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Running head: NURSING CARE OF THE CHILD WITH A RESPIRATORY DISORDER 1

NURSING CARE OF THE CHILD WITH A RESPIRATORY DISORDER 6

Nursing Care of the Child with a Respiratory Disorder

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Nursing Care of the Child with a Respiratory Disorder

Overview

Gloria is an 8-year-old girl who is admitted to the pediatric unit with a history of cystic fibrosis and difficulty breathing.

Definition of the Medical Diagnosis

The cystic fibrosis disease occurs as an autosomal recessive genetic disorder caused by the mutations in the genes responsible for cystic fibrosis transmembrane conductance regulator (CFTR) normally located in the body's mucus-secreting cells. The disease affects primarily the reproductive, respiratory and gastrointestinal tract. The manifestation of the cystic fibrosis disease includes a chronic, progressive lung disease that results in dehydrated mucus secretion resulting in obstruction of the airway and other symptoms related to malnutrition due to pancreatic insufficiency. These pulmonary symptoms range from the asymptomatic disease that has undetectable changes in the functioning of the lungs to the severe obstruction that occur early during childhood.

The gastrointestinal symptoms could range from mild cases of constipation, intermittent pancreatitis and normal liver functioning to severe cases featuring loss of the pancreatic function, malnutrition and malabsorption, CF-related diabetes and later on could lead to end-stage liver disease. If untreated, the disease could be fatal. The reproductive and sweat glands could also be affected by the disease. In most male patients with the disease, they tend to become sterile due to the impairment that occurs in the vas deferens while in the female it could result in a reduction in fertility levels. The sweat glands result in an abnormal production of chloride secretion.

Common Signs and Symptoms

There are the different clinical manifestation of cystic fibrosis that include Meconium ileus occurring in 10-15% of newborns before developing other manifestations later and absence of pancreatic enzymes that occur due to the absence or depletion that result in impairment of the digestive system resulting to meconium becoming mucilaginous (sticky) and viscid (thick). The other symptom is obstruction of the intestines due to bile-stained emesis and distended abdomen with an absence of stool (Gulanick & Myers, 2016). A third common symptom of cystic fibrosis is a chronic cough, which appears as the first signs of cystic fibrosis and becomes more frequent due to bronchial infection. Difficulty in breathing is another common symptom liked to lack oxygen in the blood, which is assessed by observing barrel chest as well as clubbing of fingers. Other symptoms include pancreatic insufficiency, steatorrhea, high electrolyte concentrations and sterility.

Potential Complications

The delayed treatment of the disease could lead to severe complications including bowel problems like intestinal blockage, gallstones and rectal prolapse, chronic respiratory failure, coughing up blood, malnutrition, diabetes, infertility, sinusitis and nasal polyps, and liver disease.

Head to Toe Assessment

HEENT: nasal polyps, sinus pain and tenderness on palpation, rhinosinusitis, purulent nasal discharge, mucosal oedema and Inferior turbinate hypertrophy.

Skin: skin dryness as a result of a deficiency in vitamin A and skin rashes due to zinc deficiency.

Neck: an examination of the neck for patients with cystic fibrosis is usually normal.

Lungs: they become hyper resonant, wheeze or crackles, purulent sputum or a productive cough that has mucoid.

Heart: the patient indicate normal cardiovascular functioning

Abdomen: the patient indicates the distension of the abdomen

Extremities: the patient might indicate digital clubbing

Diagnostic and Lab Studies Expected Outcomes

The diagnostic assessment of patients is dependent on the typical pulmonary manifestations, family history, gastrointestinal tract manifestation, positive sweat tests results. To test a patient, certain tests are recommended such as noninvasive CFTR analysis that DNA recovery from cells retrieved through buccal brushing used in establishing the carrier status (Gulanick & Myers, 2016). The second form of test is the sweat chloride test that evaluates a confirmatory test for the disease that uses pilocarpine iontophoresis method of assessment for chemical content in the sweat. Radiography could also be used to evaluate hyperinflation and peribronchial thickening changes that may occur when a patient has cystic fibrosis.

All NANDA Nursing Diagnosis

Activity intolerance

Abnormal breath sounds

Dyspnea

Cough

Hypercapnia

Pale skin colour

Irritability

Tachypnea

Restlessness

Tachycardia

3 NANDA Nursing Diagnosis, Goal Interventions and Rationale

1. .Impaired Gas Exchange: Occurs due to deficit or excess in oxygenation o carbon dioxide elimination in the alveolar-capillary membrane. Could occur due to obstruction of the airway when nasal obstruction occurs, alveoli or airway inflammation, alveolar collapse and bronchiectasis (Gulanick & Myers, 2016).

(a) Desired Outcomes

The patient attaining optimal gas exchange assessed through oxygen saturation of 90%

(b) Nursing Interventions and Rationale

Intervention	Rationale
Assessment of the respiratory and heart rate to evaluate any changes	The patient might experience an increased heart rate and respiratory rate due to compensation for early hypoxia
Provide the patient under care with adequate rest between activities with minimal interruption in sleep.	The patient might experience increased activity that results in higher oxygen requirements for paced opportunities that could result in fatigue (Doenges et al., 2016)
Administer oxygen therapy	Use of supplemental oxygen enhances attainment of adequate oxygen concentration that decreases breathing difficulty and calorie expenditure that relieves dyspnea leading to more comfort and normal oxygen concertation of greater than 90%

2. Abnormal breath sounds: this is a common symptom when there is an ineffective airway clearance

(a) Desirable Outcome

The patient will demonstrate increased air exchange.

Interventions and Rationale

Intervention	Rationale
Assess airway for patency	Ensures that the patent airway is maintained effectively as the first priority for the patient to enhance relaxation and recovery
Position the patient upright	Ensuring that the patient is in an upright position limit the contents of the abdomen from pushing upward that could inhibit the expansion of lungs when breathing resulting in breathing difficulties (Doenges et al., 2016).
Ensuring that a humidified oxygen is maintained as prescribed	The patient required the increased humidity of air inspired to reduce thickening of secretion to enhance their remove to avoid nasal obstruction

3. Restlessness

Restlessness occurs due to poor airway clearance that results in low oxygen concentration in the blood (Gulanick & Myers, 2016).

(a) Desired Outcome

The desired outcome for the patient is maintaining patent airway that results in stability in oxygen concentration to enhance sound clearing and absence of cyanosis and dyspnea by keeping the airway effective to enhance secretion clearing.

(b) Intervention and Rationale

Intervention	Rationale
Assess the depth of respiration, heart rate, respiratory rate and heart rhythm	Asymmetric chest movement, tachypnea and shallow respirations are all indicators of restlessness due to airway clearance issues and low oxygen concentration. This type of discomfort is expressed through the restlessness of a patient in moving the chest walls due to respiratory problems or obstruction of the airway. Alteration in the breathing patterns of the patient is rhythmically resulting to use of accessory muscles to compensate for expansion in the chest to increase oxygen supply (Black & Hawks, 2009)
Assess cough effectiveness and productivity	Airway obstruction could also affect the cough effectiveness and productivity, which could another cause of restless of the patient due to difficulty in the removal of secretions

Evaluation

The patient reports smooth airway clearance and is free from nasal obstruction due to the smooth removal of secretions. The patient demonstrates reduced restlessness and more relaxed mood.

References

Black, J. M., & Hawks, J. H. (2009). Medical-surgical nursing: Clinical management for positive outcomes (Vol. 1). A. M. Keene (Ed.). Saunders Elsevier

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nurse's pocket guide: diagnoses, prioritized interventions, and rationales. FA Davis.

Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.