Week 7

• NCM 109 Care of Mother and child at risk and with problems (acute and chronic)
• Ana Leah S. Grande, RN Lecturer-Clinical Instructor
• Weekly Topics


  • Week 1: Framework of MCHN, Genetics, Genetic Assessment and Counselling, Assessment for Risk Factors
  • Week 2: Nursing Role in Caring for a Family During Complications of Pregnancy, Birth or the Post Partal Period- Focus: Preexisting or Newly Acquired Illness
  • Week 3: Nursing Role in Caring for a Family During Complications of Pregnancy, Birth or the Post Partal Period- Focus: Sudden Pregnancy Complication, Pregnant Family with Special Needs
  • Week 4: Nursing Role in Caring for a Family During Complications of Pregnancy, Birth or the Post Partal Period- Focus: Complication of Labor and Birth, Surgical Interventions For Birth
  • Week 5: Nursing Role in Caring for a Family During Complications of Pregnancy, Birth or the Post Partal Period- Focus: Post-partum Complication, Family with A High Risk Newborn, Child Born with Physical or Developmental Difference
  • Week 7-11: Nursing Role in restoring and Maintaining the Health of Children and Families with Physiologic Disorders
• Week 7 Topics


  • Child with Respiratory Disorder
  • Child with Cardiovascular Disorder
• Week 7 Objectives


  • Describe the common respiratory and cardiovascular disorders
  • Assess a child with cardiovascular and respiratory disorders
  • Formulate nursing diagnoses and care plans related to the disorders
  • Establish outcomes based on the priority of needs of the child
  • Evaluate outcomes for achievement and effectiveness of care
• Hypoxemia


  Deficient oxygenation of the blood
• Paroxysmal coughing


  Series of expiratory coughs after a deep inspiration
• Tachypnea


  Increase in respiration
• Chest retractions


  Indrawing of intercostal spaces
• Clubbing of the fingers


  Change of angle between the fingernail and nailbed
• Rhonchi


  Snoring sound
• Stridor


  Harsh strident sound on inspiration
• Wheezing


  Expiratory whistle
• Rales


  Fine crackling sound
• Pulse Oximetry


  Non invasive technique for estimating arterial oxygen saturation
• Normal Pulse Oximetry Reading

  • 95 - 100%
• Normal ABG


  • pH: 7.35-7.45
  • PCO2: 35-45
  • HCO3: 22-26
• Humidification


  Adding moisture to a room by emitting a stream of fine droplets of water into the air
• MDI


  Metered dose inhalation- handheld device that provides a route for medication administration directly to the respiratory tract
• 5 general rule in using MDI

  • Shake the canister
  • Exhale deeply
  • Activate the inhaler and place in the mouth as they begin to inhale
  • Take a slow inhalation
  • Hold breath for 5 to 10 seconds
• Chest physiotherapy


  • Postural drainage
  • Percussion
  • Vibration
• Incentive spirometry


  Devices that encourage children to inhale deeply to aerate the lungs fully or to move mucus
• Endotracheal intubation


  A tube is inserted into the trachea if the patient is unable to oxygenate or ventilate adequately
• Tracheostomy


  Opening a trachea to create an artificial airway for prolonged ventilation
• Suctioning of the ET or Tracheostomy

  • Hyperoxyginate the patient
  • Use sterile technique
  • Never apply suction during suction catheter insertion
  • Apply suction only during withdrawal of the suction catheter for no more than 10 seconds
• Oxygen Administration requires careful administration and safety precaution
• Too low oxygen


  Will cause hypoxia
• Too high oxygen


  Will cause retinopathy of prematurity
• Oxygen needs proper humidification
• Oxygen concentration: 21% lowest O2 concentration
• Infants younger than 18 months are obligate nose breathers
• Keep open flames away from the oxygen, no smoking signs
• Choanal Atresia


  A congenital obstruction of the posterior nares
• Choanal Atresia


  • Maybe unilateral or bilateral
  • May have signs of respiratory distress at birth
  • May have difficulty with feeding thus IV fluid is given
  • Usually confirms during suctioning since the suction tube cannot pass through
  • Another way to confirm is by closing the newborns mouth then compressing each nostril, infants struggle to breathe and will become cyanotic
• Treatment for Choanal Atresia


  Local piercing or surgical removal of the bony growth
• Acute Nasopharyngitis


  Also called common colds
• Toddlers can have 10 to 12 colds a year
• Incubation period for common colds

  2 to 3 days
• Causes of common colds

  • Rhinovirus
  • Respiratory syncytial virus (RSV)
  • Adenovirus
  • Parainfluenza
  • Influenza viruses
• Symptoms of common colds

  • Nasal congestion
  • Watery rhinitis
  • Low grade fever
  • Pharyngitis (sore throat)
  • Cough