Maternal AND CHILD HEALTH NURSING LECTURE

HEALTH PROBLEMS COMMON IN TODDLERS d. Provide treatment and prevention information to

parents
POISONING o Save container, vomitus, spills on during
Toddlers and suicidal adolescents are most often analysis
involved o Teach parents about safety practices that will
Modes of exposure: ocular, skin, ingestion decrease chances of accidental poisonings;
Types of substances ingested: drugs, household educate as to use of drugs, labelling, storage
products, garden supplies, plants and berries and handling of household products,
² Most ingestions are acute in nature and importance of child-resistant safety
accompanied by a history of the invasion of the packaging
medicine chest or cabinet where household o Stress importance of having syrup of ipecac on
cleaners are kept the home and on trips and instruct parents
² Chronic ingestions result in accumulation of on proper administration
toxic substance, such as lead o Advise parents to keep poison control center
phone number readily available incorporate
ASSESSMENT anticipatory guidance related to
Ø Signs may vary depending on substance developmental stage of child
ingested o Discuss general first aid measures with parents
Ø Bradycardia, tachycardia, tachypnea, slow
depressed respiration, hypotension or ANTIDOTES
hypertension, hypothermia or hyperthermia Salicylate poisoning: VITAMIN K
Ø Confusion, disorientation, coma, ataxia, seizures Acetaminophen: ACETYLCYSTEINE
Ø Miosis, mydriasis, nystagmus
Ø Jaundice, cyanosis CHILD ABUSE
Ø Child may have a distinctive odor: hydrocarbons, n Physical, emotional or sexual
alcohol, garlic, sweat n 80% of children know their abuser in sexual
abuse
GENERAL INTERVENTIONS n Adults who abuse were often themselves
a. Patent airway victims of child abuse
b. Restore circulation n Occurs in all socioeconomic groups
c. Prevent absorption n Only about 10% of abusers have serious
o Determine what, when and how much was psychologic disturbances
ingested n Abuse is most common among toddlers as they
o Induce emesis within one hour of ingestion exercise autonomy and parents may sense loss
except if caustic material ingested, child is of power
comatose, with seizures or lacking gag reflex
o DOC: syrup of ipecac ASSESSMENT
o Gastric lavage may also be used to prevent Ø History inconsistent with injury
absorption Ø Bruises, lacerations, burns are most common
o Activated charcoal: minimizes absorption of Ø Fractures, sprains and dislocations are also
toxins common
o Cathartic: may be used after emesis or lavage Ø Signs of CNS injuries include subdural
to speed elimination of ingested substance; hematoma, retinal hemorrhage (shaken baby
recommended agents are sodium or syndrome)
magnesium sulfate; after vomiting occurred Ø Abdominal injuries may include lacerated liver,
ruptured spleen

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Ø Observations of parents and child may reveal Ø may affect extremities on one side
interactional problems (hemiplegia)
Ø four extremities (quadriplegia)
NURSING INTERVENTIONS Ø Lower extremities(diplegia/paraplegia)
a. ER: Attend to the physical needs of child first
b. Report suspected child abuse to appropriate 2. Athetosis/ dyskinetic
agency n constant, involuntary, purposeless, slow, writhing
c. Provide a role model for parents in terms of motions (worm-like movement)
stimulation, communication, feeding, and daily Ø occurs with extrapyramidal tract (basal
care of child ganglia) lesion
d. Encourage parents to be involved in child’s care Ø affects all four extremities, face, neck and
e. Encourage parents to express feelings tongue
concerning abuse, hospitalizations and home Ø drooling is common
situation Ø disappears during sleep
f. Provide family education concerning child-care, Ø also affects facial muscles
especially safety and nutrition needs, discipline 3. Ataxia
and age-appropriate stimulation n disturbance in equilibrium (lack of balance, poor
g. Initiate referrals for long-term follow-up coordination, dizziness, hypotonia)
Ø occurs with extrapyramidal tract (cerebellar)
CEREBRAL PALSY lesion
n Neuromuscular disorder resulting from damage Ø muscles and reflexes are normal
to or altered structure of the part of the brain Ø unable to perform coordinated motion, finger
responsible for controlling motor function to nose test, or rapid repetitive movements
4. Mixed type
CAUSES n symptoms of spasticity and athetoid or ataxic
PRENATALLY: genetic, altered neurologic development, 5. Tremor
infection, trauma, anoxia to mother n repetitive, rhythmic, involuntary contractions of
PERINATALLY: drugs at delivery, precipitate delivery, fetal flexor and extensor muscles
distress, breech delivery with delay Ø occurs with extrapyramidal tract (basal
POSTNATALLY: kernicterus (high level of indirect ganglia) lesion
bilirubin) or head trauma Ø often a mild disability
6. Rigidity
ASSESSMENT n resistance to flexion and extension resulting from
1. Spasticity simultaneous contraction of both agonist and
n Exaggerated hyperactive reflexes (increased antagonist muscle groups
muscle tone, scissoring of legs, poorly Ø occurs with extrapyramidal tract (basal
coordinated body movements for voluntary ganglia) lesion
activities) Ø diminished or absent reflexes
Ø occurs with pyramidal tract lesion Ø potential for severe contractures
Ø results in contractures
Ø also affect ability to speak ASSOCIATED PROBLEMS
Ø Has hypertonic muscles
Ø exaggerated deep tendon reflex o Mental retardation

Ø positive Babinski reflex o Hearing loss

Ø fails to demonstrate parachute reflex o Defective speech

Ø continuation of tonic neck reflex o Dental anomalies

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o Orthopedic problem Ø Ex: scalds: heal by regeneration of tissue for 2-6

o Visual disabilities weeks
o Seizures
o Disturbances of body image, touch, perception THIRD DEGREE BURN (FULL THICKNESS BURN)
o Feelings of worthlessness n Involves dermis, epidermis, adipose tissues,
fascia, muscle and bone
NURSING INTERVENTIONS Ø Avascular without blanching or pain
a. Obtain careful pregnancy, birth, and childhood Ø Dry, pale, leathery skin
history Ø Diuresis 2-5 days after the burn, as fluid shifts
b. Observe the child’s behavior in various situations back
c. Assists with ADL Ø Fluid shift from intravascular to interstitial
d. Provide a safe environment compartments
e. Provide physical therapy to prevent contractures Ø Hypovolemia and symptoms of shock from fluid
and assist in mobility shift, including renal function
f. Provide client teaching and discharge planning Ø Infection due to altered skin integrity
concerning:
o Nature or disease: CP is nonfatal, non-curable NURSING INTERVENTIONS
disorder a. Stop the injury in an emergency situation to
o Need for continued physical, occupational, prevent further injury
speech therapy b. Maintain a patent airway in the immediate
o Care for orthopedic devices postburn phase, inhalation of smoke may cause
o Provision for child’s return to school airway edema
o Availability to support groups/community c. Monitor VS, I & O
agencies d. Assess CV, renal, respiratory and neurologic
status to assess for signs of shock
BURNS e. Administer IV analgesic to relieve pain; do not
n Injury to the body caused by excessive heat administer IM injections
usually higher than 140F/40C f. Assist with debridement to promote healing
g. Elevate the burned body part to promote venous
CAUSES drainage and decrease edema
Contact with hot liquid or electricity: most common h. Prevent heat loss to reduce metabolic demands
cause of burns in children under age 3 i. Give the child the opportunity to maintain the
Flames: most common cause of burns in older children developmental tasks already achieved such as
eating in high chair, not using diaper if the child
ASSESSMENT has been toilet-trained and allowing self-feeding
FIRST DEGREE BURN (PARTIAL THICKNESS OF if the child is able to prevent regression
SKIN) j. Rock, cuddle and treat the patient like any other
n Involves the superficial epidermis child to encourage normalcy in this situation
Ø Dry painful, red skin with edema
Ø Looks like sunburn TREATMENT
a. TOPICAL THERAPY
SECOND DEGREE BURN (PARTIAL THICKNESS OF n Silver sulfadiazine: a paste applied to burn site
THE SKIN) to limit infection
n Involves the entire epidermis o Effective for both gram (-) and gram (+)
Ø Moist, weeping blisters with edema organisms
Ø Very painful n Providone iodine: inhibit bacterial growth

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n Nitrofurazone(furacin) if pseudomonas is present NURSING INTERVENTIONS

a. Administer antibiotics as ordered; prevention of
b. DEBRIDEMENT kidney infection/ glomerulonephritis important
n Removal of necrotic tissue from the burned area b. Provide warm baths and allow child to void in
n Hydrotherapy before debridement, then give water to alleviate painful voiding
analgesic c. Force fluids
d. Encourage measures to acidify urine (cranberry
c. GRAFTING juice, acid-ash diet)
n Homografting (Allografting): placement of skin e. Provide client teaching and discharge planning
(Sterilized/frozen) from cadaver or donor on concerning
clean burn site o Avoidance of tub baths (contamination from
n Heterografts (xenografts): from other sources dirty water may allow microorganisms to
such as pigs travel up urethra)
n Autografts: removal of skin from unburned part o Avoidance of bubble baths that might irritate
of the body urethra
o Importance for girls to wipe perineum from front
SAMLE QUESTION!!! to back
The clothes of a 4-year old girl catch fire during a family o Increase in foods/ fluids that acidify urine
picnic. The girl’s mother, a nurse tells her child to drop and
roll to extinguish the flames. Which action should the UNDESCENDED TESTES (CRYTORCHIDISM)
nurse take next? Use the garden hose to wet her n Unilateral or bilateral absence of teste in scrotal
daughter down sac
n Testes normally descends at 8 months of
gestation will therefore be absent in premature
HEALTH POBLEMS COMMON IN PRESHCOOLER infants
n Incidence increased in children having
UTI genetically transmitted diseases
1. Bacterial invasion of the kidneys or bladder n Unilateral cryptorchidism most common
2. More common in girls, preschool and school- age n 75% will descend spontaneously by age 1 year
children
3. Usually caused by E. coli MEDICAL MANAGEMENT
4. PREDISPOSING FACTORS: poor hygiene, v Whether or not to treat is still controversial; if
irritation from bubble baths, urinary reflux testes remain in abdomen, damage to the testes
5. The invading organism ascends the urinary tract, (sterility) is possible because of increased body
irritating the mucosa and causing the temperature
characteristic symptoms v If not descended by age 8 or 9, chorionic
gonadotropin can be given
ASSESSMENT v ORCHIPEXY: surgical procedure to retrieve and
Ø Low grade fever secure testes placement; performed between
Ø Abdominal pain ages 1-3 years
Ø Enuresis (intermittent urinary incontinence
during sleep) ASSESSMENT
Ø Pain/ burning on urination Ø Unable to palpate testes in scrotal sac
Ø Frequency (feeling of wanting to urinate) Ø When palpating testes, be careful not to elicit
Ø Hematuria (blood in urine) cremasteric reflex, which pulls testes higher In
pelvic cavity

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b. Secondary: in children who have developed

NURSING INTERVENTIONS complete control and lose it
a. Advise parents of absence of testes and provide o May occur at any time of day but is most
information about treatment options frequent at night
b. Support parents if surgery is to be performed o More common in boys
c. Pos-op, avoid disturbing the tension mechanism o No organic cause can be identified; familial
(will be in place for about one week) tendency
d. Avoid contamination of incision
ETIOLOGIC POSSIBILITIES
HYPOSPADIAS a. Sleep disturbances
n Urethral opening located anywhere along the b. Delayed neurologic development
ventral surface of penis c. Immature development of bladder leading to
n Chordee (ventral curvature of the penis) often decreased capacity
associated, causing constriction d. Psychologic problems
n In extreme cases, child’s sex may be uncertain
MEDICAL MANAGEMENT
EPISPADIAS v Bladder retention exercises (kegel exercise)
n Very rare-more often associated with bladder v Behavior modification e.g. bed alarm devices
exstrophy v Drug therapy: results are temporary; side effects
n Need early referral for parental counseling may be unpleasant or even dangerous
n Patients may be totally incontinent o Tricyclic antidepressants: Imipramine
HCl (Tofranil)
MEDICAL MANAGEMENT o Anticholinergics
v Minimal defects need no intervention
v Neonatal circumcision delayed, tissue may be ASSESSMENT FINDINGS
needed for corrective repair Ø PHYSICAL EXAM: NORMAL
v Surgery performed at age 3-9 months; 2 years of Ø History of repeated involuntary urination
age for complex repairs
NURSING INTERVENTION
ASSESSMENT FINDINGS a. Provide information / counseling to family as
Ø Urinary meatus misplaced needed
Ø Inability to make straight stream of urine o Confirm that it is not conscious behavior and
that child is not purposely misbehaving
NURSING INTERVENTIONS o Assure parents that they are not responsible
a. Diaper normally and that this is a relatively common problem
b. Provide support for parents b. Involve child in care; give praise and support with
c. Provide support for child at time of surgery small accomplishments
d. Postoperatively, check pressure dressing, o Age 5-6 years: can strip bed of wet sheets
monitor catheter drainage, assess pain o Age 10-12 years: can do laundry and change
bed
ENURESIS c. Avoid scolding and belittling child
n Involuntary passage of urine after the age of
control is expected (about 4 years) WILM’S TUMOR (NEPHROBLASTOMA)
Types: n Large, encapsulated malignant tumor that
a. Primary: in children who have never achieved develops in the renal parenchyma, more
control

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frequently at the upper pole of the left kidney d. Provide care for the child receiving
(usually unilateral) chemotherapy and radiation therapy
n Originates during fetal life from undifferentiated e. The nurse should assess toileting habits before
embryonic tissues creating a teaching plan for the school-age child
n Peak age of occurrence: 3-4 years(6mo-5yrs) with a UTI. Based on her findings, the nurse
n Associated with congenital anomalies such as: should instruct the child in proper front-to- back
aniridia (lack of color in the iris), wiping, hand washing and toilet use every 2
cryptorchidism,hypospadias, hours.
pseudohermaphroditism
n Prognosis good if there are no metastases The nurse is assessing a young female child who may
have a urinary tract infection (UTI). A female child is more
ASSESSMENT FINDINGS susceptible to UTIs than a male because she has: shorter
Ø STAGE I: limited to kidney urethra
Ø STAGE II: tumor extends beyond kidney, but is
completely encapsulated HEMATOLOGIC AND IMMUNE SYSTEM

Ø STAGE III: tumor confined to abdomen

The hematologic and immune systems consists of blood
Ø STAGE IV: tumor has metastasized to lung, liver,
and blood-forming tissues and structures such as the
bone or brain
lymph nodes, thymus, spleen and tonsils
Ø STAGE V: bilateral renal involvement at
diagnosis
Blood is composed of several components:
Ø Usually mother notices mass while bathing or
dressing child; nontender, usually midline near
1. Erythrocytes (RBC) – carry oxygen to the
liver
tissues and remove carbon dioxide
Ø Hypertension and possible hematuria, anemia,
2. Leukocytes (WBC) – include lymphocytes,
and signs of metastasis
monocytes, and granulocytes; these participate in
Ø Anemia
the immune response
Ø Diagnostics: IVP(intravenous pyelogram)
3. Thrombocytes (platelets) – contribute to clotting
reveals mass/ CT scan or sonogram
4. Plasma (fluid part of blood) – carries antibodies
and nutrients to tissues and carries wastes away
MEDICAL MANAGEMENT
v Nephrectomy, with total removal of tumor/kidney
NATURAL (INNATE) IMMUNITY: present at birth
affected.
v Postsurgical radiation in treatment of stages II, III 1. Naturally acquired active immunity
and IV; stage I disease does not usually require
radiation, but it may be used if the tumor n the immune system makes antibodies after
histology is unfavorable exposure to disease. It requires contact with the
v Postsurgical chemotherapy: Vincristine, disease
Daunorubicin, Doxorubicin
2. Naturally acquired passive immunity
NURSING INTERVENTIONS
a. Do not palpate abdomen to avoid possible n no active immune process is involved. The
dissemination of cancer cells antibodies are passively received through
b. Handle child carefully when bathing and giving placental transfer by IgG and breastfeeding
care (colostrum)

c. Provide care for the client with a nephrectomy;

usually performed 24-48 hours of diagnosis

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ARTIFICIALLY ACQUIRED IMMUNITY § Risk for deficient fluid volume

TREATMENT
1. Artificially acquired active immunity v Avoiding aspirin, sutures and cauterization
which may aggravate bleeding
n medically engineered substances are ingested or v Blood transfusion if necessary
injected to stimulate the immune response v Cryoprecipitate administration
against a specific disease. v Administration of fresh frozen plasma
n E.g., immunizations v Promoting vasoconstriction during bleeding
episodes by applying ice, pressure and
2. Artificially acquired passive immunity
hemostatic agents
v Drug therapy: Hemostatic (Desmopressin
n antibodies are injected without stimulating the
acetate – DDAVP) to promote release of factor
immune response.
VIII in individuals with mild or moderate
n E.g., Hepatitis B immune globulin, Varicella
hemophilia A
zoster immune globulin

INTERVENTIONS
HEMOPHILIA
a. Monitor VS and I & O
b. Assess CV status and check for signs of bleeding
n Results in the deficiency of one of the
c. Measure the joint’s circumference and compare it
coagulation factors
to that of an unaffected joint to assess for
n Bleeding disorder for children; males are
bleeding into the joint, which may lead to
common
hypovolemia
n An X-linked recessive disorder
d. Note swelling, pain or limited joint mobility.
CAUSES: genetic inheritance
Changes may indicate progressive decline in
function
TYPES
e. Pad toys and other objects in the child’s
1. HEMOPHILIA A (FACTOR VIII DEFICIENCY OR
environment to promote child safety and prevent
CLASSIC HEMOPHILIA): most common type
bleeding
2. HEMOPHILIA B (FACTOR IX DEFICIENCY OR
f. Recommend protective headgear; soft foam,
CHRISTMAS FACTOR)
toothettes (instead of bristle toothbrushes), and
3. HEMOPHILIA C (FACTOR XI DEFICIENCY)
stool softeners as appropriate to prevent
bleeding
ASSESSMENT FINDINGS
g. Discourage abnormal weight gain, which
Ø Bleeding into the throat, mouth and thorax
increases the load on joints
Ø Hemarthrosis (bleeding in the joint cavity);
assessed if hemophilia is severe
WHEN BLEEDING OCCURS
Ø Multiple bruises without petechiae
a. Elevate the affected extremity above the heart to
Ø Peripheral neuropathies from bleeding near
decrease circulation to affected area and
peripheral nerves
promote venous return
Ø Prolonged bleeding after circumcision,
b. Immobilize the site
immunizations or minor injuries
c. Apply pressure to the site for 10-15 minutes to
Ø Diagnosis: PTT (Partial Thromboplastin Time)
stop bleeding
prolonged
d. Decrease anxiety to lower the child’s HR
Ø Normal platelet count; Abnormal clotting factor
e. Apply ice to the site to promote vasoconstriction

NURSING DIAGNOSIS
§ Risk for injury

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TO TREAT HEMARTHROSIS v RBC count is low, with microcytic and

a. Immobilize the affected extremity; elevate it in a hypochromic cells (in early stages, RBC count
slightly flexed position to prevent further injury may be normal, except in infants and children)
b. Decrease pain and anxiety v Serum iron levels are low, with high binding
c. Avoid excessive handling or weight-bearing for capacity
48 hours
d. Begin mild range-of-motion exercises after 48 NURSING DIAGNOSIS
hours to facilitate absorption and prevent § Imbalanced Nutrition: Less Than Body
contractures Requirements
§ Fatigue
IRON DEFICIENCY ANEMIA § Impaired Gas Exchange
n The most common nutritional anemia during
childhood TREATMENT
n IDA is characterized by poor RBC production v Increased iron intake (for children and
n It occurs most commonly when the child adolescents) by adding foods rich in iron to diet,
experiences rapid physical growth, has low iron or (for infants) adding iron supplements
intake, inadequate iron absorption or loss of
blood DRUG THERAPY
1. Oral preparation of iron or a combination of iron
BLOOD LOSS and ascorbic acid (which enhances iron
CAUSES absorption)
INADEQUATE DIETARY INTAKE OF IRON: <1-2 mg/day 2. Vitamin supplement: Cyanocobalamin (Vitamin
(may occur following prolonged, un supplemented B12) if intrinsic factor is lacking
breastfeeding or bottle-feeding of infants) 3. Iron supplement: Iron dextran if additional
IRON MALABSORPTION: chronic diarrhea, celiac therapy is needed
disease
INTERVENTIONS
ASSESSMENT FINDINGS a. Provide foods high in iron: liver, dark, leafy
§ INITIALLY, ASYMPTOMATIC vegetables, and whole grains
§ ADVANCED ANEMIA: b. Administer iron before meals with citrus juice.
1. Fatigue Iron is best absorbed in an acidic environment
2. Listlessness c. Give liquid iron through a straw to prevent
3. Pallor staining the child’s skin and teeth. For infants,
4. Susceptibility to infections administer by oral syringe toward the back of the
5. Tachycardia mouth
6. Numbness and tingling of the extremities d. Do not give iron with milk products because it will
7. Vasomotor disturbances interfere with iron absorption

DIAGNOSTIC TEST RESULTS LEUKEMIA

v Bone marrow studies reveal depleted or absent n Leukemia is the abnormal, uncontrolled
iron stores and normoblastic hyperplasia proliferation of WBCs
v Hemoglobin, hematocrit and serum ferritin levels n WBCs are produced so rapidly that immature
are low cells (blast cells) are released into the circulation.
v Mean corpuscular hemoglobin is severely These blast cells are nonfunctional and cannot
decreased in severe anemia fight infection. This proliferation robs healthy cells
of sufficient nutrition.

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n In children, the most common type of leukemia is DRUG THERAPY

ACUTE LYMPHOCYTIC LEUKEMIA (ALL) 1. Analgesics
n ALL is marked by extreme proliferation of 2. Antiemetics
immature lymphocytes 3. Chemotherapy with agents such as Methotrexate
n In adolescents, ACUTE MYELOGENOUS 4. Corticosteroids: Prednisone
LEUKEMIA (AML) is more common and is
believed to result from a malignant INTERVENTIONS
transformation of a single stem cell a. Monitor VS, I & O
b. Give special attention to mouth care to prevent
CAUSES AND CONTRIBUTING FACTORS infection and bleeding
o Chemical exposure and viruses c. Inspect the skin frequently to assess for skin
o Chromosomal disorders breakdown
o Down syndrome d. Give increased fluids to flush chemotherapeutic
o Ionizing radiation drugs through the kidneys
e. Provide a high-protein, high-calorie, bland diet
ASSESSMENT FINDINGS with no raw fruits or vegetables. Eliminating raw
Ø Blood in urine, stool or emesis fruits and vegetables helps prevent infection
Ø Bone and joint pain f. Provide pain relief as ordered and document its
Ø Fatigue effectiveness and adverse effects. Analgesics
Ø History of infections depress the CNS thereby reducing pain
Ø Low-grade fever g. Monitor the CNS to assess for changes such as
Ø Lymphadenopathy confusion that may result from cerebral damage
Ø Pallor h. Provide nursing measures to ease the adverse
Ø Petechiae and ecchymosis reactions of radiation and chemotherapy to
Ø Poor wound healing and oral lesions promote comfort and encourage adequate
nutritional intake
DIAGNOSTIC TEST RESULTS
² Blast cells appear in the peripheral blood ASTHMA
² Blast cells may be as high as 95% in the bone n Asthma is a reversible, diffuse, obstructive
marrow as measured by marrow aspiration in the pulmonary disease that produces the following
posterior iliac crest effects:
² Initial WBC count may be less than 10,000/ul at o inflammation of the mucus membrane
the time of diagnosis in a child with ALL between o smooth muscle bronchospasm
ages 3 and 7. (This child has the best prognosis) o increased mucus secretion leading to airway
obstruction and air trapping
NURSING DIAGNOSIS
§ Acute or chronic pain CAUSES:
§ Risk for infection Hyperresponsiveness of the lower airway (may be
idiopathic or intrinsic; may be caused by a
TREATMENT hyperresponsive reaction to an allergen, exercise or
v Bone marrow transplantation environmental change)
v High-protein, high-calorie, bland diet • IVF as
necessary ASSESSMENT FINDINGS
v Oxygen therapy as needed Ø alteration in chest contour from chronic air
v Radiation therapy trapping
v Transfusion therapy Ø altered cerebral function

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Ø diaphoresis
Ø dyspnea
Ø exercise intolerance
Ø fatigue and apprehension
Ø wheeze
Ø unequal or decreased breath sounds
Ø use of accessory muscles

DIAGNOSTICS:
² pulse oximetry may show decreased oxygen
saturation
² ABGs – increased PaCO2 from respiratory
acidosis
² skin test identifies the source of the allergy
² sputum analysis rules out respiratory infection

MEDICAL MANAGEMENT
DRUG THERAPY: BRONCHODILATORS
a. Beta – adrenergic agonists
b. Corticosteroids
c. Nonsteroid anti – inflammatory agents
d. Xanthine derivatives

NURSING INTERVENTIONS
a. Place client in high Fowler’s position
b. Administer oxygen as ordered
c. Administer medications as ordered
d. Provide humidification / hydration to loosen
secretions
e. Provide chest percussion and postural drainage
f. Monitor for respiratory distress
g. Provide client teaching and discharge planning
concerning:
1. Modification of environment
o ensure room is well ventilated
o stay indoors during grass cutting or when pollen
count is high
o use damp dusting
o avoid rugs, draperies or curtains, stuffed
animals
o avoid natural fibers (wool and feathers)
2. Importance of moderate exercise (swimming is
excellent)
3. Purpose of breathing exercises (to increase the
end expiratory pressure of each respiration)

10 HIGH-RISK TODDLER AND PRESCHOOLER