a. IVF’s, Nebulization, and Oxygen Therapy
 INTRAVENOUS FLUID MEDICAL DATE ORDERED MANAGEMENT/ DATEPERFORM TREATMENT ED DATE CHANGED/ D/C D5 0.3 Nacl 500 cc 30 ugtts/min Date Ordered: August 2010 13, A hypotonic solution that has greater concentration of free water molecules that are found inside the cell. Purpose of hypotonic solution is to give up their water to a dehydrated cell so it can return to isotonic equilibrium. Used to replace fluid loss from the body to provide normal daily maintenance requirement. It is also indicated as a source of water and electrolytes. Patient was able to tolerate the IV Fluid, consequently, has improved his hydration status gradually as evidenced by balanced levels of fluid electrolytes. Also, No side effects were noted, however the patient may manifest pain on the area of infusion as evidenced by facial grimaces.




Date Performed: August 2010 to August 2010 13, 16,

Date of Discontinuation : August 17,2010

Nursing Responsibilities on Intravenous Fluid: Prior: a. Check the pt name and doctor’s order before administration.

• Wash your hands thoroughly. Hang the IV solution with attached primed administration set on the IV pole. Lightly palpate the vein with the index and middle fingers of your nondominant hand.• • • Explain to the patient the indication of IVF infusion as well as the procedure Prepare all the materials needed for IV insertion Unless initiating IV therapy is urgent. During: • • Select the puncture site. • • • • Apply a tourniquet about 4-6 inches above the intended puncture site to dilate the vein. Check for radial pulse. provide any scheduled care before establishing the infusion to minimize movement of the affected limb during the procedure. Tell the patient that you are about to insert the device. . stretch the skin taut below the puncture site to stabilized the vein. Clean the site with alcohol pads. reclining position. Work in a circular motion outward from the site to a diameter of 2-4 inches. Using the thumb of your non-dominant hand. • • • Place the IV pole in the proper slot in the patient’s bed frame. leaving the arm in a dependent position to increase capillary refill of the lower hands and arms. Verify the patient’s identity by comparing the information on the solution container with the patient’s wristband or any identification item. Allow the antimicrobial solution to dry. Leave the tourniquet in a place for no longer than 3 minutes. Place the patient in a comfortable. • • • Grasp the access cannula.

 NEBULIZATION MEDICAL DATE ORDERED MANAGEMENT/ DATEPERFORME TREATMENT D. After: • • • • After the venous access device has been inserted. regulate the flow rate. When the catheter is advanced. Cover the site with a sterile gauze pad or small adhesive bandage. clean the skin completely. and your initials. gauge of needle and length of cannula. attach the IV tubing and begin the infusion. To advance the cannula while infusing IV solution. date and time of insertion. Check frequently for impaired circulation to the infusion site. Aggressively push the needle directly through the skin and into the vein in one motion. and withdraw the needle. Using the sterile technique. use the other to advance the catheter into the vein. Then. Label the last piece of tape with the type. release the tourniquet and remove the inner needle. DATE CHANGED/ and D/C GENERAL DESCRIPTION INDICATION(S) OR PURPOSE CLIENT’S RESPONSE TO THE TREATMENT . decrease the IV flow rate.• • • • Hold the needle bevel up and enter the skin directly over the vein at a 15-25 degree angle. Grasp the cannula hub to hold it in the vein. While stabilizing the vein with one hand.

Once the nebulization is complete. however there is an absence of DOB and other signs of respiratory depression. When being nebulized. thick secretions and presence of rales/wheezes Still the patient manifested increased RR and HR.Nebulization Date Ordered: August 14. the patient should cough to dislodge the excess fluid from the lungs. A nebulization procedure is indicated to lessen the difficulty of breathing. 2010 to August 17. the patient should take slow.2010 A nebulization is a procedure in which the medication is being vaporize in order to be inhaled by the patient and treat bronconstrictio n or to expel secretions that blocks airways. Nursing Responsibilities in Nebulization: Prior to the procedure: • • • • • Check for the doctor’s order on the patient’s chart Identify the patient. deep breaths and should stop if pulse increases to more than 20 beats per minute.2010 Date Performed: August 15. Obtain baseline assessment of patient’s respiratory status Prepare all the equipments necessary Explain the procedure and indication or medication .

Monitor VS especially RR and HR Document for the procedure done and for any findings regarding effect of nebulization. ." Febrile seizures are the most common neurologic conditions of childhood. with the average age onset between 18 and 22 months. Boys are affected about twice as often as girls.• • Ensure correct delivery of the prescribed medication Do not exceed recommended dosage During the procedure: • • • Elevate the head 30 degree from bed Place mouthpiece near to the mouth and instruct the patient to inhale deeply as dose is released. SUMMARY According to the definition given by the International League Against Epilepsy (ILAE)BFC is "a seizure in association with a febrile illness in the absence of a central nervous system (CNS) infection or acute electrolyte imbalance in children older than 1 month of age without prior afebrile seizures. VII. Instruct patient’s SO to avoid accidentally spraying the inhalant into the eyes of the patient. affecting approximately 3% of children. Most febrile seizures occur after 6 months of age and usually before 3 years. They are unusual after 5 years of age. which may blur vision temporarily After the procedure: • • • Apply back tapping in order to move the secretions out of the lungs.

otitis media (23%). August 13th. gastroenteritis (7%).5 °C. In addition. roseola infantum (5%). She stated that Baby Kulot would not eat anything. As days pass by. alteration obvious presumed underlying except predisposition. Lewis 1979) the primary cause of fever causing seizures. During the period. drug abuse during pregnancy that has teratogenic effect in the intra uterine life of the fetus. postnatal trauma (chronic effects of trauma that did cause brain damage or damaged an area called the hippocampus in the front central temporal lobe that if damaged. His vital signs upon admission were T: 39. not even rice. it is due to increased familial no susceptibility. She was advised by the physician to give paracetamol and perform tepid sponge bath to facilitate evaporation so that his temperature will decrease.8 °C or 101. Mama Kulot also noticed Baby Kulot’s dry cough which impedes his sleeping and eating pattern. Baby Kulot’s temperature would randomly decrease and increase maintaining above 37.Also. genetic immaturity cause of or thermoregulatory pathophysiological mechanism. and loud music. becomes highly epileptogenic). Upon arrival and admission. congenital malformation. . On the fifth day. (Nelson and Ellenberg 1978. she called her mother and decided to rush Baby Kulot to the hospital. environmental stimuli such as bright lights. fever above 38. Mama Kulot verbalized that she brought Baby Kulot to the hospital for checkup because of the said condition. Baby Kulot was experiencing fever for 5 days prior to admission.8 °F. and constitutes dramatic beginning of an illness ( upper respiratory or gastrointestinal infection). and noninfectious illness (12%)). Mama Kulot was shocked when she saw Baby Kulot suddenly fainted and experienced seizure while playing. P: 115 bpm and R:58 cpm thus leading to his diagnosis of Benign Febrile Convulsion secondary to Bronchopneumonia. Baby Kulot manifested the following: fever. infection (upper respiratory tract infection or pharyngitis (38%). BFC’s modifiable risk factors would include: Maternal alcohol intake and smoking during pregnancy. Taking no chances on this matter.5°C. dizziness and seizures/convulsions as written in his chart. pneumonia (15%).

The DOH is responsible in educating the public about different alterations in health. Also. With the above situation. Kulot has no previous diagnosis related to any neurological disorder or CNS infection. They should also allot added funds to education in order to educate the people which can help in the prevention of illnesses. To the Researchers The group recommends that they may keep on finding ways for early detection of Benign Febrile seizure and pneumonia to improve the quality of life of those inflicted with the condition. there is no evidence of meningitis. Hence. They should not give up in making and discovering new and useful innovations for this will benefit the whole human race. To Professionals and Service . Not only do they have a big influence in the public but also they have the power to improve the status of the people. Further. To the Department of Health The group recommends that they may conduct more programs regarding different areas of health. RECOMMENDATIONS To the Government The group recommends that they may allot added funds to the health of its people in order to lessen the mortality and morbidity rates. since he is just 1 year old and 3 months old he is at risk in developing the said condition because of the immaturity of the thermoregulatory system of the brain. benign febrile convulsion resulted from the infection of the lungs due to bronchopneumonia.With the said incidence it has been detected that the occurrence of benign febrile convulsion is due to the fact that Kulot has underlying disease condition which is bronchopneumonia. IX.

skills and attitude in serving their patients. . It can also aid in rendering proper health teachings and information to client having or at risk of developing the condition. It could also improve the quality of nursing care delivery and for the students to be able to uplift their knowledge. To the Nursing Education This serves as a stepping stone in the field of nursing education giving knowledge and background regarding the condition. treatment and prognosis is also stated at the previous paragraph that could give nursing students together with the different medical field regarding different preventive options and treatment interventions regarding the disease proper. This could raise interest to the reader to appreciate the vast variety of learning within the profession. To Nursing Administration This could act as a landmark in promoting different seminars regarding different seizures and pneumonia cases together with their etiology and course of treatment. to give knowledge to the public at large and to act as an information channel giving the students who are enrolled to the nursing profession educative and informative lecture discussion regarding the wide network of diseases arising from the respiratory system. The disease etiology.This may serve as informative source for nurses and the profession alike regarding the disease condition and the general information and comprehensive treatment involved in the case. diagnostic.

bronchioles. terminal bronchioles and spread to the alveoli Secretion of large amounts of mucus brought about by the injured mucus secreting cells (goblet cells) that line the respiratory tract. Injured cells release biochemical mediators of the inflammatory response—histamine and bradykinin. Cells of the mucosa lining the airways are inflamed. Increased capillary permeability Increased blood flow to the area 3 . 1 Capillary vasodilation WBCs such as neutrophils and monocytes enter the area through the process of chemotaxis. Pathogen invades the lower respiratory tract specifically the bronchi. Inflammatory immune response is initiated by the biochemical mediators.Bronchopneum onia Modifiable factors: Non-modifiable factors: • Exposure to pathogens • Polluted Environment • Age • Upper Respiratory Tract Infection • Immature immune system • Low socioeconomic status ETIOLOGIC AGENTS: bacteria.

2 .

Alveoli lose air spaces and solidify.2 3 Phagocytosis of pathogens and debris occurs. Phagocytes release endogenous pyrogens They leak into the airway and alveoli causing swelling and edema. Pyrogens stimulate the hypothalamus to increase body temperature. 2010 4 USE OF ACCESSORY MUSCLES WHEN BREATHING. terminal bronchioles and alveoli. bronchioles. 2010 Airway is clogged with exudates and fluids. 2010 CRACKLES or RALES heard upon auscultationAugust 13. blood cells & plasma proteins to leave the blood stream.August 6. FEVER of 38 °C5 days prior to admissionAugust 6. Less oxygen reaches the alveoli Decreased lung compliance and recoil RAPID SHALLOW BREATHINGAugust 13. exudates) accumulates in the bronchi. 1 INEFFECTIVE COUGH. 2010 . 2010 Fluid (mucus.August 13. Capillaries open up allowing plasma.

4 Decreased oxygen reaching the alveoli Decreased O2 and CO2 exchange in the alveoli INCREASED RRAugust 13. 2010 _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ ___ _ _ _ _ Hypoxemi a Decreased oxygenation to body tissues and organs Severe hypoxia Multiple organ failure Death .

8 °C Upper Respiratory Tract infection and Due to the inflammatory process brought about by the bronchopneumonia of the patient. activation of epileptogenic neurons occurs Exhibit a paroxysmal depolarization shift Epileptogenic neurons fire more and more often.Benign Febrile Convulsion Non-modifiable factors: • • Age.5 °C) Kill the microorganism and adversely affect its growth and replication At the peak of fever.boys are affected twice than females Modifiable factors: • • Fever. specifically the interleukin 1 beta stimulate the hypothalamus to increase the body temperature.August 13. and with greater amplitude 5 . endogenous pyrogens. hours prior to admission (Upon admission 39. The interleukin 1 beta causes neuronal excitability that may link fever and seizure activity FEVER of 40 °C. 2010.> 6 mos and < 3 years Gender.above 38.

2010 Decreased oxygen circulation in the body CIRCUM-ORAL AND PERIPHERAL CYANOSIS. anterior thalamus.5 Intensity reaches it threshold point Cortical excitation spreads Excitation of subcortical.August 13. 2010 EXTENSION OF UPPER EXTREMITIESAugust 13. 2010 .August 13.August 13. 2010 Oxygen is consumed at high rate Stiffening of respiratory muscles DIFFICULTY OF BREATHING. thalamic. and brain stem areas TONIC PHASE Contraction of muscles Excitation of cortex. 2010 UNINTENTIONAL CRY OR GRUNTAugust 13. and basal ganglia 6 Stiffness of extremitie s LOSS OF CONSCIOUSNES S.

2010 .August 13. 2010 INCREASED MOUTH SECRETIONSAugust 13.6 Seizure discharge is interrupted Production of intermittent muscle contractions Exhaustion of epileptogenic neurons CLONIC PHASE Relaxation of bowel and/or bladder SUDDEN PASSAGE OF URINE.August 13. 2010 ROLLING OF EYEBALLS.

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