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What is a complication of Nebulized aerosol therapy?
Tachycardia
- Nursing actions
- assess the child's cardiac status
- stop the medication
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What is a complication of use of a metered dose inhaler (MDI) or Dry poweder inhaler (DPI)?
Fungal infections of the mouth may occur with corticosteroid use.
- Nursing Actions
- administer cool liquids
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Chest physiotherapy (CPT)
use of a set of techniques that include percussion, vibration, and postural drainage. Gravity and positioning loosen respiratory secretions and move them into the central airways where they can be removed by coughing or suctioning to promote removal of excessive secretions from specific area of the lungs.
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Contraindications for chest physiotherapy (CPT)
decreased cardiac reserves, pulmonary embolism, or increased intracranial pressure
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Nursing actions for Chest physiotherapy
- schedule treatments 1 hour before meals or 2 hours after meals and at bedtime to decrease the likelihood of vomiting or aspirating
- administer a bronchodilator medication or nebulizer treatment 30 min to 1 hr prior to postural draingage if prescribed
- offer the child an emesis basin and facial tissues
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Chest physiotherapy positions
Remain in each postition for 10 to 15 mins
- apical sections of the upper lobes- fowler's position
- posterior sections of the upper lobes- side-lying position
- right lobe - on the left side with a pillow under the chest wall
- left lobe - trendelenburg position
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Complications of chest physiotherapy
Hypoxia
- Nursing actionsMonitor respiratory status
- D/C procedure if the child experiences dyspnea
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What are the early signs of hypoxemia?
- tachypnea
- tachycardia
- restlessness
- pallor of the skin and mucous membranes
- elevated blood pressure
- symptoms of respiratory distress (use of accessory muscles, nasal flaring, tracheal tugging, adventitious lung sounds)
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what are the late signs of hypoxemia?
- confusion and stupor
- cyanosis of skin and mucous membranes
- bradypnea
- bradycardia
- hypotension
- cardiac dysrhythmias
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Signs and symptoms of hypercarbia
- restlessness
- hypertension
- headache
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While administering oxygen be sure to monitor temp for hypothermia.
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Nursing implications for Oxygen hood-- small plastic hood that fits over the infant's head
- use a minimum flow rate of 4 to 5 L/min to prevent carbon dioxide buildup
- ensure that the child's neck, chin, or shoulders do not rub against the hood.
- secure a pulse oximeter to the child for continuous SaO2 monitoring.
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Nursing implications for oxygen tent--- large plastic tent that fits over the crib or bed and can provide oxygen and humidity if prescribed
- for children over 2 to 3 months old
- set on high flow rate to flood the tent with oxcgen. then adjust flow meter to the desired amount prior to placing the child into the tent. Repeat if the tent has been opened for an extended period of time.
- an oxygen level greater than 30% to 50% FiO2 is hard to maintain, especially if the child is restless in bed.
- keep the tent around the perimeter of the bed.
- plan care to minimize how often the tent is opened
- monitor the temperature inside the tent to ensure that is is appropriate
- use plastic or vinyl toys, avoiding soft toys and toys that are mechanical or electrical
- keep the child warm and dry
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Nursing implications for nasal cannula--- disposable plastic tube with two prongs for insertion into the nostrils that delivers an oxygen concentrations of 24% to 40% FiO2 at a flow rate of 1 to 6 L/min
- safe, easy, and well tolerated
- child can eat, talk, and ambulate
- assess patency of nares
- ensure proper fit
- monitor for skin breakdown or dry mucous membranes
- water soluble gel if nares are dry
- provide humidification for flow rates greater than 4 L/min
- monitor child frequently
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Complications of oxygen therapy
Combustion
- Nursing actionsPlace "no smoking" or "oxygen in use" signs
- know where fire extinguisher is located
- have child wear cotton to avoid sparks of static electricity
- ensure all electric machinery are well grounded
- avoid toys that may induce sparks
- do no use volatile, flammable materials (acetone, alcohol) near children using oxygen
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complications of oxygen therapy
oxygen toxicity- can result from high concentrations of O2 (typically 50%), lung duration of oxygen therapy (typically greater than 24 to 48 hours) and the child's degree of lung disease
signs and symptoms- nonproductive cough, substernal pain, nasal stuffiness, nausea and vomiting, fatigue, headache, sore throat, and hypoventilation
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Endotracheal suctioning (ETS)
- high-fowler or fowler's position
- perform ETS through a tracheostomy or an endotracheal tube. Obtain a suction catheter with an outer diameter of no more than 1 cm (0.5in) of the internal diameter of the endotracheal tube
- hyperoxygenate the child using a bag-valve-mask (BVM) resuscitator or specialized ventilator function with an FiO2 of 100%.
- Obtain baseline breath sounds and vital signs
- Open sterile package
- Place sterile drape or towel on child's chest
- set up container touching only outside
- Pour 100 ml of sterile water or 0.9% sodium chloride (NaCl) into container
- Use sterile gloves
- clean/nondominant hands to hold connecting tubes
- sterile/dominant hand to hold sterile catheter
- set suction pressure no higher than 110 mm Hg for children, and 95 mm Hg for infants
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