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Physical examination Purulent rhinitis Reddened nasal mucosa Flaring of alae nasi Petechiae on palate Red, swollen tonsillar tissue Harsh or ineffective speech Swollen and tender cervical lymph nodes Adventitious lung sounds (rhonchi, rales, wheezing) Tachypnea and tachycardia Retraction of supraclavicular, intercostal or subcostal muscles Hyperresonance (distended alveoli) Dull sound with percussion (consolidated alveoli) Headache from sinusitis Rubbing ear from ear pain Fever Coughing Cyanosis Non-midline trachea Grunting sound on expiration Dyspnea or apnea Crowing sound on inspiration (stridor) Enlarged antero-posterior chest diameter
Oral fluids Liquefying agents (expectorant) Humidification - Vaporizers - Nebulizers - Mist tents - Metered dose inhalers Coughing Chest physiotherapy Postural drainage with percussion Vibration Therapies to improve Oxygenation Oxygen administration Pharmacologic therapy Antihistamines (nasal sprays or drops) Bronchodilators Salbutamol (Ventolin) Theophylline epinephrine Antiinflammatory Incentive spirometry Breathing techniques Blowing through straw or balloon Suctioning Tracheostomy
Cystic fibrosis
- A disease in which there is generalized dysfunction of the exocrine glands. Mucus secretions of the body particularly pancreas and lungs are affected. Involvement of sweat glands leads to electrolyte imbalances. Etiolgy of Cystic fibrosis Chromosomal abnormality of the long arm of the chromosome 7 leads to an inability to transport molecules across cell membranes resulting in dehydration of epithelial cells in airways and pancreas. Pathophysilogy of Cystic fibrosis
Effects of cystic fibrosis on various organs - Lungs: Bronchiectasis Bronchitis Pneumonia Atelectasis Hyper inflation
Pneumothorax Sinusitis Nasal polyps Secondary corpulmonale - Pancreas: Pancreatic insufficiency Malaabsorption Steatorrhoea Pancreatitis Diabetes mellitus Meconium ileus (Newborn)
Esophageal varices - Gall bladder: Gall stones - Genital: Sterility - Sweat glands: Salt depletion Electrolyte imbalances - Salivary glands: Plugging and dilatation of ducts Abnormal electrolyte concentrations in saliva
Cyanosis Hemoptysis Atelectasis, pneumothorax, emphysema, respiratory failure an - GIT Meconium ileus Newborn will not pass meconium in 24 hrs. Abdominal distention and vomiting Pancreatic enzyme deficiency leading to Impaired conversion of food into absorbable nutrients. Impaired fat absorption Deficiency of vit. A,D,E and K. Decreased muscle mass and thin extremities Poor weight gain Bulky, foul smelling, frothy stool (steatorhhea) Prolapse of rectum, fecal impaction and intussusception Pancreas Acute pancreatitis & diabetes mellitus Genito urinary Delayed sexual functions Secondary amenorrhoea and cevicitis Infertility in male and female Sweat glands Infant tastes salty when kissed
For infants change diapers immediately when the stool is passed. After a bowel movement check the childs rectum for prolapse. If prolapse is present with a gloved lubricated finger replace it gently back. After replacement tape the buttocks together to maintain gentle pressure on the anus. Nursing diagnosis 4: High risk for ineffective family coping R/T chronic illness of a child. Interventions Teach the home care Regular follow up visits Arrange for schooling or a home tutor Encourage all family members in giving care
Source: http://www.nursing-lectures.com/2011/08/cystic-fibrosis-nursing-diagnosis-and-careplan.html