initiation of
antibiotic therapy
✔ Continuous respiratory status monitoring (pulse oximetry/ blood gases)
✔ Maintain IV infusion
✔ Allow child to remain in the caregiver’s lap and in the position that is most comfortable
✔ Medications: antibiotics (cephalosporins), corticosteroids
✔ Patient/ family teaching:
- once airway is cleared explain droplet precautions
- education regarding prophylactic antibiotics for household members and contacts
54
ACUTE LARYNGITIS
1. Most common in older children and adolescents
2. Causative agents are usually virus and is almost always
self-limiting without extended duration or sequelae
55
ACUTE LARYNGITIS S/Sx
- Hoarseness
- Sore throat Headache
- Coryza
- Nasal Congestion
- Fever
- Malaise
56
ACUTE LARYNGITIS Treatment
✔ supportive of the symptomatic presentation
✔ Fluids and humidified oxygen are highly encouraged
57
ACUTE LARYNGITIS Nursing Interventions
✔ Assist the patient to expectorate secretions adequately
✔ Avoid the spread of infection
✔ Maintain patent airway
58
Infectious Mononucleosis
- An acute, common infectious disease among young people under 25 years of age
- disease course is typically mild but can be severe in some cases, potentially leading to serious complications
- Caused by a virus similar to Epstein-Barr virus
- Transmission occurs through direct contact with oral secretions, blood, or through transplantation
59
Infectious Mononucleosis S/Sx
✔ Fatigue
✔ Malaise
✔ Sore throat
✔ Fever with: Generalized lymphadenopathy, splenomegaly, skin rash on trunk, enlarged and reddened tonsils, enlarged spleen, jaundice
60
Infectious Mononucleosis Test results
✔ Epstein-Barr (EB) virus is the principal causing agent
✔ Incubation period following exposure is 4-6 weeks
✔ Diagnosis is established by atypical leukocytes and (+)
heterophil agglutination test
✔ Spot test to determine blood agglutination of significant agglutinins
61
Infectious Mononucleosis Therapeutic Management
✔ Mild analgesic, rest, activity as tolerated
✔ Force fluids and humidified air
62
Infectious Mononucleosis Nursing Interventions
✔ Encourage rest
✔ Allow activities as tolerated
✔ Encourage rest
✔ Allow activities as tolerated
✔ Offer lozenges, liquids, ice chips (as appropriate) for throat pain
✔ Use liquid analgesics if swallowing hurts
✔ Monitor for serious complications (respiratory distress,
neurologic)
✔ Medications: mild liquid analgesic, ampicillin/ amoxicillin,
gargles for sore throat, antipyretics, corticosteroids (for
severe complications)
63
Infectious Mononucleosis Nursing Interventions: Patient/family teaching
- Complications are not usual
- Acute symptoms dissipate in a week to 10 days
- When spleen is enlarged, activities which may receive a blow to the abdomen must be avoided
- Exposure to persons outside the family should be carefully considered and adolescents should be
supported and assured that the illness is temporary
- Fatigue may take several weeks
- Immediate medical attention when respiratory distress or stridor is manifested
64
OTITIS MEDIA
1. Fluid and inflammation in the middle ear
2. Most frequently caused by RSV and influenza viruses
which may become bacterial
3. Transmission: airborne and direct contact
65
OTITIS MEDIA Clinical Manifestations
✔ middle ear pain and inflammation
✔ fever and otalgia (AOM)
✔ fluid in middle ear without infectious symptoms (OME)
✔ Eardrum perforation and tympanosclerosis (eardrum scarring)
✔ Cervical or preauricular lymph gland enlargement
✔ Rhinorrhea (nasal drainage), vomiting, diarrhea
✔ Loss of appetite
✔ Labyrinthitis (infection of inner ear) and mastoiditis (infection of
mastoid sinus) could occur
66
OTITIS MEDIA Therapeutic Management
✔ Observation
✔ Treat fever and ear pain
✔ Analgesic-antipyretics
✔ Heat or cold application
✔ Topical pain relief
✔ Tympanostomy tubes (recurrent & with bilateral hearing loss)
✔ Myringotomy (eardrum incision) to alleviate pain or drain fluid
67
OTITIS MEDIA Nursing Interventions
✔ Observation
✔ Treat fever and ear pain
✔ Heat pack application over ear
✔ Position child on affected side
✔ Assist in removal of drainage: wicks inserted loosely and frequent cleansing of outer ear
✔ Parent teaching on prophylactic care: upright position
when feeding ; avoid smoking around infants
✔ Provide emotional support by explaining the process for
management of drainage and encourage follow up evaluation of hearing
68
RSV (RESPIRATORY SYNCYTIAL VIRUS)
BRONCHIOLITIS
1. Acute viral infection of the bronchioles which frequently occurs in children <2 years of age
2. RSV or Respiratory Syncytial Virus is responsible for most
cases
3. Inflammatory process leads to airway edema and accumulation of thick, viscid mucus, causing air to be
trapped in the lungs.
4. The child can breathe air in but has difficulty expelling it. This hinders the exchange of gases, and cyanosis appears.
5. Transmission: direct contact with respiratory secretions; airborne particles; contaminated fomite contact
69
RSV (RESPIRATORY SYNCYTIAL VIRUS)
BRONCHIOLITIS S/Sx
✔ Rhinorrhea, low-grade fever, sneezing, decreased appetite
and dry and persistent coughing
✔ Wheezing, retractions, crackles, nasal flaring, dyspnea, prolonged expiratory phase and intermittent cyanosis
✔ Extremely shallow respirations and air hunger
✔ Barrel-shaped chest
✔ Dehydration
70
RSV (RESPIRATORY SYNCYTIAL VIRUS) Test Results
✔ Physical examination and medical history are the main diagnostic tools
✔ Nasal and nasopharyngeal secretions testing
- enzyme-linked immunosorbent assay (ELISA)
- Rapid immunofluorescent antibody (IFA)
71
RSV (RESPIRATORY SYNCYTIAL VIRUS) Therapeutic Management
✔ Symptomatic
- Fluids
- Medications as prescribed
- Airway maintenance
- Supplemental oxygen for inadequate oxygen saturation
✔ Hospitalization
- only for inadequate hydration, respiratory distress or complicating conditions
✔ Mist therapy combined with oxygen by hood or tent
✔ Ribavirin: a specific aerosol antiviral medication for RSV
bronchiolitis (for severely ill)
✔ Drug for prevention: RSV immune globulin intravenous
72
RSV (RESPIRATORY SYNCYTIAL VIRUS) Nursing Interventions
- Airway- neck slightly extended
- Bed head elevated 30-45 degrees
- Cool humidified O2
- Dehydration Monitoring
- Encourage handwashing
- For contact precaution
- Globulin immunization
73
ASTHMA
1. A chronic inflammatory bronchial response of airway
obstruction, bronchospasm, hyperexudation, and bronchial edema in response to patient-specific triggers
2. Triggers: can range from allergens or animal dander to anxiety, chemicals, cold air, weather changes, foods,
exercise, or URI pathogens; in infants, the most common is
RSV
74
ASTHMA S/Sx
- Breathlessness
- Dyspnea
- Long expiratory
rate
- Wheezing
- Tight chest
- Cough,
- Weakness from work of
breathing due to limited
airflow,
- Copious w/ white cast
mucus,
- Dehydration
75
ASTHMA: Pulmonary Function Test
Group of tests to measure lung function and gas exchange
1. Peak Expiratory Flow Rate (PEFR)
2. Spirometry
How: put in mouth, blows out as hard and as fast as possible, repeat twice more, record highest reading
76
Peak Expiratory Flow Rate (PEFR)
maximum volume of air released during a forced expiration
77
Spirometry
age 5 and older; measures both expired and inspired air through a mouthpiece; promotes maximum effort (with visual feedback); loosens secretion
78
ASTHMA Therapeutic Management
1. Step therapy with short acting beta agonist, depending on classification
- Intermittent asthma: as needed for symptoms
- Mild Persistent asthma: as needed for symptoms
- Moderate persistent asthma: daily to maintain maximum
functionality
- Severe persistent asthma: multiple times daily
2. Medications
- inhaled corticosteroids
- bronchodilators
- leukotriene modifiers
- Cromolyn sodium
- metered-dose inhaler
- anticholinergics
3. Avoid cough suppressants
4. For mild but persistent asthma- inhaled
anti-inflammatory corticosteroid: fluticasone
5. Severe persistent- oral & inhaled corticosteroid+ long acting bronchodilator +
short acting beta 2 agonist bronchodilator:
albuterol or terbutaline
6. Cromolyn sodium
- mast cell stabilizer; prevent
bronchoconstriction thereby preventing symptoms of asthma
7. Montelukast (Singulair)
- leukotriene receptor antagonist; used
as prophylaxis & for chronic asthma
8. theophylline/ aminophylline - WOF SE such as tachycardia and
hypotension
79
Asthma Nursing Interventions
✔ Monitor VS, oxygen saturation, breath sounds and ABG
✔ Monitor for S/Sx of hypoxia and carbon dioxide intoxication
(restlessness, mental confusion)
✔ Supervise respiratory exercises
- Increase fluid intake avoid milk & milk products
- Position upright & lean forward
80
Nursing Care: Acute Care for Status Asthmaticus
✔ B2 agonists and corticosteroid administration
- Allow child to assume comfortable position
- Administer oxygen for saturation above 90% and rescue meds
- Monitor for relief of respiratory distress
- Use calming methods if hyperventilation is noted in acute phase (slowed respiration techniques)
- Monitor for tachycardia, restlessness, irritability and hyperactivity
- Teach and monitor pulse oximetry
- Monitor IV fluids 85
81
PNEUMONIA
Acute inflammation of the pulmonary parenchyma associated with alveolar consolidation
82
What Causes Pneumonia
1. Bacterial
- pneumococcal (M. pneumoniae), streptococcal,
staphylococcal, chlamydial
2. Viral
- RSV, Cytomegalovirus, adenovirus, Influenza
3. Aspiration of lipid or hydrocarbon subs
4. NB born >24 hours after rupture of membranes
5. NB who aspirated amniotic fluid & meconium
83
Types of Pneumonia Infections
1. Pneumococcal
2. Chlamydial
3. Viral
84
Pneumococcal
abrupt, follows an URTI
85
Pneumococcal S/Sx
- Blood tinged sputum before 24 hours
- Crackles
- Thick purulent sputum after 24-48 hours
- Dullness on percussion
- High fever
- Retractions
- Chest pain
- Chills
- Nasal flaring
- Dyspnea
- Tachypnea
86
Pneumococcal Management
a. Ampicillin or 3rd generation cephalosporin
b. Amoxicillin Clavulanate (Augmentin)- for penicillin resistant organisms
c. Bed rest
d. Reposition child frequently
e. Humidified O2
f. CPT (Current Procedural Terminology)
g. Encourage to cough
h. Small frequent feedings
87
Chlamydial
common in NB up to12 weeks
88
Chlamydial S/Sx
- Nasal Congestion
- Tachypnea Rales
- Sharp cough
- Wheezing
89
Chlamydial MGT.
Macrolide antibiotic
- erythromycin
90
Viral Pneumonia
S/Sx
- Low grade fever
- Tachypnea
- Rales
- Non productive cough
- Diminished breath sounds
MGT.:
- Bed rest
- Antipyretic
- IVF
91
CYSTIC FIBROSIS
1. With generalized dysfunction of the exocrine glands
2. Autosomal recessive trait
3. Cause:
- abnormality of long arm of chromosome 7 inability to transport small molecules across cell membranes leading to dehydration of epithelial cells in the airway & pancreas
92
CYSTIC FIBROSIS Diagnostic Test
Pilocarpine Iontophoresis- >60 mEq/L (sweat test)
93
CYSTIC FIBROSIS S/Sx: tenacious secretions in pancreas & lungs
a. Increase Cl concentration of sweat
b. Boys have persistent blocking of vas deferens
c. Girls have thick cervical secretions
d. Large, bulky & greasy stool (steatorrhea)
e. Rectal prolapse
94
CYSTIC FIBROSIS
- Meconium ileus
- Protuberant abdomen
- Malnutrition
- Fat soluble vitamin
deficiencies
- Clubbed fingers
- Enlarged anteroposterior
diameter of chest
- Respiratory acidosis
- Hypoalbuminemia- edema
95
CYSTIC FIBROSIS NURSING DIAGNOSIS WITH INTERVENTIONS
1. Risk for Imbalanced Nutrition, less than body requirements r/t inability to digest fat
- high calorie, high protein, moderate fat diet
- adequate salt intake
- water soluble Vit. ADE
- Breastfeeding with formula- soybean formula for milk allergy
- take synthetic pancreatic lipase before each meal
- offer water frequently
- guard against overexertion or heat exposure
2. Ineffective Airway clearance r/t inability to clear mucus
- add acetylcysteine to mist
- no cough suppressants
- frequent repositioning
- bed rest- plan activities & rest periods before meals
