Professional Documents
Culture Documents
The child’s respiratory failure does ■ Place the child on a ■ The alarm on the monitor alerts The child’s respiratory failure is easily
not progress to respiratory arrest. cardiorespiratory monitor with a staff that the child is having managed with prompt assessment
20-second alarm. bradycardia or an apneic spell. and treatment.
■ Have resuscitation equipment, ■ Equipment should be at bedside in
including oxygen, resuscitation bag case of respiratory arrest. Bag-valve
with mask, and suction apparatus mask ventilation is recommended
at bedside. as the child’s respiratory secretions
contain bacteria.
■ Stimulate child if apneic; if no ■ Stimulation may encourage
response, begin manual ventilations spontaneous respirations; if not,
and call for emergency ventilation is necessary. Calling for
resuscitation. emergency resuscitation ensures
help in managing the child in a
timely manner.
■ Monitor heart rate and perform ■ The apneic child may have
compressions if necessary. bradycardia resulting from cardiac
hypoxia.
2. Risk for Injury related to infection of cerebrospinal fluid and potential sequelae
The child will suffer minimal CNS ■ Administer prescribed antibiotics ■ Administration of antibiotics helps The child’s condition improves
injury secondary to infection. and corticosteroids as scheduled. eradicate the pathogen and significantly within 48–72 hours (fever
prevent cerebral edema. decreases and no signs of neurologic
Adminstration of corticosteroids sequelae are detected).
diminishes inflammatory response
and reduces the chance of
neurologic sequelae.
■ Note return of fever, nuchal rigidity, ■ Watching for common sequelae
or irritability. Monitor vital signs, such as subdural effusions or septic
assess for signs of increased arthritis ensures prompt treatment.
intracranial pressure, measure head
circumference once or twice daily,
note changes in responsiveness.
Notify the physician immediately if
any signs are detected.
The child will not develop cerebral ■ Monitor for syndrome of ■ SIADH can be either avoided or Cerebral edema does not develop. If
edema as a result of water retention. inappropriate antidiuretic hormone quickly managed if early SIADH or increased ICP occurs, the
secretion (SIADH) and watch for recognition is achieved. condition is treated promptly so
signs of increased intracranial effects on the child are minimal.
pressure (ICP).
■ Perform strict intake and output ■ Low urine output with a high
measurements. Determine urine specific gravity is a sign of fluid
specific gravity. Check electrolytes retention and SIADH. The child is
and osmolality of both serum and maintained with lower fluids and
urine. Weigh the child daily. Restrict provided sodium supplements to
fluids and give sodium chloride as reduce the possibility for cerebral
ordered. edema. (continued)
744 ■ CHAPTER 20
2. Risk for Injury related to infection of cerebrospinal fluid and potential sequelae (continued)
The child will be free of injury ■ Be aware of needle sticks that ■ Prompt recognition leads to The child does not sustain injury from
resulting from disseminated continue to bleed and lesions that management of the coagulopathy. DIC.
intravascular coagulation (DIC). continue to ooze. Monitor clotting
times.
■ Administer blood products, vitamin ■ Prompt recognition allows for early
K, or heparin as ordered. initial treatment of DIC. The child
may bleed to death if treatment is
delayed.
The child will be free of injury ■ Monitor vital signs including pulse, ■ Monitoring allows for prompt The child recovers from shock quickly
secondary to shock. respirations, and blood pressure. diagnosis of shock based on clinical with no complications. Prompt
Note perfusion (capillary refill, signs. management of shock can enhance
central versus proximal pulses). the child’s recovery, since it prevents
Check level of consciousness. Note complications associated with poor
urine output. perfusion (tissue acidosis and
■ Begin fluid resuscitation as ordered. ■ Intravenous fluid bolus may ischemia).
improve perfusion.
■ Administer inotropes if ordered. ■ Inotropes enhance perfusion when
response to fluid challenge is
minimal.
3. Impaired Social Interaction related to decreased level of consciousness, hospitalization, and isolation
The child’s social interaction will be ■ Educate parents and other visitors ■ Family members help fulfill the The child’s social and developmental
near normal despite isolation. to use proper infection control emotional and social needs of the ill needs are met by family members
techniques. and contagious child. despite the child’s illness and
■ Encourage parents to help with ■ Parental involvement in the child’s hospitalization.
daily activities such as feeding and care provides the child with a sense
bathing. of security and emotional well-
being. Parents have a sense of
control and a feeling that they are
doing something to enhance the
child’s recovery.
■ Have age-appropriate games and ■ Providing the child with toys and
toys in the room. Play with the games as well as sensory
child. When the child is feeling stimulation helps the child achieve
better, encourage watching a sense of well-being.
television/videotape or listening to
the radio/audiotape.
The child with any degree of hearing ■ Arrange for hearing assessment ■ Hearing loss is a common The child with identified hearing loss
loss will be identified. prior to discharge. complication. Early intervention is is referred to appropriate specialist or
needed to promote growth and program for intervention.
development.
The child will be as comfortable as ■ Minimize tactile stimulation. ■ Sensory stimulation increases The child is calm and expresses
possible. discomfort. increased comfort.
Alterations in Neurologic Function ■ 745
5. Risk for Infection (Family and Close Contacts) related to pathogens in the cerebrospinal fluid
Caretakers or family members will ■ Explain rationale and dose schedule ■ Rifampin and ciprofloxacin provide Family members and other close
have no apparent evidence of for taking rifampin or ciprofloxacin. prophlylaxis for many bacterial contacts verbalize schedule for
infection. pathogens responsible for meningitis. rifampin or ciprofloxacin therapy.
Nursing Management
Initial nursing care focuses on providing supportive care as described for the child with bac-
terial meningitis. Give acetaminophen as ordered to reduce fever, headache, and muscle or