SIDS (London, Ladweig, Ball, & Bindler, pp.

1398-1400)
Definition-the sudden unexpected death of an infant under 1 year of age with onset of the fatal episode during sleep that remains unexplained after a thorough investigation, including an autopsy, a review of the circumstances of death and leading cause of death in infants between 1 month and 1 year of age, with 90% of cases occurring before 6 months. A. Risk Factors a. Race i. Most common in Native American infants ii. Followed by Black, Hispanic, white and Asian infants b. Gender i. More common in males c. Age: most common in infants between 2 and 4 months of age d. Time of year: more prevalent in WINTER months e. Exposure to passive smoke f. Sleeping arrangement i. prone or side-lying position and turning to prone, sharing bed with others, use of pillows and quilts with bedding

g. Overheating due to excessive blankets, clothing on infant, room temperature B. Maternal Risk factors

a. Maternal age less than 20yrs at 1st pregnancy and a short interval between pregnancies
b. Prenatal smoking, binge alcohol, and illicit drug use c. Anemia d. Poor prenatal care, low weight gain during pregnancy e. History of STD’s or UTIs C. Causes a. No known causes, all other disease processes ruled out D. Signs and Symptoms

a. 1st symptom= Cardiac arrest
b. Evidence of a struggle or change in position during sleep c. Presence of frothy, blood-tinged secretions from the mouth and nares d. Found dead in crib in am or after nap e. Parents report no cries or disturbances during the night

You can say. You can say to parents. “It is the only way we can be sure of what caused your baby’s death. touch. The nurse’s role is to be empathetic and provide support during one of the greatest crises a family must face. d. CROUP-LARYNGOTRACHEOBRONCHITIS (London. Older children may need reassurance that SIDS will not happen to them. Provide literature and a name of the local contact for a SIDS support group. “Paul’s (use the infant’s name) skin will feel cool. Provide parents with a private area and a support person who reinforces that the infant’s death was not their fault. This reaffirms the child’s existence for many parents. Personal items can be placed in a memory book. toys and pillows d. Allow parents to hold. Prepare the family for the viewing of the infant. Explain that pooling of blood on the dependent areas will look like bruises. Before bringing the infant to parents. Advise parents that surviving sibling may benefit from psychologic support. Prevention a.E. if they desire. b. Ladweig. Make sure this position is used when the infant is cared for by others b. and apply Vaseline to lips. Avoid the use of loose bedding. Recommended sleep position-ON THE BACK (supine) ii.” f. swab the mouth clean. c.” They probably know this. Ball. but a gentle explanation demonstrates empathy. Provide names of resource people and phone numbers for SIDS support groups. Reinforce the physician’s explanation about the need for an autopsy. 14001403) . Pacifier at night (per PPT) F. pp. e. as well as for the national foundation. comb the hair. Answer parents’ questions and provide them with sources for further information. wash the face. An autopsy is required for all unexplained deaths. Parents need to be able to express their grief in their own way and hear that they are not being blamed for the infant’s death. and handprints. & Bindler. Many emergency department and pediatric units have a social worker who provides ongoing contact with the family. Use a firm mattress c. Counseling (from Table 47-3 on pg 1399) a. Educate on sleep positions i. wrap in a clean blanket. They may also believe that bad thoughts or wishes about their baby brother or sister caused the death. Siblings often require emotional support in the weeks and months after the death. Viewing the infant allows parents a chance to say good-bye. footprints. 2007. Describe how the infant will look and feel. g. He will be very still and his eyes will be closed. h. Parents may not be able to take in all of your answers. Provide parents with a lock of hair. and rock the infant if desired.

racemic epinephrine): aerosolized through face mask  Rapid acting bronchodilator  Decreases bronchial and tracheal secretions and mucosal edema  Used to decrease symptoms of moderate to severe respiratory distress  Side effects • Tachycardia (160-200 bpm) • HTN • Dizziness. HA and Nausea may necessitate stopping medication o Corticosteriods  Anti-inflammatory  Used to decrease edema  Has a long half-life  Side effects • Child may experience cardiovascular symptoms. “BIG THREE” pediatric respiratory illnesses-affect greatest # of children • LTB (laryngotracheobronchitits)-this is what Croup is most often used to refer to o A viral invasion of the upper airway o Extends throughout larynx. musical sound that is created by narrowing of the airway) Seal-like barking cough Treatment MAINTAIN AND IMPROVE AIRWAY  Humidification/Vaporizers o Cool mist  Supplemental Oxygen when Pulse Ox <92%  Medication o Beta-agonists and beta-adrenergics (albuterol. trachea. bronchi o Barking-seal like cough o Stridor o Rhinorrhea o Sore thorat • Epiglottis (most life threatening-medical emergency) o Progresses rapidly-HOURS o Bacterial cause o High fever 102.2 F o Stridor Signs    and Symptoms (this refers to LTB only-which I think is all we need to know) Tachypnea Inspiratory STRIDOR (a high pitched.Definition: a broad classification of upper airway illness that result from swelling of the epiglottis and larynx. Swelling usually extends into the trachea and bronchi.2F o Intense sore throat o ^HR and RR o Dysphagia o Drooling o Prefers upright position (tripod position with chin thrust) • Bacterial tracheitis o Progressive from URI o 1-2days o High fever -102.HTN • Requires close observation • Children less need emergency airways • Stridor resolves faster .

LARYNGECTOMY (LeMone & Burke.. or shoulder drop due to damage to the spinal accessory nerve. 1255-1256) Laryngectomy-removal of the larynx PURPOSE   Tumors localized to a portion of the larynx Cancers that extend beyond the vocal cords Types Partial laryngectomy  50% or more of larynx is removed  Voice is preserved. protect the stoma with a cupped hand or washcloth  Manifestations of potential complications of laryngectomy to be reported to the physician include loss of hearing or facial expression due to auditory or facial nerve injury. o Promptly removing secretions from skin surrounding the stoma to prevent irritation and skin breakdown. thryroid cartilage. although it may be changed  Normal speaking. and swallowing are restored Total laryngectomy  Entire larynx is removed along with epiglottis. 13651371)    What   Characterized by noncardiac pulmonary edema and progressive refractory hypoxemia Severe form of Respiratory failure Mortality rate 30-40% happens? Surfactant –producing cells are damaged by the inflammatory process leading to o a deficit of surfactant o increased alveolar surface tension o alveolar collapse with atelectasis Lungs become less compliant  .there is no risk for aspiration during swallowing  Normal speech is lost (need device to speak)  Permanent tracheostomy is created o Tracheostomy may be removed after several weeks leaving a natural stoma or it may be left in place permanentaly. 2008. pp. such as a gauze square on a tie around the neck. to prevent particulate matter from entering the lower respiratory tract. several tracheal rings. there is no restriction on other activities.  Stress the importance of not yelling or screaming  Encourage smoking cessation  Tracheostomy stoma care and preventing respiratory infection o Using a humidifier or vaporizer add humidity to inspired air o Increasing fluid intake to maintain mucosal moisture and loosen secretions o Shielding the stoma with a stoma guard. and hyoid bone  Because trachea and esophagus are permanently separated by surgery. o Showering and bathing are allowed. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) (LeMone & Burke. pp. breathing. 2008. o Water sports are contraindicated with a permanent tracheostomy. Teaching  Teach to protect the stoma from particulate matter in the air with a gauze square or other stoma protector.

 Gas exchange is impaired As ARDS progresses  Hypoxia becomes significant  Metabolic acidosis develops  Carbon dioxide exchange is impaired as well as oxygen exchange= combined respiratory and metabolic acidosis  Leading causes of ARDS death o Sepsis o Multiple organ system dysfunction      Kidneys Liver GI tract CNS Cardiovascular system Causes       Shock Trauma Inhalation injuries Infections Drug overdose Other o Disseminated intravascular coagulation o Pancreatitis o Uremia o Amniotic fluid and air emboli o Multiple transfusions o Open heart surgery with cardiopulmonary bypass Near drowning Sepsis Nervous system injury    Manifestations Early signs o Dyspena o Tachypena o Anxiety Progressive signs o Intercostals retractions o Use of accessory muscles o Cyanosis o Crackles (rales) and rhonchi o Mental status changes o Agitation o Confusion o Lethargy Infants o Stridor o Retractions .

central venous pressures. Refractory hypoxemia (hypoxemia that does not improve with oxygen administration) is the hall 2.Diagnostic tests 1. and restlessness are early signs of cerebral hypoxia due to decreased C/O. Placed to monitor pulmonary artery pressures and cardiac output I. at least every 2 hours. Attention to nutrition a. Corticosteriods-under investigation at this point B. Assess heart and lung sound frequently. Swan-Ganz catheter line a. Correction of the underlying condition H. Monitor pulmonary artery pressures.shows decreased lung compliance with reduced vital capacity Pulmonary artery pressure monitoring a. Record urine output hourly. May be ordered to prevent thrombophlebitis and possible pulmonary embolus or disseminated intravascular coagulation. Medications a. Enteral or parenteral feeding is necessary to maintain nutritional status and prevent tissue catabolism F. **Mechanical Ventilation** a. mark of ARDS ABGs Chest x-ray Pulmonary function testing. Helping distinguish ARDS from cardiogenic pulmonary edema 4. Inhaled nitric oxide b. Does not cure ARDS c. Assess LOC at least q4h. D. Low-molecular-weight heparin a. Increasing crackles or abnormal heart sounds may indicate heart failure. and cardiac output reading q 1-4h. Supports respiratory function while the underlying problem is identified and treated C. Shows normal pressure in ARDS b. Surfactant therapy c. Carefully tailored to avoid fluid imbalances E. more frequently immediately following initiation of mechanical ventilation or addition of PEEP. Treatment of any infection a. Accurate daily weights are the best indicator of fluid volume status. a possible complication of ARDS Nursing Dx and Interventions Decreased Cardiac Output   Monitor and record vital signs. confusion. 5. 3.      . Prone positioning in conjunction with mechanical ventilation reduces the pressure of surrounding tissue on dependent regions and improves oxygenation. Treatment A. With IV antibiotic therapy G. Altered LOC. Weight daily at the same time. Frequently prvide good skin care. Because a significant portion of the cardiac output goes directly to the kidneys. Management is endotracheal intubation and mechanical ventilation with PEEP b. a fall in urine output to less than 30mL per hour is the first sign of decreased cardiac output. including apical pulse. Careful fluid replacement a.

These medications may be prescribed to decrease cardiac workload. Keep oxygen at the bedside following weaning and extubations. Dysfunctional Ventilatory Weaning Response The client with dysfunctional ventilatory weaning response has difficulty adjusting to reduced mechanical ventilator support. Diversion helps distract the focus from breathing. Interventions  Assess vital signs q 15-30 minutes. Assessment findings indicative of dysfunctional weaning include:  Dyspena.  Maintain IV fluids as ordered. Provide diversion. weaning may be discontinued overnight to provide rest. and RR  Diminished or adventitious breath sounds. diaphoresis  ^BP. such as television or radio. HR. gasping breaths or paradoxic abdominal breathing. sedatives.    Fully explain all weaning procedures. Limit procedures and activities during weaning periods. or agitation  Decreased oxygen saturation level  Cyanosis or pallor. apprehension. Sedatives or analgesics that depress respirations can impair the weaning process. Begin weaning procedures in the morning. Remain with the client during initial periods following changes of ventilator setting or T-piece trials. when the client is well rested and alert. use of accessory muscles  Decreased LOC  Deteriorating ABG values  Shallow.      . Administer analgesics. Adequate explanations help reduce anxiety and improve the ability to cooperate. prolonging the weaning process. Provide pulmonary hygiene with percussion and postural drainage. along with expected changes in breathing. Avoid administering drugs that may depress respirations during the weaning process (except as ordered at night to facilitate rest when ventilator support is provided). Maintaining patent airways and adequate alveolar ventilation is vital during the weaning process. and neuromuscular blockers as needed. IV fluids are given to maintain vascular volume and prevent dehydration.  Place in Fowler’s or high-Fowler’s position.

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