PEDIATRIC

Bronchoasthma r/t

Nursing Assessment for Asthma / Childhood Asthma

● Respiratory Assessment
● Observe the child’s breathing pattern. Look for signs of difficulty
breathing, like fast breathing (tachypnea), use of accessory muscles
(muscles in the neck or between the ribs working hard to breathe), or
wheezing sounds when breathing out.
● Listen to Lung Sounds
● Use a stethoscope to listen to the lungs. Wheezing (a high-pitched
whistling sound), especially on exhalation, is a common finding in
asthma.
● Check for Coughing
● Note if the child has a persistent cough, which may worsen at night or
during exercise. The cough can be dry or may produce mucus.
● Observe for Chest Tightness
● Ask the child if they feel any tightness or pressure in their chest, which
is a common symptom of asthma.
● Assess for Shortness of Breath
● Look for signs that the child is having trouble breathing or feels short of
breath, especially after physical activity or during certain times (like at
night).
● Identify Triggers
● Determine if there are any specific triggers that seem to worsen the
child’s asthma, such as allergens (dust, pollen), irritants (smoke, strong
odors), cold air, or exercise.
● Review Past Medical History
● Check if there is a history of asthma or allergies in the family. Also,
review the child’s past medical history for any previous asthma attacks
or hospitalizations.
● Assess Medication Use
 ● Inquire about any asthma medications the child is taking, such as
quick-relief inhalers (like albuterol) or long-term control medications.
Check how often they are using these medications and if they are
using them correctly.
● Note Any Allergic Reactions
● Look for signs of allergies (like runny nose, itchy eyes, skin rashes) that
can be associated with asthma.
● Monitor Peak Flow Readings
● If the child uses a peak flow meter (a device that measures how well air
moves out of the lungs), review their readings. A lower reading than
usual can indicate worsening asthma.
● Evaluate Activity Tolerance
● Assess if the child’s asthma is affecting their ability to participate in
normal activities or play.

Nursing Interventions and Rationales Nursing Care Plan (NCP) for

Asthma / Childhood Asthma
● Assess respiratory status
● Get a baseline to determine the effectiveness of interventions and course of
treatment.
● During attacks, the patient will have tachypnea, wheezing and labored
breathing, nasal flaring, and/or retractions
● Monitor peak flow rates in children over 5 years old. Pulmonary function
testing
● In asthma, patients can inhale, but it is more difficult to exhale the air taken in.
A peak flow meter measures the lungs’ ability to expel air and regular use can
help recognize the signs of an attack before symptoms begin.
● Peak flow testing can help determine if treatment is working.
● Routine pulmonary function testing helps determine the course and
progression of the disease
● Assess the patient’s level of anxiety and provide relaxation techniques
● Being unable to breathe causes anxiety which, in turn, causes even more
constriction of the airways. Help the patient to learn coping and relaxation
techniques to control breathing and help reduce the severity of the attack
● Position upright
● Patients will need to sit upright to promote lung expansion and make air flow
easier. Patients may often be found in the tripod position.
● Administer medications via nebulizer
● Bronchodilators and corticosteroids can help reduce inflammation and
swelling which makes breathing difficult. A nebulizer works well to deliver an
adequate amount of medication into the lungs.
● Educate patient and parents/caregivers on how and when to use medications
and rescue inhalers (age-appropriate)
● Depending on the child’s age, an inhaler may be required for acute symptoms
and before and after exercise. Demonstrate use of inhaler with spacer for
children over 5 years old.
● Assist parents and providers in the creation of an Asthma Action Plan for
school or daycare
● An asthma action plan helps the parents, school, and daycare providers to
understand and control asthma in children.
● This plan outlines the patient’s known triggers and how to manage symptoms
that arise. If the patient must take maintenance or rescue medications during
school hours, this plan outlines the importance of that treatment and how to
administer those medications.
● Provide education for patients/parents regarding the use of maintenance
medications and how to recognize and avoid triggers
● Depending on the child’s age, the patient may use oral maintenance
medications or daily inhalers. Proper use of these devices helps maximize the
effectiveness of treatment.
● Help the patient to understand what triggers asthma attacks and how to avoid
those situations.
● Help parents understand that lifestyle and environmental changes may be
made, including pets in the home and exposure to cigarette smoke. Wash
patient’s sheets/linens weekly to kill and prevent dust mites.
 ● Encourage routine immunizations to help prevent diseases that may make
asthma worse.

NURSING CARE OF THE CHILD AND FAMILY

The primary role of the nurse is to provide education to the child and family so
that they are able to self-manage the asthma.

After the diagnosis of asthma is established, care should be given to the child
and family to ensure that they have a basic understanding of asthma and how
it is managed. The educational process should be comprehensive and
ongoing. It should include all members of the health-care team and should
occur across various settings.

Additionally, the nurse should develop a partnership with the parents and the
child. This partnership includes the development of mutually agreed-upon
treatment goals. The child should be involved as much as possible in
establishing goals of therapy.

The nurse must create an environment that encourages open communication.

Such a relationship will allow the nurse to effectively assess barriers to care as
well as adherence to treatment.

All patients should receive basic education regarding asthma in a culturally

competent manner. The essential components of an educational program
include basic facts about asthma, how to assess the level of control, how
asthma is treated (this includes information about medications and allergen
avoidance), how to use prescribed devices, how to Asthma 211 respond to
signs and symptoms of worsening asthma, and when and where to seek
medical attention. The educational plan should be individualized to meet the
needs of the parents and child and should include the provision of an asthma
action plan.

Prior to providing the education, the nurse should make an assessment of

what the parents and child already know about asthma. This evaluation
provides the nurse with the opportunity to reinforce accurate messages and to
correct inaccurate ones. The nurse should also determine how much
information to provide at each setting so as not to overwhelm the parents and
the child.
SCABIES

Classic scabies. In classic scabies infection, typically 10-15 mites (range, 3-50) live
on the host; little evidence of infection exists during the first month (range, 2-6 wk),
but after 4 weeks and with subsequent infections, a delayed type IV hypersensitivity
reaction to the mites, eggs, and scybala (feces) occurs.

Crusted scabies. Crusted, or Norwegian, scabies (so named because the first
description was from Norway in the mid-1800s) is a distinctive and highly contagious
form of the disease; in this variant, hundreds to millions of mites infest the host
individual, who is usually immunocompromised, elderly, or physically or mentally
disabled and impaired.

Nodular scabies. Nodules occur in 7-10% of patients with scabies, particularly

young children; in neonates unable to scratch, pinkish brown nodules ranging in size
from 2-20 mm in diameter may develop.

Assessment and Diagnostic Findings

The diagnosis of scabies can often be made clinically in patients with a pruritic rash
and characteristic linear burrows.

● Burrow ink test. A burrow can be located by rubbing a washable

felt-tip marker across the suspected site and removing the ink with an
alcohol wipe; when a burrow is present, the ink penetrates the stratum
corneum and delineates the site; this technique is particularly useful in
children and in individuals with very few burrows.
● Tetracycline. Topical tetracycline solution is an alternative to the
burrow ink test; after application and removal of the excess tetracycline
solution with alcohol, the burrow is examined under a Wood light; the
remaining tetracycline within the burrow fluoresces a greenish color;
 this method is preferred because tetracycline is a colorless solution and
large areas of skin can be examined.
● Skin scraping. Definitive testing relies on the identification of mites or
their eggs, eggshell fragments, or scybala; this is best undertaken by
placing a drop of mineral oil directly over the burrow on the skin and
then superficially scraping longitudinally and laterally across the skin
with a scalpel blade.
● Adhesive tape test. Strips of tape are applied to areas suspected of
being burrows and then rapidly pulled off; these are then applied to
microscope slides and examined; the adhesive tape test is easy to
perform and had high positive and negative predictive values, making it
a good screening test.

Nursing Diagnosis SCABIES

Based on the assessment data, the major nursing diagnosis for patients with
scabies:

● Risk for infection related to tissue damage.

● Impaired skin integrity related to edema.
● Acute pain related to injury to biological agents.
● Disturbed sleep pattern related to itchiness and pain of lesions.

Nursing Care Planning and Goals

The major nursing care planning goals for a patient with scabies:

● Patient remains free of infection, as evidenced by normal vital signs and

absence of signs and symptoms of infection.
● Patient and communities demonstrate an understanding of the plan to
heal tissue and prevent injury.
● Patient and communities describe measures to protect and heal the
tissue, including wound care.
 ● Patient describes satisfactory pain control at a level less than 3 to 4 on
a rating scale of 0 to 10.

Nursing Interventions

The following are the nursing interventions for a patient with scabies :

● Prevent infection. Wash hands and teach the patient and SO to wash
hands before contact with patients and between procedures with the
patient; encourage fluid intake of 2,000 to 3,000 mL of water per day,
unless contraindicated; teach the patient, family, and caregivers, the
purpose and proper technique for maintaining isolation; if infection
occurs, teach the patient to take antibiotics as prescribed. Instruct the
patient to take the full course of antibiotics even if symptoms improve or
disappear.
● Restore skin integrity. Monitor the status of skin around the wound;
monitor patient’s skin care practices, noting the type of soap or other
cleansing agents used, temperature of water, and frequency of skin
cleansing; tell the patient to avoid rubbing and scratching; provide
gloves or clip the nails if necessary; and instruct patient, significant
others, and family in the proper care of the wound including hand
washing, wound cleansing, dressing changes, and application of topical
medications).
● Relieve pain. Acknowledge reports of pain immediately; provide rest
periods to promote relief, sleep, and relaxation; provide analgesics as
ordered, evaluating the effectiveness and inspecting for any signs and
symptoms of adverse effects; and determine the appropriate pain relief
method.
 RESPIRATORY NURSING CARE PLAN (BRONCHOPNEUMONIA)

NURSING DIAGNOSIS: Ineffective airway clearance related to

inflammation increased secretion, proc as evidenced by presence of
secretion, productive cough and tachypnea

GOALS: Patient will maintain a patent airway as evidenced by clear breath sounds,
oxygen saturation within normal limits, and the ability to cough to clear secretions.

ASSESSMENT

1. Identify patients at risk for ineffective airway clearance.

Those with diseases and disorders that specifically cause respiratory dysfunction;
cystic fibrosis, asthma, emphysema, or neuromuscular disorders that affect the
ability to clear secretions; ALS, myasthenia gravis, those with swallowing
impairments or a poor gag/cough reflex, and patients who are on mechanical
ventilation or have a tracheostomy are at risk for poor airway clearance.

2. Assess lung sounds.

Diminished lung sounds or adventitious lung sounds such as wheezing, stridor,
rhonchi, or crackles can result from an accumulation of secretions or a blocked
airway.

3. Assess respirations.
Note the rate, depth, pattern, and use of accessory muscles when breathing.
Increasing rate, nasal flaring, and accessory muscle use is an attempt to
compensate for ineffective breathing.

INTERVENTIONS

1. Position to decrease secretions.

Maintain an elevated head of bed as tolerated to help prevent secretions from
accumulating. Sliding down in the bed or a slumped posture prevents proper lung
expansion and can reduce coughing effectiveness.

2. Suction as needed.
Patients may require naso/tracheal/oral suctioning to clear the airway, especially in
the presence of an artificial airway or if the patient is unable to cough or swallow.

3. Mobilize secretions.
Teach coughing and deep breathing exercises. If coughing is painful the patient can
splint the abdomen with a pillow. Use an incentive spirometer to keep the lungs
expanded. Encourage movement and walking to mobilize secretions.

4. Give respiratory medications.

Administer bronchodilators to open airways, mucolytics or expectorants to thin
mucus and make it easier to cough up, and antibiotics to treat respiratory infections
as ordered.

5. Involve respiratory therapy.

Respiratory therapists can incorporate more advanced interventions and can
recommend treatment changes. They often administer nebulizer treatments and can
apply humidification to oxygen to prevent dryness. They can also perform chest
physiotherapy which loosens secretions and improves drainage.

6. Encourage fluid intake.

Drinking plenty of fluids thins secretions and prevents dehydration. Instruct patients
to drink 2L of water a day if not contraindicated.

7. Discuss lifestyle modifications.

Patients who smoke should be advised to quit, especially if they have lung conditions
such as COPD or asthma as this only exacerbates their conditions. Patients who are
subjected to smoke inhalation at a worksite should use a mask.
8. Educate on signs of ineffective airway clearance and prevention.
Patients and caregivers should be educated on signs and symptoms to seek
treatment promptly. This can include signs of infection such as a fever or change in
mucus color and amount as well as any changes to respiratory rate or pattern.
Instruct on proper techniques to suction and that a humidifier in the home can keep
secretions thin.

9. Obtain sputum sample.

If the nurse suspects that there is a risk of infection, sputum samples can be cultured
for the presence of bacteria.

10. Ensure proper equipment at discharge.

Coordinate with the discharge planner to ensure respiratory equipment needed for
the patient, such as a CPAP, nebulizer, oxygen concentrator, or suctioning equipment
are delivered. The nurse or RT can also educate the patient or caregiver on how to
safely and effectively use the equipment.
Ineffective breathing pattern related to inflammation as evidenced by
tachypnea

Teach and assist the patient with proper deep-breathing exercises.

Demonstrate proper splinting of the chest and effective coughing while in an
upright position. Encourage the patient to do so often.
Coughing can be voluntary or reflexive, and lung expansion maneuvers like deep
breathing with an incentive spirometer can stimulate a cough. The nurse encourages
patients to perform an effective directed cough to improve airway patency. This
involves correct positioning, deep inspiration, closing the glottis, contracting
expiratory muscles against the closed glottis, opening the glottis suddenly, and
exhaling forcefully. The nurse may assist by placing hands on the lower rib cage to
guide slow deep breaths and provide external pressure during exhalation if needed.
These may include:

● Deep breathing exercises facilitate the maximum expansion of the

lungs and smaller airways and improve the productivity of cough.
● Coughing is a reflex and a natural self-cleaning mechanism that
assists the cilia in maintaining patent airways. It is the most helpful way
to remove most secretions.
● Splinting reduces chest discomfort and an upright position favors
deeper and more forceful cough effort making it more effective.

Assess and record respiratory rate and depth at least every 4 hours.
The average respiratory rate for adults is 10 to 20 breaths per minute. It is important
to take action when there is an alteration in breathing patterns to detect early signs
of respiratory compromise.

Assess ABG levels according to facility policy.

This monitors oxygenation and ventilation status.

Observe breathing patterns.

Unusual breathing patterns may imply an underlying disease process or dysfunction.
Cheyne-Stokes respiration signifies bilateral dysfunction in the deep cerebral or
diencephalon related to brain injury or metabolic abnormalities. Apneusis and ataxic
breathing are related to the failure of the respiratory centers in the pons and medulla.

Auscultate breath sounds at least every four (4) hours.

This is to detect decreased or adventitious breath sounds.

Assess for the use of accessory muscle.

Work of breathing increases greatly as lung compliance decreases.

Monitor for diaphragmatic muscle fatigue or weakness (paradoxical motion).

Paradoxical movement of the abdomen (an inward versus outward movement during
inspiration) is indicative of respiratory muscle fatigue and weakness.

Observe for retractions or flaring of nostrils.

These signs signify an increase in respiratory effort.

Place patient with proper body alignment for maximum breathing pattern.
A sitting position permits maximum lung excursion and chest expansion.

Encourage sustained deep breaths by:

● Using demonstration: highlighting slow inhalation, holding end

inspiration for a few seconds, and passive exhalation
● Utilizing incentive spirometer
● Requiring the patient to yawn

These techniques promote deep inspiration, which increases oxygenation and

prevents atelectasis. Controlled breathing methods may also aid slow respirations in
tachypneic patients. Prolonged expiration prevents air trapping.

Encourage diaphragmatic breathing for patients with chronic disease.

This method relaxes muscles and increases the patient’s oxygen level.
Maintain a clear airway by encouraging the patient to mobilize their own
secretions with successful coughing.
This facilitates adequate clearance of secretions.

Suction secretions, as necessary.

This is to clear the blockage in the airway.

Stay with the patient during acute episodes of respiratory distress.

This will reduce the patient’s anxiety, thereby reducing oxygen demand.

Ambulate patient as tolerated with doctor’s order three times daily.

Ambulation can further break up and move secretions that block the airways.

Encourage frequent rest periods and teach the patient to pace activity.
Extra activity can worsen shortness of breath. Ensure the patient rests between
strenuous activities.

Encourage small frequent meals.

This prevents crowding of the diaphragm.

Help the patient with ADLs, as necessary.

This conserves energy and avoids overexertion and fatigue.

Avail a fan in the room.

Moving air can decrease feelings of air hunger.

Educate patient or significant other on proper breathing, coughing, and

splinting methods.
These allow sufficient mobilization of secretions.
Activity intolerances related to high respiratory demands AEB
tachypnea

Determine the patient’s response to activity. Note reports of dyspnea,

increased weakness and fatigue, changes in vital signs during and after
activities.
Establishes patient’s capabilities and needs and facilitates the choice of
interventions.

Assess the patient’s baseline level of function and activity tolerance.

Using a standardized tool such as the Functional Independence Measure (FIM) can
provide a baseline of function and activity tolerance and can help determine the
appropriate interventions and monitor the patient’s progress.

Provide a quiet environment and limit visitors during the acute phase as
indicated.
Encourage the use of stress management and diversional activities as appropriate.

Encourage the patient to perform deep-breathing exercises.

Deep-breathing exercises can help reduce stress and when used together with a
spirometer can help clear secretions from the lungs.

Explain the importance of rest in the treatment plan and the necessity of
balancing rest activities.
During the acute phase, bedrest is maintained to reduce metabolic demands and
conserve energy for healing. Subsequent activity restrictions are determined based
on the patient’s response to activity and the resolution of respiratory insufficiency.
The nurse emphasizes the importance of rest and advises the debilitated patient to
avoid excessive exertion, as it can exacerbate symptoms. Encouraging a
comfortable position, such as semi-Fowler’s position, supports rest and optimal
breathing. Frequent position changes are encouraged to aid in clearing secretions
and improve pulmonary ventilation and blood flow. Outpatients receive education on
the importance of avoiding overexertion and engaging in moderate activity during the
early stages of treatment.
Pace activity for patients with reduced activity.
Effective coughing may exhaust an already compromised patient. Fatigue may be a
contributing factor to ineffective coughing.

Assist patient to assume a comfortable position for rest and sleep.

The patient may be comfortable with an elevated head of the bed, sleeping in a
chair, or leaning forward on an overbed table with pillow support.

Assist with self-care activities as necessary. Provide for a progressive

increase in activities during the recovery phase and demand.
Minimizes exhaustion and helps balance oxygen supply and demand.

Encourage the patient to set realistic goals for activity and progress.
Setting realistic goals can help the patient stay motivated and feel a sense of
accomplishment as they progress.

Encourage the patient to have adequate rest and sleep as needed. Encourage
activities such as walking or stretching.
Rest is necessary for the body to heal, but too much rest can actually contribute to
fatigue. Encouraging the patient to engage in gentle activities can help improve
energy levels and prevent deconditioning.

Refer the patient to a rehabilitation specialist for further fatigue management

strategies.
A rehab specialist can provide additional support and specialized insights for the
client to manage their fatigue.
Fluid volume deficit related to decreased oral intake

1. Assess vital sign changes: increasing temperature, prolonged fever,

orthostatic hypotension, tachycardia.
Elevated temperature and prolonged fever increase metabolic rate and fluid
loss through evaporation. Orthostatic BP changes and increasing tachycardia
may indicate systemic fluid deficit.
2. Assess skin turgor, moisture of mucous membranes.
Indirect indicators of adequacy of fluid volume, although oral mucous
membranes may be dry because of mouth breathing and supplemental
oxygen.
3. Investigate reports of nausea and vomiting.
The presence of these symptoms reduces oral intake.
4. Monitor intake and output (I&O), noting color, the character of urine.
Calculate fluid balance. Be aware of insensible losses. Weigh as
indicated.
Provides information about the adequacy of fluid volume and replacement
needs.
5. Force fluids to at least 3000 mL/day or as individually appropriate.
Meets basic fluid needs, reducing the risk of dehydration and mobilizing
secretions, and promotes expectoration.
6. Administer medications as indicated: antipyretics, antiemetics.
To reduce fluid losses.
7. Provide supplemental IV fluids as necessary.
In the presence of reduced intake and/or excessive loss, the parenteral route
may correct the deficiency.
8. Identify factors contributing to nausea or vomiting: copious sputum,
aerosol treatments, severe dyspnea, pain.
Choice of interventions depends on the underlying cause of the problem.
9. Provide a covered container for sputum and remove it at frequent
intervals. Assist and encourage oral hygiene after emesis, after aerosol
and postural drainage treatments, and before meals.
Eliminates noxious sights, tastes smells from the patient environment, and
can reduce nausea.
10. Schedule respiratory treatments at least 1 hr before meals.
Reduces the effects of nausea associated with these treatments.
11. Maintain adequate nutrition to offset hypermetabolic state secondary to
infection. Ask the dietary department to provide a high-calorie,
high-protein diet consisting of soft, easy-to-eat foods.
To replenish lost nutrients.
12. Consider limiting the use of milk products.
Milk products may increase sputum production.
13. Elevate the patient’s head and neck, and check for tube position during
NG tube feedings.
To prevent aspiration. Note: Don’t give large volumes at one time; this could
cause vomiting. Keep the patient’s head elevated for at least 30 minutes after
feeding. Check for residual formula regular intervals.
14. Auscultate for bowel sounds. Observe for abdominal distension.
Bowel sounds may be diminished if the infectious process is severe.
Abdominal distension may occur due to air swallowing or reflect the influence
of bacterial toxins on the gastrointestinal (GI) tract.
15. Provide small, frequent meals, including dry foods (toast, crackers)
and/or foods that appeal to the patient.
Patients experiencing symptoms such as shortness of breath, fatigue, and
decreased appetite may benefit from consuming fluids to maintain hydration
and provide essential nutrients. These measures may enhance intake even
though appetite may be slow to return.
16. Evaluate general nutritional state, obtain baseline weight.
The presence of chronic conditions (COPD or alcoholism) or financial
limitations can contribute to malnutrition, lowered resistance to infection,
and/or delayed response to therapy.
17. Monitor and record intake and output accurately. Observe urine color.
Watch out for urinary output <30ml per hour.
Helps assess fluid balance. Urinary output less than 30 ml for two consecutive
hours is a sign of fluid volume deficit. Dark-colored urine reflects increased
urine concentration.
18. Weigh the patient daily at the same time of the day in the same clothes
using the same scale; Monitor for trends (weight changes of 1-1.5 kg
 day).
Aids in establishing accurate measurement of weight. A fluid volume deficit or
excess indicator is a weight change of 1- 1.5 kg/day.
19. Assess skin turgor and mucous membranes for any indication of
dehydration.
Dryness of the tongue and mucous membranes of the mouth, longitudinal
tongue furrows are symptoms of deficient fluid volume.
20. Monitor and record vital signs.
Changes in vital signs seen in a patient with hypovolemia include increased
temperature, increased heart rate, and decreased blood pressure.
21. Encourage frequent oral hygiene.
Oral hygiene can moisten dried mucous membranes and allows the patient to
react to the sensation of thirst.
22. Advice patient to increase fluid intake for at least 2.5 L/day as
appropriate.
This measure helps in maintaining adequate hydration.
23. Maintain intravenous fluid therapy as indicated.
Parenteral fluid replacement is administered to prevent the occurrence of
shock.
24. Provide humidified oxygen therapy as indicated.
Humidity lessens convective moisture losses while in oxygen therapy.
Altered nutritional status than body requirement related to feeding
difficulty AEB poor oral intake

Obtain the patient’s height and weight. Weigh the patient daily at the same
time with the same clothes before breakfast.
These measurements are required to determine nutritional needs. Daily weights
provide feedback about whether the treatment plan needs adjustments.

Collaborate with a licensed dietitian regarding the nutritional status and diet
planning.
Based on lab values, assessment, and other indicators, the dietitian can
determine the patient’s daily caloric and nutritional requirements to increase
weight and maintain an ideal weight. The dietitian will also consider the patient’s
ability and preferences of food intake.

Provide good oral care and place the patient in an optimal position.
Poor oral hygiene and ill-fitted dentures can make the experience of eating
unpleasant and make the patient eventually lose interest in eating. Elevating the
head of the bed or even placing the patient in the chair while eating ensures the
best posture possible for food digestion.

Provide an inviting environment and offer opportunities to socialize during

mealtimes.
A pleasant environment without distraction, noise, and offensive or medicinal
odors makes it more enjoyable for the patient. In addition, socializing during meal
times has patients looking forward to mealtimes and might increase motivation to
eat.
Offer assistance with eating.
Preparing the meal tray, such as opening milk cartons, spreading butter on a
dinner roll, or cutting meat in bite-size pieces, facilitates the process and helps the
patient conserve energy for eating.

When feeding a client, be patient and allow enough time to complete the
meal.
Offering enough time between bites to thoroughly chew the food and offering sips
to drink makes the meal more enjoyable and encourages the patient to eat as
much as possible.

Encourage nutritional supplements and healthy snacks between meals.

Extra snacks and supplements, such as nutritional shakes, increase caloric intake.
However, advise the patient not to substitute meals with supplemental shakes.

Collaborate with occupational therapy to assist with individualized utensils

for disabled patients.
Physical impairment and deformities can make it more difficult and
energy-consuming to perform tasks such as eating. Adaptive aids such as scoop
dishes, curved utensils, or plate rims make eating much more manageable and
promote independence.

If swallowing impairment is suspected, collaborate with speech therapy.

Speech therapy will evaluate the patient’s impairment, and based on the results,
make recommendations about diet modifications, such as food consistency and
whether to use a straw.
Administer pain medication and antiemetics as ordered.
Nausea and pain may decrease appetite. Treating these conditions well before
meal time gives the medication enough time to work and increases patient
compliance to consuming meals.

Provide small frequent meals instead of three full meals.

If the patient cannot finish meals at designated times, offer more mealtimes with
smaller portions. Small, frequent portions might be more tolerable and increase
overall calorie intake.

Fear related to difficulty in breathing, unfamiliar situation,

procedure AEB crying and lack of coperation
 Hyperthermia

Nursing Interventions and Rationale for Pediatric Hyperthermia

Nursing Interventions

1. Monitor Vital Signs Frequently

o Intervention: Regularly monitor and document the child’s temperature,

heart rate, respiratory rate, and blood pressure.

o Rationale: Frequent monitoring helps assess the severity of hyperthermia

and the effectiveness of interventions.

2. Administer Antipyretics as Prescribed

o Intervention: Administer antipyretic medications such as acetaminophen

or ibuprofen as ordered.

o Rationale: Antipyretics help reduce fever and provide comfort.

3. Ensure Adequate Hydration

o Intervention: Encourage oral fluid intake and, if necessary, administer

intravenous fluids to maintain hydration.

o Rationale: Adequate hydration helps regulate body temperature and

prevents dehydration.

4. Promote Cooling Measures

o Intervention: Apply cool compresses to the forehead, axillae, and groin;

provide a lukewarm sponge bath; and ensure the child is dressed in light
clothing.

o Rationale: Cooling measures help lower body temperature and provide

comfort.

5. Maintain a Comfortable Environment

o Intervention: Keep the room temperature cool, use fans, and reduce
excess bedding.
 o Rationale: A cool environment helps reduce body temperature and
promotes comfort.

6. Monitor and Report Signs of Dehydration

o Intervention: Observe for signs of dehydration, such as dry mucous

membranes, decreased urine output, and skin turgor, and report to the
healthcare provider.

o Rationale: Early detection of dehydration allows for prompt intervention to

prevent complications.

7. Encourage Rest and Limit Physical Activity

o Intervention: Encourage the child to rest and avoid strenuous activities.

o Rationale: Rest helps conserve energy and reduce metabolic demands,

which can help lower body temperature.

8. Assess for Underlying Causes of Fever

o Intervention: Perform a thorough assessment to identify potential sources

of infection or other causes of fever.

o Rationale: Identifying and treating the underlying cause of hyperthermia is

essential for effective management.

9. Educate Parents and Caregivers

o Intervention: Provide education on how to manage fever at home,

including proper medication administration, hydration, and when to seek
medical help.

o Rationale: Educated caregivers are better equipped to manage fever and

recognize signs of complications.

10. Monitor for Complications

o Intervention: Observe for potential complications of hyperthermia, such as

febrile seizures, altered mental status, or heat-related illnesses, and take
appropriate actions.
 o Rationale: Early identification and management of complications can
prevent serious adverse outcomes.

Ineffective breathing pattern

Nursing Intervention and Rationale for Pediatric Ineffective Breathing Pattern

Nursing Intervention

1. Monitor Respiratory Rate, Depth, and Pattern

o Intervention: Assess and document the child's respiratory rate, depth, and
pattern regularly.

o Rationale: Monitoring respiratory parameters helps identify changes in

breathing pattern and detect respiratory distress early.

2. Positioning

o Intervention: Position the child in a comfortable position that promotes

optimal lung expansion (e.g., semi-Fowler's position or sitting upright).

o Rationale: Proper positioning enhances lung mechanics, improves

oxygenation, and facilitates easier breathing.

3. Administer Oxygen Therapy as Prescribed

o Intervention: Administer supplemental oxygen using appropriate devices

(e.g., nasal cannula, face mask) as ordered.

o Rationale: Oxygen therapy improves oxygenation, supports respiratory

function, and alleviates respiratory distress.

4. Monitor Oxygen Saturation

o Intervention: Continuously monitor oxygen saturation using pulse

oximetry.

o Rationale: Monitoring oxygen saturation provides real-time information on

the child's respiratory status and guides oxygen therapy adjustments.

5. Encourage Deep Breathing Exercises

 o Intervention: Encourage the child to perform deep breathing exercises and
coughing to improve lung expansion and secretion clearance.

o Rationale: Deep breathing exercises enhance respiratory function, prevent

atelectasis, and facilitate the removal of respiratory secretions.

6. Assist with Respiratory Treatments

o Intervention: Administer prescribed respiratory treatments, such as

nebulization or chest physiotherapy techniques (e.g., percussion,
vibration).

o Rationale: Respiratory treatments help clear airway secretions, improve

lung compliance, and maintain airway patency.

7. Monitor Respiratory Effort and Use of Accessory Muscles

o Intervention: Assess the child for signs of increased work of breathing,

use of accessory muscles, nasal flaring, or retractions.

o Rationale: Monitoring respiratory effort helps detect worsening respiratory

distress and guides the need for escalated interventions.

8. Maintain a Calm Environment

o Intervention: Create a calm and quiet environment to reduce anxiety and

minimize factors that can increase respiratory effort.

o Rationale: A calm environment promotes relaxation, reduces respiratory

distress, and conserves energy.

9. Collaborate with Respiratory Therapy

o Intervention: Collaborate with respiratory therapists to optimize respiratory

treatments and management strategies.

o Rationale: Respiratory therapists provide specialized expertise in

managing respiratory conditions and can assist in implementing effective
treatment plans.

10. Educate Parents and Caregivers

 o Intervention: Educate parents and caregivers about signs of ineffective
breathing pattern, when to seek medical assistance, and how to support
respiratory interventions at home.

o Rationale: Educated caregivers can recognize early signs of respiratory

distress, adhere to treatment plans, and facilitate continuity of care at
home.

ABG, corticosteroid, weight loss, no smoking, no trigger (dust etc.)

Altered nutrition: less than body requirement

Nursing Interventions and Rationale for Pediatric Patients with Altered Nutrition: Less
Than Body Requirement

Nursing Interventions

1. Assess Nutritional Status

o Intervention: Conduct a thorough assessment of the child’s nutritional

status, including dietary intake, weight, height, and growth patterns.

o Rationale: Baseline data is necessary to identify nutritional deficiencies

and monitor the effectiveness of interventions.

2. Monitor Weight and Growth

o Intervention: Regularly monitor and document the child's weight and

growth parameters.

o Rationale: Tracking weight and growth helps evaluate the child’s nutritional
progress and detect any deviations from expected growth patterns.

3. Provide Age-Appropriate, Nutrient-Dense Foods

o Intervention: Offer foods that are high in calories and nutrients appropriate
for the child’s age and developmental stage.
 o Rationale: Nutrient-dense foods ensure the child receives the necessary
vitamins and minerals for growth and development.

4. Small, Frequent Meals

o Intervention: Encourage small, frequent meals and snacks throughout the

day.

o Rationale: Small, frequent meals can increase caloric intake and make
eating less overwhelming for the child.

5. Involve a Dietitian

o Intervention: Collaborate with a pediatric dietitian to create a personalized

nutrition plan.

o Rationale: A dietitian can provide specialized guidance and

recommendations tailored to the child's specific nutritional needs.

6. Educate Parents and Caregivers

o Intervention: Educate parents and caregivers about the importance of

nutrition and how to prepare high-calorie, nutritious meals.

o Rationale: Educated caregivers are more likely to implement effective

nutritional strategies at home.

7. Encourage Nutritional Supplements

o Intervention: Recommend and administer nutritional supplements if

prescribed (e.g., high-calorie shakes, vitamins).

o Rationale: Supplements can help meet nutritional needs that are not being
met through regular food intake.

8. Address Underlying Medical Conditions

o Intervention: Identify and manage any underlying medical conditions that

may contribute to poor nutritional intake (e.g., gastrointestinal disorders,
infections).
 o Rationale: Treating underlying conditions can improve appetite and
nutrient absorption.

9. Promote a Positive Eating Environment

o Intervention: Create a calm and positive environment during meal times,

free from distractions and pressure.

o Rationale: A positive eating environment can encourage the child to eat

more and enjoy meals.

10. Hydration Monitoring

o Intervention: Ensure adequate hydration by encouraging fluid intake

between meals.

o Rationale: Proper hydration is essential for overall health and can improve
appetite.

11. Behavioral Strategies

o Intervention: Implement behavioral strategies to encourage eating, such

as rewarding positive eating behaviors.

o Rationale: Positive reinforcement can motivate the child to consume more

food.

12. Monitor for Signs of Malnutrition

o Intervention: Observe for signs of malnutrition such as hair loss, brittle

nails, and fatigue.

o Rationale: Early detection of malnutrition allows for prompt intervention to

prevent further complications.

13. Provide Emotional Support

o Intervention: Offer emotional support to the child and family, addressing

any concerns or anxieties related to eating.
 o Rationale: Emotional support can reduce stress and anxiety, which may
improve the child's willingness to eat.

Dr lecture note:

Identify the causes of the child decreased intake

-decreased intake @ appetite can assist in elimination of problem

Encourage parent to bring the food from home & to be with child during meals

- Parent presence stimulate the home environment and will increased the likehood the child
to eat

Allow the child to select the menu.

-Allowing the child to select foods gives the child control and provide an opportunities to
select foods that the child likes and will eat

Offer frequent, nutritious snacks and encourages parent to do the same

-The child may eat junk food and then refused nutritious foods offered at mealtimes

Offer small portion . Use small dishes, cup and glass

-Children may be overwhelmed by large portion and refused to eat

Allow the child to eat with the other children

-Older children may distract the child and decreased separation anxiety
Request a dietary consultation

-Registered dietician can assist in planning age-appropriate nutritious meals

Nutrition management

Nursing Responsibilities and Rationale in Pediatric Nutrition Management

1. Conduct Comprehensive Nutritional Assessment

· Responsibility: Perform a thorough nutritional assessment, including dietary

intake, weight, height, BMI, growth patterns, and laboratory values.

· Rationale: A comprehensive assessment provides baseline data to identify

nutritional deficiencies and develop an appropriate care plan.

2. Monitor Growth and Development

· Responsibility: Regularly monitor and document the child's weight, height, and
growth parameters.

· Rationale: Tracking growth helps evaluate the effectiveness of nutritional

interventions and detect any deviations from expected growth patterns.

3. Provide Nutrient-Dense, Age-Appropriate Foods

· Responsibility: Offer foods high in calories and nutrients that are appropriate for
the child’s age and developmental stage.

· Rationale: Nutrient-dense foods ensure the child receives essential vitamins and
minerals necessary for growth and development.

4. Encourage Small, Frequent Meals

· Responsibility: Promote the consumption of small, frequent meals and snacks

throughout the day.

· Rationale: Smaller, more frequent meals can increase caloric intake and prevent
the child from feeling overwhelmed by large portions.

5. Involve a Pediatric Dietitian

 · Responsibility: Collaborate with a pediatric dietitian to create and implement a
personalized nutrition plan.

· Rationale: A dietitian can provide specialized guidance and recommendations

tailored to the child's specific nutritional needs.

6. Educate Parents and Caregivers

· Responsibility: Provide education to parents and caregivers about the importance

of nutrition and how to prepare high-calorie, nutritious meals.

· Rationale: Educated caregivers are better equipped to implement effective

nutritional strategies at home.

7. Administer Nutritional Supplements

· Responsibility: Recommend and administer nutritional supplements if prescribed,

such as high-calorie shakes or vitamins.

· Rationale: Supplements can help meet nutritional needs that may not be fulfilled
through regular food intake.

8. Manage Underlying Medical Conditions

· Responsibility: Identify and address any underlying medical conditions that may
affect nutritional intake, such as gastrointestinal disorders or infections.

· Rationale: Treating underlying conditions can improve appetite and nutrient

absorption.

9. Promote a Positive Eating Environment

· Responsibility: Create a calm and positive environment during meal times, free
from distractions and pressure.

· Rationale: A positive eating environment can encourage the child to eat more and
enjoy their meals.

10. Ensure Adequate Hydration

· Responsibility: Encourage adequate fluid intake between meals to maintain

hydration.
 · Rationale: Proper hydration is essential for overall health and can support appetite
and digestion.

11. Implement Behavioral Strategies

· Responsibility: Use behavioral strategies, such as rewarding positive eating

behaviors, to encourage the child to eat.

· Rationale: Positive reinforcement can motivate the child to consume more food.

12. Monitor for Signs of Malnutrition

· Responsibility: Observe for signs of malnutrition, such as hair loss, brittle nails,
fatigue, and poor wound healing.

· Rationale: Early detection of malnutrition allows for prompt intervention to prevent

further complications.

13. Provide Emotional Support

· Responsibility: Offer emotional support to the child and family, addressing any
concerns or anxieties related to nutrition and eating.

· Rationale: Emotional support can reduce stress and anxiety, which may improve
the child's willingness to eat.

No snack before meals

Respiration management

Nursing Responsibilities and Rationale in Pediatric Respiration Management

Assessment and Monitoring

1. Assess respiratory rate, rhythm, and effort regularly.

o Rationale: Early identification of respiratory compromise is crucial for

timely intervention.

2. Monitor oxygen saturation using pulse oximetry.

 o Rationale: Continuous monitoring helps track the effectiveness of
treatment and detect deterioration.

3. Observe for signs of respiratory distress (e.g., nasal flaring, grunting,

retractions).

o Rationale: Early recognition of respiratory distress allows for prompt

intervention.

4. Auscultate breath sounds to detect abnormalities (e.g., wheezing, crackles).

o Rationale: Detecting abnormal breath sounds can help identify the

underlying respiratory condition.

5. Monitor vital signs including heart rate, blood pressure, and temperature.

o Rationale: Vital signs provide comprehensive information on the child's

overall condition and response to treatment.

Oxygen Therapy

1. Administer supplemental oxygen as prescribed.

o Rationale: Adequate oxygenation is essential for preventing hypoxia and

ensuring tissue perfusion.

2. Adjust oxygen delivery method based on the child's needs (e.g., nasal
cannula, face mask).

o Rationale: Proper use of oxygen delivery devices maximizes the

effectiveness of oxygen therapy.

3. Ensure proper fit and placement of oxygen delivery devices.

o Rationale: Proper fit ensures effective oxygen delivery and prevents

discomfort.

4. Monitor oxygen saturation to ensure therapeutic levels.

o Rationale: Ensuring therapeutic levels of oxygen saturation helps maintain

adequate tissue oxygenation.
Medication Administration

1. Administer prescribed medications (e.g., bronchodilators, steroids,

antibiotics) accurately.

o Rationale: Timely and accurate medication administration is essential for

managing respiratory conditions.

2. Monitor for therapeutic effects and side effects of medications.

o Rationale: Monitoring helps ensure medication effectiveness and detect

adverse reactions.

3. Educate parents and caregivers on the proper use of inhalers and

nebulizers.

o Rationale: Educating caregivers ensures proper medication administration

at home and adherence to the treatment plan.

Non-Invasive Ventilation

1. Set up and operate non-invasive ventilation devices (e.g., CPAP, BiPAP) as

prescribed.

o Rationale: Non-invasive ventilation can improve respiratory function and

reduce the need for intubation.

2. Monitor the child's response to non-invasive ventilation.

o Rationale: Proper setup and monitoring ensure the therapy is effective and
comfortable for the child.

3. Ensure proper fit and comfort of the mask or nasal prongs.

o Rationale: Proper fit ensures effective ventilation and reduces discomfort.

Intubation and Mechanical Ventilation

1. Assist with intubation procedures and ensure proper tube placement.

o Rationale: Intubation and mechanical ventilation are life-saving

interventions for severe respiratory failure.
 2. Monitor ventilator settings and alarms to ensure appropriate ventilation.

o Rationale: Proper care and monitoring prevent complications and ensure

effective ventilation.

3. Provide oral care and prevent ventilator-associated pneumonia.

o Rationale: Oral care helps prevent infections and complications associated

with mechanical ventilation.

Hydration and Nutrition

1. Maintain fluid balance by monitoring intake and output.

o Rationale: Adequate hydration and nutrition are essential for overall health
and recovery.

2. Administer intravenous fluids if oral intake is inadequate.

o Rationale: Ensuring proper hydration helps prevent dehydration and

overhydration.

3. Encourage small, frequent meals and provide nutritional support.

o Rationale: Proper nutrition supports the child's immune system and

recovery.

Chest Physiotherapy

1. Perform chest physiotherapy techniques (e.g., percussion, vibration) as

prescribed.

o Rationale: Chest physiotherapy helps clear secretions and improve lung

function.

2. Teach parents and caregivers how to perform chest physiotherapy at home.

o Rationale: Educating caregivers ensures continuity of care at home.

3. Encourage coughing and deep breathing exercises.

 o Rationale: Coughing and deep breathing exercises help maintain airway
clearance and lung expansion.

Positioning

1. Position the child to optimize breathing (e.g., elevate the head of the bed).

o Rationale: Proper positioning improves respiratory mechanics and reduces

work of breathing.

2. Encourage positions that maximize lung expansion (e.g., sitting upright).

o Rationale: Maximizing lung expansion enhances oxygenation and

ventilation.

Anxiety related to fear of unknown and separation from significant

others and familiar surrounding

1. Orient the child and parent to the hospital and the routines of the unit. Familiarity with the
environment and expectation will decreased anxiety caused by fear of unknown

2. Prepared the child and parent for all procedure in an age –appropriate way. Preparation
for an event decreased anxiety and fear

3. Encourage the parent to stay with the child when possible and to be involved in the
childcare. Presence of the parent support the parental role and decreased the child
separation anxiety

4. Hold and cuddle the infant or young child. Holding and cuddling children increased feeling
of security and trust

5. If the parent cannot stay with the child, provide for consistent caregiver. Continuity of care
provides the child with a consistent person with whom a child can develop a trusting
relationship

6. Encourage parent to be honest to the child when they are leave and inform the nurse
where they can be reached and when they will return. Trust is increased when parent and
caregiver are honest with the child . If the parent just disappear , the child will feel anger,
abandonment and acute anxiety

1. Establish a Therapeutic Relationship:

· Rationale: Building trust and rapport with the child helps reduce anxiety by
providing a familiar and supportive presence.

· Implementation: Spend time talking with the child in a calm and reassuring
manner. Use age-appropriate language and encourage the child to express their
feelings.

2. Provide Familiarity and Consistency:

· Rationale: Children feel more secure when their environment and routines are
predictable.

· Implementation: Maintain consistent daily routines, such as meal times and play
activities. Bring comforting items from home if possible, like a favorite toy or
blanket.

3. Offer Distraction Techniques:

· Rationale: Distracting the child from anxious thoughts can help reduce their fear
and anxiety.

· Implementation: Engage the child in age-appropriate activities such as drawing,

storytelling, or playing games. These activities can redirect their focus away from
their worries.

4. Encourage Parental Involvement and Support:

· Rationale: Parents play a crucial role in providing comfort and reassurance to their
child.

· Implementation: Allow parents to stay with the child as much as possible,

especially during procedures or times of heightened anxiety. Encourage parents
to comfort their child and explain procedures in a reassuring manner.

5. Teach Relaxation Techniques:

 · Rationale: Teaching relaxation techniques empowers the child to manage their
anxiety.

· Implementation: Depending on the child's age, teach techniques such as deep

breathing, progressive muscle relaxation, or guided imagery. Practice these
techniques together to help the child feel more in control of their emotions.

6. Collaborate with Multidisciplinary Team:

· Rationale: Anxiety in children may require input from various healthcare

professionals for comprehensive care.

· Implementation: Consult with child psychologists, child life specialists, and other
healthcare providers to develop a holistic plan of care that addresses the child's
emotional and psychological needs.

7. Provide Age-Appropriate Information:

· Rationale: Knowledge about what to expect can reduce anxiety by decreasing

uncertainty.

· Implementation: Explain procedures, treatments, and hospital routines in simple,

concrete terms suitable for the child's developmental level. Use visual aids or
storybooks to help the child understand what will happen next.

8. Create a Safe Physical Environment:

· Rationale: A calming environment can help reduce anxiety and promote a sense of
security.

· Implementation: Ensure the child's room or treatment area is quiet, well-lit, and
free from unnecessary stimuli. Offer a comfortable seating area for the child and
their family members.

9. Use Play Therapy:

· Rationale: Play is a natural way for children to express emotions and process
experiences.
 · Implementation: Provide opportunities for therapeutic play with dolls, puppets, or
medical play kits. Allow the child to act out their feelings and experiences, which
can help them cope with anxiety in a safe and supportive manner.

10. Monitor and Assess Anxiety Levels:

· Rationale: Regular assessment helps track the child's anxiety levels and response
to interventions.

· Implementation: Use age-appropriate anxiety assessment tools or observation

techniques to evaluate the child's emotional state. Adjust interventions based on
their individual needs and responses.

11. Promote Coping Skills Development:

· Rationale: Teaching coping skills empowers the child to manage anxiety both
during and after healthcare experiences.

· Implementation: Teach coping strategies such as positive self-talk, using a comfort

item, or engaging in a favorite activity. Encourage the child to practice these skills
regularly to build resilience.

12. Involve Child Life Specialists:

· Rationale: Child life specialists are trained to support children and families during
stressful healthcare experiences.

· Implementation: Collaborate with child life specialists to provide therapeutic

activities, preparation for procedures, and emotional support tailored to the child's
developmental level and individual needs.

13. Educate Parents on Supportive Behaviors:

· Rationale: Parents play a crucial role in comforting and reassuring their child during
times of anxiety.

· Implementation: Provide parents with guidance on supportive behaviors such as

using calming techniques, maintaining a positive attitude, and advocating for their
child's emotional needs within the healthcare setting.

14. Offer Pharmacological Interventions if Indicated:

· Rationale: In severe cases of anxiety, pharmacological interventions may be
necessary to alleviate distress.

· Implementation: Collaborate with the healthcare team to assess the

appropriateness of medications such as anxiolytics. Administer medications as
prescribed while monitoring for effectiveness and side effects.