nutrition and diet
TRANSCRIPT
Nutrition and Diet
Anila Simon PhD-c, RN, CVRN, CMSRN AppleRN Classes
Overview
• Healthy diet – variety of nutrients• Minimize salt, sugar and saturated fat• BMI and weight management• Overall indicator of nutritional level –
Albumin• Special concern – pregnancy, adolescent,
elderly
• Healthy diet – variety of nutrients• Minimize salt, sugar and saturated fat• BMI and weight management• Overall indicator of nutritional level –
Albumin• Special concern – pregnancy, adolescent,
elderly
• Healthy diet – variety of nutrients• Minimize salt, sugar and saturated fat• BMI and weight management• Overall indicator of nutritional level –
Albumin• Special concern – pregnancy, adolescent,
elderly
• Healthy diet – variety of nutrients• Minimize salt, sugar and saturated fat• BMI and weight management• Overall indicator of nutritional level –
Albumin• Special concern – pregnancy, adolescent,
elderly
• Full liquid – clear liquids plus liquid dairy products, all juice,pureed vegetables
• Pureed – clear and full liquids plus pureed meats, fruits,scrambled eggs
• Mechanical soft – clear and full liquids plus diced or groundfoods
• Soft/low-residue – foods that are low in fiber and easy to digest• High-fiber (whole grains, raw and dried fruits)• Low sodium – no added salt or 1 to 2 g of sodium• Low cholesterol – no more than 300 mg/day of dietary
cholesterol• Diabetic – balanced intake of protein, fats, and carbohydrates of
about 1,800 calories• Dysphagia – pureed food and thickened liquids• Regular – no restrictions
• Full liquid – clear liquids plus liquid dairy products, all juice,pureed vegetables
• Pureed – clear and full liquids plus pureed meats, fruits,scrambled eggs
• Mechanical soft – clear and full liquids plus diced or groundfoods
• Soft/low-residue – foods that are low in fiber and easy to digest• High-fiber (whole grains, raw and dried fruits)• Low sodium – no added salt or 1 to 2 g of sodium• Low cholesterol – no more than 300 mg/day of dietary
cholesterol• Diabetic – balanced intake of protein, fats, and carbohydrates of
about 1,800 calories• Dysphagia – pureed food and thickened liquids• Regular – no restrictions
• Full liquid – clear liquids plus liquid dairy products, all juice,pureed vegetables
• Pureed – clear and full liquids plus pureed meats, fruits,scrambled eggs
• Mechanical soft – clear and full liquids plus diced or groundfoods
• Soft/low-residue – foods that are low in fiber and easy to digest• High-fiber (whole grains, raw and dried fruits)• Low sodium – no added salt or 1 to 2 g of sodium• Low cholesterol – no more than 300 mg/day of dietary
cholesterol• Diabetic – balanced intake of protein, fats, and carbohydrates of
about 1,800 calories• Dysphagia – pureed food and thickened liquids• Regular – no restrictions
• Full liquid – clear liquids plus liquid dairy products, all juice,pureed vegetables
• Pureed – clear and full liquids plus pureed meats, fruits,scrambled eggs
• Mechanical soft – clear and full liquids plus diced or groundfoods
• Soft/low-residue – foods that are low in fiber and easy to digest• High-fiber (whole grains, raw and dried fruits)• Low sodium – no added salt or 1 to 2 g of sodium• Low cholesterol – no more than 300 mg/day of dietary
cholesterol• Diabetic – balanced intake of protein, fats, and carbohydrates of
about 1,800 calories• Dysphagia – pureed food and thickened liquids• Regular – no restrictions
Therapeutic Diets– Clear-liquid diet
• Intended for short-term use or as transitiondiet
• Liquids that leave little residue (clear fruitjuices, gelatin, broth)
• Consists of clear fluids or foods that arerelatively transparent to light, liquid at bodytemperature
• Foods include water, fat-free broth, bouillon,clear carbonated beverages, gelatin, hardcandy, lemonade, frozen fruit bars, dilutedjuices, regular or decaffeinated coffee or tea
Therapeutic Diets– Clear-liquid diet
• Intended for short-term use or as transitiondiet
• Liquids that leave little residue (clear fruitjuices, gelatin, broth)
• Consists of clear fluids or foods that arerelatively transparent to light, liquid at bodytemperature
• Foods include water, fat-free broth, bouillon,clear carbonated beverages, gelatin, hardcandy, lemonade, frozen fruit bars, dilutedjuices, regular or decaffeinated coffee or tea
Therapeutic Diets– Clear-liquid diet
• Intended for short-term use or as transitiondiet
• Liquids that leave little residue (clear fruitjuices, gelatin, broth)
• Consists of clear fluids or foods that arerelatively transparent to light, liquid at bodytemperature
• Foods include water, fat-free broth, bouillon,clear carbonated beverages, gelatin, hardcandy, lemonade, frozen fruit bars, dilutedjuices, regular or decaffeinated coffee or tea
Therapeutic Diets– Clear-liquid diet
• Intended for short-term use or as transitiondiet
• Liquids that leave little residue (clear fruitjuices, gelatin, broth)
• Consists of clear fluids or foods that arerelatively transparent to light, liquid at bodytemperature
• Foods include water, fat-free broth, bouillon,clear carbonated beverages, gelatin, hardcandy, lemonade, frozen fruit bars, dilutedjuices, regular or decaffeinated coffee or tea
Full liquid diet
• Clear liquids plus liquid dairy products, alljuice, pureed vegetables
• The full liquid diet is often used as a stepbetween a clear liquid diet and a regular diet,for example, after surgery or fasting.
• It may also be used after certain procedures.• This diet may also be appropriate for patients
who have swallowing and chewing problems.
• Clear liquids plus liquid dairy products, alljuice, pureed vegetables
• The full liquid diet is often used as a stepbetween a clear liquid diet and a regular diet,for example, after surgery or fasting.
• It may also be used after certain procedures.• This diet may also be appropriate for patients
who have swallowing and chewing problems.
• Clear liquids plus liquid dairy products, alljuice, pureed vegetables
• The full liquid diet is often used as a stepbetween a clear liquid diet and a regular diet,for example, after surgery or fasting.
• It may also be used after certain procedures.• This diet may also be appropriate for patients
who have swallowing and chewing problems.
• Clear liquids plus liquid dairy products, alljuice, pureed vegetables
• The full liquid diet is often used as a stepbetween a clear liquid diet and a regular diet,for example, after surgery or fasting.
• It may also be used after certain procedures.• This diet may also be appropriate for patients
who have swallowing and chewing problems.
Therapeutic Diets (continued)– Mechanically altered diet
• Foods to be avoided include nuts, dried fruits,raw fruits and vegetables, fried foods,chocolate products, smoked or salted meats,foods with coarse textures
– Soft diet• Avoid foods that contain seeds or nuts
Therapeutic Diets (continued)– Mechanically altered diet
• Foods to be avoided include nuts, dried fruits,raw fruits and vegetables, fried foods,chocolate products, smoked or salted meats,foods with coarse textures
– Soft diet• Avoid foods that contain seeds or nuts
Therapeutic Diets (continued)– Mechanically altered diet
• Foods to be avoided include nuts, dried fruits,raw fruits and vegetables, fried foods,chocolate products, smoked or salted meats,foods with coarse textures
– Soft diet• Avoid foods that contain seeds or nuts
Therapeutic Diets (continued)– Mechanically altered diet
• Foods to be avoided include nuts, dried fruits,raw fruits and vegetables, fried foods,chocolate products, smoked or salted meats,foods with coarse textures
– Soft diet• Avoid foods that contain seeds or nuts
Therapeutic Diets– Low-residue, low-fiber diet
• Foods include white bread, refined cookedcereals, cooked potatoes without skins, whiterice, refined pasta
• Avoid raw fruits, vegetables, nuts, seeds, plantfiber, whole grains
– High-fiber diet• Consists of fruits and vegetables and whole-
grain products• Increase fiber gradually, provide adequate
fluids
Therapeutic Diets– Low-residue, low-fiber diet
• Foods include white bread, refined cookedcereals, cooked potatoes without skins, whiterice, refined pasta
• Avoid raw fruits, vegetables, nuts, seeds, plantfiber, whole grains
– High-fiber diet• Consists of fruits and vegetables and whole-
grain products• Increase fiber gradually, provide adequate
fluids
Therapeutic Diets– Low-residue, low-fiber diet
• Foods include white bread, refined cookedcereals, cooked potatoes without skins, whiterice, refined pasta
• Avoid raw fruits, vegetables, nuts, seeds, plantfiber, whole grains
– High-fiber diet• Consists of fruits and vegetables and whole-
grain products• Increase fiber gradually, provide adequate
fluids
Therapeutic Diets– Low-residue, low-fiber diet
• Foods include white bread, refined cookedcereals, cooked potatoes without skins, whiterice, refined pasta
• Avoid raw fruits, vegetables, nuts, seeds, plantfiber, whole grains
– High-fiber diet• Consists of fruits and vegetables and whole-
grain products• Increase fiber gradually, provide adequate
fluids
Therapeutic Diets– Cardiac diet
• Restrict saturated fat, trans-fat, cholesterol, sodium– Fat-restricted diet
• Restrict amount of total fat, including saturated, trans-,polyunsaturated, monounsaturated fats
– High-calorie, high-protein diet• Foods include whole milk and milk products, peanut
butter, nuts, seeds, beef, chicken, fish, pork, eggs, sugar,cream, mayonnaise, milkshakes, nutritionalsupplements
Therapeutic Diets– Cardiac diet
• Restrict saturated fat, trans-fat, cholesterol, sodium– Fat-restricted diet
• Restrict amount of total fat, including saturated, trans-,polyunsaturated, monounsaturated fats
– High-calorie, high-protein diet• Foods include whole milk and milk products, peanut
butter, nuts, seeds, beef, chicken, fish, pork, eggs, sugar,cream, mayonnaise, milkshakes, nutritionalsupplements
Therapeutic Diets– Cardiac diet
• Restrict saturated fat, trans-fat, cholesterol, sodium– Fat-restricted diet
• Restrict amount of total fat, including saturated, trans-,polyunsaturated, monounsaturated fats
– High-calorie, high-protein diet• Foods include whole milk and milk products, peanut
butter, nuts, seeds, beef, chicken, fish, pork, eggs, sugar,cream, mayonnaise, milkshakes, nutritionalsupplements
Therapeutic Diets– Cardiac diet
• Restrict saturated fat, trans-fat, cholesterol, sodium– Fat-restricted diet
• Restrict amount of total fat, including saturated, trans-,polyunsaturated, monounsaturated fats
– High-calorie, high-protein diet• Foods include whole milk and milk products, peanut
butter, nuts, seeds, beef, chicken, fish, pork, eggs, sugar,cream, mayonnaise, milkshakes, nutritionalsupplements
Therapeutic Diets (continued)– Carbohydrate-consistent diet
• Used in management of diabetes mellitus,hypoglycemia, lactose intolerance,galactosemia, dumping syndrome, obesity
– Sodium-restricted diet• Used to treat hypertension, congestive heart
failure, cardiac and liver disease• Encourage intake of fresh rather than
processed foods• Avoid canned, boxed, microwaved foods
Therapeutic Diets (continued)– Carbohydrate-consistent diet
• Used in management of diabetes mellitus,hypoglycemia, lactose intolerance,galactosemia, dumping syndrome, obesity
– Sodium-restricted diet• Used to treat hypertension, congestive heart
failure, cardiac and liver disease• Encourage intake of fresh rather than
processed foods• Avoid canned, boxed, microwaved foods
Therapeutic Diets (continued)– Carbohydrate-consistent diet
• Used in management of diabetes mellitus,hypoglycemia, lactose intolerance,galactosemia, dumping syndrome, obesity
– Sodium-restricted diet• Used to treat hypertension, congestive heart
failure, cardiac and liver disease• Encourage intake of fresh rather than
processed foods• Avoid canned, boxed, microwaved foods
Therapeutic Diets (continued)– Carbohydrate-consistent diet
• Used in management of diabetes mellitus,hypoglycemia, lactose intolerance,galactosemia, dumping syndrome, obesity
– Sodium-restricted diet• Used to treat hypertension, congestive heart
failure, cardiac and liver disease• Encourage intake of fresh rather than
processed foods• Avoid canned, boxed, microwaved foods
Therapeutic Diets (continued)– Protein-restricted diet
• Used to treat renal and liver disease• The less protein allowed in the diet, the more
important that protein in the diet be of high biologicalvalue (all essential amino acids)
– Renal diet• Used to treat acute renal failure, chronic renal failure
Therapeutic Diets (continued)– Protein-restricted diet
• Used to treat renal and liver disease• The less protein allowed in the diet, the more
important that protein in the diet be of high biologicalvalue (all essential amino acids)
– Renal diet• Used to treat acute renal failure, chronic renal failure
Therapeutic Diets (continued)– Protein-restricted diet
• Used to treat renal and liver disease• The less protein allowed in the diet, the more
important that protein in the diet be of high biologicalvalue (all essential amino acids)
– Renal diet• Used to treat acute renal failure, chronic renal failure
Therapeutic Diets (continued)– Protein-restricted diet
• Used to treat renal and liver disease• The less protein allowed in the diet, the more
important that protein in the diet be of high biologicalvalue (all essential amino acids)
– Renal diet• Used to treat acute renal failure, chronic renal failure
Therapeutic Diets (continued)– Potassium-modified diet
• Foods low in potassium include applesauce, greenbeans, cabbage, lettuce, grapes, blueberries, summersquash
• Foods high in potassium include avocado, bananas,carrots, fish, oranges, potatoes, raisins, spinach,strawberries, tomatoes
– High-calcium diet• Lactose-intolerant clients should incorporate nondairy
sources of calcium in their diet regularly
Therapeutic Diets (continued)– Potassium-modified diet
• Foods low in potassium include applesauce, greenbeans, cabbage, lettuce, grapes, blueberries, summersquash
• Foods high in potassium include avocado, bananas,carrots, fish, oranges, potatoes, raisins, spinach,strawberries, tomatoes
– High-calcium diet• Lactose-intolerant clients should incorporate nondairy
sources of calcium in their diet regularly
Therapeutic Diets (continued)– Potassium-modified diet
• Foods low in potassium include applesauce, greenbeans, cabbage, lettuce, grapes, blueberries, summersquash
• Foods high in potassium include avocado, bananas,carrots, fish, oranges, potatoes, raisins, spinach,strawberries, tomatoes
– High-calcium diet• Lactose-intolerant clients should incorporate nondairy
sources of calcium in their diet regularly
Therapeutic Diets (continued)– Potassium-modified diet
• Foods low in potassium include applesauce, greenbeans, cabbage, lettuce, grapes, blueberries, summersquash
• Foods high in potassium include avocado, bananas,carrots, fish, oranges, potatoes, raisins, spinach,strawberries, tomatoes
– High-calcium diet• Lactose-intolerant clients should incorporate nondairy
sources of calcium in their diet regularly
Therapeutic Diets– Low-purine diet
• Restrict such foods as anchovies, herring,mackerel, sardines, glandular meats, gravies,meat extracts, goose
– High-iron diet• Foods include organ meats, egg yolks,
whole-wheat products, green leafyvegetables, dried fruits
Therapeutic Diets– Low-purine diet
• Restrict such foods as anchovies, herring,mackerel, sardines, glandular meats, gravies,meat extracts, goose
– High-iron diet• Foods include organ meats, egg yolks,
whole-wheat products, green leafyvegetables, dried fruits
Therapeutic Diets– Low-purine diet
• Restrict such foods as anchovies, herring,mackerel, sardines, glandular meats, gravies,meat extracts, goose
– High-iron diet• Foods include organ meats, egg yolks,
whole-wheat products, green leafyvegetables, dried fruits
Therapeutic Diets– Low-purine diet
• Restrict such foods as anchovies, herring,mackerel, sardines, glandular meats, gravies,meat extracts, goose
– High-iron diet• Foods include organ meats, egg yolks,
whole-wheat products, green leafyvegetables, dried fruits
Enteral Nutrition– Description
• Provides liquefied foods into gastrointestinal tract via tube• Continuous or bolus
– Indications• Clients who have functional gastrointestinal system, but oral
intake not possible• For clients with swallowing problems, burns, major trauma, liver
failure, severe malnutrition– Nursing considerations
• Monitor weight, labs (metabolic issues)• Check tube placement, check residual• Intake and output, Flush tube with water before an after (prevent
dehydration)• HOB 30 degree
• Enteral feeding using Kangaroo Pump
Enteral Nutrition– Description
• Provides liquefied foods into gastrointestinal tract via tube• Continuous or bolus
– Indications• Clients who have functional gastrointestinal system, but oral
intake not possible• For clients with swallowing problems, burns, major trauma, liver
failure, severe malnutrition– Nursing considerations
• Monitor weight, labs (metabolic issues)• Check tube placement, check residual• Intake and output, Flush tube with water before an after (prevent
dehydration)• HOB 30 degree
• Enteral feeding using Kangaroo Pump
Enteral Nutrition– Description
• Provides liquefied foods into gastrointestinal tract via tube• Continuous or bolus
– Indications• Clients who have functional gastrointestinal system, but oral
intake not possible• For clients with swallowing problems, burns, major trauma, liver
failure, severe malnutrition– Nursing considerations
• Monitor weight, labs (metabolic issues)• Check tube placement, check residual• Intake and output, Flush tube with water before an after (prevent
dehydration)• HOB 30 degree
• Enteral feeding using Kangaroo Pump
Enteral Nutrition– Description
• Provides liquefied foods into gastrointestinal tract via tube• Continuous or bolus
– Indications• Clients who have functional gastrointestinal system, but oral
intake not possible• For clients with swallowing problems, burns, major trauma, liver
failure, severe malnutrition– Nursing considerations
• Monitor weight, labs (metabolic issues)• Check tube placement, check residual• Intake and output, Flush tube with water before an after (prevent
dehydration)• HOB 30 degree
• Enteral feeding using Kangaroo Pump
Nursing Interventions• Assist in advancing the diet as appropriate.• Instruct clients about the appropriate diet
regimen.• Provide interventions to promote appetite (good
oral hygiene, favorite foods, minimalenvironmental odors).
• Educate clients about medications that may affectnutritional intake.
• Assist clients with feeding to promote optimalindependence.
• Assist in advancing the diet as appropriate.• Instruct clients about the appropriate diet
regimen.• Provide interventions to promote appetite (good
oral hygiene, favorite foods, minimalenvironmental odors).
• Educate clients about medications that may affectnutritional intake.
• Assist clients with feeding to promote optimalindependence.
• Assist in advancing the diet as appropriate.• Instruct clients about the appropriate diet
regimen.• Provide interventions to promote appetite (good
oral hygiene, favorite foods, minimalenvironmental odors).
• Educate clients about medications that may affectnutritional intake.
• Assist clients with feeding to promote optimalindependence.
• Assist in advancing the diet as appropriate.• Instruct clients about the appropriate diet
regimen.• Provide interventions to promote appetite (good
oral hygiene, favorite foods, minimalenvironmental odors).
• Educate clients about medications that may affectnutritional intake.
• Assist clients with feeding to promote optimalindependence.
Nursing Interventions• Assist with preventing aspiration.• Position in Fowler’s position or in a chair.• Support the upper back, neck, and head.• Have clients tuck their chin when swallowing to help propel
food down the esophagus.• Observe for aspiration and pocketing of food in the cheeks
or other areas of the mouth.• Observe for signs of dysphagia, such as coughing, choking,
gagging, and drooling of food.• Keep clients in semi-Fowler’s position for at least 1 hr after
meals.• Provide oral hygiene after meals and snacks.
• Assist with preventing aspiration.• Position in Fowler’s position or in a chair.• Support the upper back, neck, and head.• Have clients tuck their chin when swallowing to help propel
food down the esophagus.• Observe for aspiration and pocketing of food in the cheeks
or other areas of the mouth.• Observe for signs of dysphagia, such as coughing, choking,
gagging, and drooling of food.• Keep clients in semi-Fowler’s position for at least 1 hr after
meals.• Provide oral hygiene after meals and snacks.
• Assist with preventing aspiration.• Position in Fowler’s position or in a chair.• Support the upper back, neck, and head.• Have clients tuck their chin when swallowing to help propel
food down the esophagus.• Observe for aspiration and pocketing of food in the cheeks
or other areas of the mouth.• Observe for signs of dysphagia, such as coughing, choking,
gagging, and drooling of food.• Keep clients in semi-Fowler’s position for at least 1 hr after
meals.• Provide oral hygiene after meals and snacks.
• Assist with preventing aspiration.• Position in Fowler’s position or in a chair.• Support the upper back, neck, and head.• Have clients tuck their chin when swallowing to help propel
food down the esophagus.• Observe for aspiration and pocketing of food in the cheeks
or other areas of the mouth.• Observe for signs of dysphagia, such as coughing, choking,
gagging, and drooling of food.• Keep clients in semi-Fowler’s position for at least 1 hr after
meals.• Provide oral hygiene after meals and snacks.
• Thank you
Parenteral NutritionOverview
Anila SimonApple RN Coaching
Parenteral NutritionOverview
›Description– Supplies all necessary nutrients via veins
› Indications– Severe dysfunctional or nonfunctional
gastrointestinal (GI) tract, or unable to processnutrients– Limited oral intake–AIDS, cancer, burn injuries, malnutrition, or
receiving chemotherapy
Parenteral Nutrition
›Description– Supplies all necessary nutrients via veins
› Indications– Severe dysfunctional or nonfunctional
gastrointestinal (GI) tract, or unable to processnutrients– Limited oral intake–AIDS, cancer, burn injuries, malnutrition, or
receiving chemotherapy
› Carbohydrates : Mainly in the form of glucose; ranges from 5%glucose solution for peripheral parenteral nutrition to 50% to 70%glucose solution for TPN
› Amino acids, Vitamins, Minerals and trace elements, Water
› Electrolytes: sodium, potassium, magnesium, calcium
› Insulin
› Heparin
› May be added to reduce buildup of fibrinous clot at catheter tip
› Fat emulsion (lipids) : Most fat emulsions prepared from soybeanor safflower oil, with egg yolk for emulsification
Components› Carbohydrates : Mainly in the form of glucose; ranges from 5%
glucose solution for peripheral parenteral nutrition to 50% to 70%glucose solution for TPN
› Amino acids, Vitamins, Minerals and trace elements, Water
› Electrolytes: sodium, potassium, magnesium, calcium
› Insulin
› Heparin
› May be added to reduce buildup of fibrinous clot at catheter tip
› Fat emulsion (lipids) : Most fat emulsions prepared from soybeanor safflower oil, with egg yolk for emulsification
› Review the client’s medical record. TPN also includes administration oflipids (egg allergy)
› Document patient’s weight (daily), BMI, nutritional status, diagnosis, andcurrent laboratory data.
› Blood test :- serum chemistry profile, PT/aPTT, iron, total iron-bindingcapacity, lipid profile, liver function tests, electrolyte panel, BUN,prealbumin and albumin level, creatinine, blood glucose, and plateletcount.
› Use IV pump and special filter for administering TPN solution.
› No additives to solution
Pre TPN Consideration› Review the client’s medical record. TPN also includes administration of
lipids (egg allergy)
› Document patient’s weight (daily), BMI, nutritional status, diagnosis, andcurrent laboratory data.
› Blood test :- serum chemistry profile, PT/aPTT, iron, total iron-bindingcapacity, lipid profile, liver function tests, electrolyte panel, BUN,prealbumin and albumin level, creatinine, blood glucose, and plateletcount.
› Use IV pump and special filter for administering TPN solution.
› No additives to solution
› I&O, daily weights, vital signs› Lab values (e.g., serum electrolytes, blood glucose)› ongoing evaluation of the client’s underlying condition. This data is
used to determine the client’s response to therapy.› Monitor serum and urine glucose – insulin sliding scale› Presence of oily appearance or a layer of fat on top of the solution
– DONOT USE› The bag and tubing should be changed every 24 hr. New tubing is
used with every bag.› Discontinuation should be done gradually. Use D10W if there is
discontinuation.
Ongoing Care› I&O, daily weights, vital signs› Lab values (e.g., serum electrolytes, blood glucose)› ongoing evaluation of the client’s underlying condition. This data is
used to determine the client’s response to therapy.› Monitor serum and urine glucose – insulin sliding scale› Presence of oily appearance or a layer of fat on top of the solution
– DONOT USE› The bag and tubing should be changed every 24 hr. New tubing is
used with every bag.› Discontinuation should be done gradually. Use D10W if there is
discontinuation.
› Air embolism, Hypervolumea› Hyperglycemia–Monitor blood glucose levels every 4 to 6 hours– Administer regular insulin as prescribed
› Infection› Pneumothorax – catheter correct place
Complications
› Air embolism, Hypervolumea› Hyperglycemia–Monitor blood glucose levels every 4 to 6 hours– Administer regular insulin as prescribed
› Infection› Pneumothorax – catheter correct place
› 1. A nurse is planning care for a client who has a newprescription for Total parenteral nutrition (TPN). Which of thefollowing interventions should the nurse include in the plan ofcare? (Select all that apply.)› A. Examine trends in weight loss.› B. Review prealbumin finding.› C. Administer an IV solution of Normal saline as substitute.› D. Add a micron filter to IV tubing.› E. Use an IV infusion pump.
› 1. A nurse is planning care for a client who has a newprescription for Total parenteral nutrition (TPN). Which of thefollowing interventions should the nurse include in the plan ofcare? (Select all that apply.)› A. Examine trends in weight loss.› B. Review prealbumin finding.› C. Administer an IV solution of Normal saline as substitute.› D. Add a micron filter to IV tubing.› E. Use an IV infusion pump.
› A. CORRECT: Examining trends in weight loss will help toevaluate the outcome of PPN.› B. CORRECT: Reviewing the prealbumin finding will determine
nutritional deficiency over a short period of time.› C. INCORRECT: An IV solution of 10% dextrose is administered
as total parenteral nutrition (TPN) using a central vein.› D. CORRECT: A micron filter is always used when infusing PN
solution.› E. CORRECT: An IV infusion pump is always used to regulate
the flow and provide accurate delivery of the PN solution.
Answer› A. CORRECT: Examining trends in weight loss will help to
evaluate the outcome of PPN.› B. CORRECT: Reviewing the prealbumin finding will determine
nutritional deficiency over a short period of time.› C. INCORRECT: An IV solution of 10% dextrose is administered
as total parenteral nutrition (TPN) using a central vein.› D. CORRECT: A micron filter is always used when infusing PN
solution.› E. CORRECT: An IV infusion pump is always used to regulate
the flow and provide accurate delivery of the PN solution.
Infection and Basic Care
Anila SimonApple RN Coaching
Learn Nursing International
Skin integrity and wound care
• Braden scale• Isotonic saline or wound cleansers to clean• Warm or body temp solutions• Clean wound at every dressing change if
contaminated• Avoid cotton balls – shed fibers. Use gauze• Daily assessment• Nutrition and mobility
• Braden scale• Isotonic saline or wound cleansers to clean• Warm or body temp solutions• Clean wound at every dressing change if
contaminated• Avoid cotton balls – shed fibers. Use gauze• Daily assessment• Nutrition and mobility
• Braden scale• Isotonic saline or wound cleansers to clean• Warm or body temp solutions• Clean wound at every dressing change if
contaminated• Avoid cotton balls – shed fibers. Use gauze• Daily assessment• Nutrition and mobility
• Braden scale• Isotonic saline or wound cleansers to clean• Warm or body temp solutions• Clean wound at every dressing change if
contaminated• Avoid cotton balls – shed fibers. Use gauze• Daily assessment• Nutrition and mobility
Chickenpox (Varicella)– Description
• Caused by varicella zoster virus• Transmission: direct contact, droplet spread, contaminated
objects– Assessment
• Macular rash that begins on scalp and trunk, moves toextremities; lesions become pustules, vesicles, then crusts
– Interventions• In hospital setting, strict isolation (contact, droplet precautions)• Supportive care at home
– Prevent scratching of lesions– Administer oatmeal or Aveeno baths for pruritus– Administer antihistamines as prescribed– Isolate child until all lesions are crusted
Chickenpox (Varicella)– Description
• Caused by varicella zoster virus• Transmission: direct contact, droplet spread, contaminated
objects– Assessment
• Macular rash that begins on scalp and trunk, moves toextremities; lesions become pustules, vesicles, then crusts
– Interventions• In hospital setting, strict isolation (contact, droplet precautions)• Supportive care at home
– Prevent scratching of lesions– Administer oatmeal or Aveeno baths for pruritus– Administer antihistamines as prescribed– Isolate child until all lesions are crusted
Chickenpox (Varicella)– Description
• Caused by varicella zoster virus• Transmission: direct contact, droplet spread, contaminated
objects– Assessment
• Macular rash that begins on scalp and trunk, moves toextremities; lesions become pustules, vesicles, then crusts
– Interventions• In hospital setting, strict isolation (contact, droplet precautions)• Supportive care at home
– Prevent scratching of lesions– Administer oatmeal or Aveeno baths for pruritus– Administer antihistamines as prescribed– Isolate child until all lesions are crusted
Chickenpox (Varicella)– Description
• Caused by varicella zoster virus• Transmission: direct contact, droplet spread, contaminated
objects– Assessment
• Macular rash that begins on scalp and trunk, moves toextremities; lesions become pustules, vesicles, then crusts
– Interventions• In hospital setting, strict isolation (contact, droplet precautions)• Supportive care at home
– Prevent scratching of lesions– Administer oatmeal or Aveeno baths for pruritus– Administer antihistamines as prescribed– Isolate child until all lesions are crusted
Herpes Zoster (Shingles)
• Herpes zoster is a viral infection.• It initially produces chickenpox, after which the
virus lies dormant in the dorsal root ganglia ofthe sensory cranial and spinal nerves.
• It is then reactivated as shingles later in life.• Shingles is usually preceded by a prodromal
period of several days, during which pain, itching,tingling, or burning may occur along the involveddermatome.
• Shingles can be very painful and debilitating.
• Herpes zoster is a viral infection.• It initially produces chickenpox, after which the
virus lies dormant in the dorsal root ganglia ofthe sensory cranial and spinal nerves.
• It is then reactivated as shingles later in life.• Shingles is usually preceded by a prodromal
period of several days, during which pain, itching,tingling, or burning may occur along the involveddermatome.
• Shingles can be very painful and debilitating.
• Herpes zoster is a viral infection.• It initially produces chickenpox, after which the
virus lies dormant in the dorsal root ganglia ofthe sensory cranial and spinal nerves.
• It is then reactivated as shingles later in life.• Shingles is usually preceded by a prodromal
period of several days, during which pain, itching,tingling, or burning may occur along the involveddermatome.
• Shingles can be very painful and debilitating.
• Herpes zoster is a viral infection.• It initially produces chickenpox, after which the
virus lies dormant in the dorsal root ganglia ofthe sensory cranial and spinal nerves.
• It is then reactivated as shingles later in life.• Shingles is usually preceded by a prodromal
period of several days, during which pain, itching,tingling, or burning may occur along the involveddermatome.
• Shingles can be very painful and debilitating.
• Risk Factors– Concurrent illness– Stress– Compromise to the immune system– Fatigue– Poor nutritional status
• Laboratory Tests– Cultures provide a definitive diagnosis (but the
virus grows so slowly that cultures are often ofminimal diagnostic use).
– Occasionally, an immuno fluorescence assay canbe done.
• Risk Factors– Concurrent illness– Stress– Compromise to the immune system– Fatigue– Poor nutritional status
• Laboratory Tests– Cultures provide a definitive diagnosis (but the
virus grows so slowly that cultures are often ofminimal diagnostic use).
– Occasionally, an immuno fluorescence assay canbe done.
• Risk Factors– Concurrent illness– Stress– Compromise to the immune system– Fatigue– Poor nutritional status
• Laboratory Tests– Cultures provide a definitive diagnosis (but the
virus grows so slowly that cultures are often ofminimal diagnostic use).
– Occasionally, an immuno fluorescence assay canbe done.
• Risk Factors– Concurrent illness– Stress– Compromise to the immune system– Fatigue– Poor nutritional status
• Laboratory Tests– Cultures provide a definitive diagnosis (but the
virus grows so slowly that cultures are often ofminimal diagnostic use).
– Occasionally, an immuno fluorescence assay canbe done.
• Subjective Data– Paresthesia– Pain that is unilateral and extends horizontally along a
dermatome• Objective Data
– Vesicular, unilateral rash (the rash and lesions occuron the skin area innervated by the infected nerve)
– Changes in or loss of vision if the eye is affected– Rash that is erythematous, vesicular, pustular, or
crusting (depending on the stage)– Rash that usually lasts several weeks– Low-grade fever
• Subjective Data– Paresthesia– Pain that is unilateral and extends horizontally along a
dermatome• Objective Data
– Vesicular, unilateral rash (the rash and lesions occuron the skin area innervated by the infected nerve)
– Changes in or loss of vision if the eye is affected– Rash that is erythematous, vesicular, pustular, or
crusting (depending on the stage)– Rash that usually lasts several weeks– Low-grade fever
• Subjective Data– Paresthesia– Pain that is unilateral and extends horizontally along a
dermatome• Objective Data
– Vesicular, unilateral rash (the rash and lesions occuron the skin area innervated by the infected nerve)
– Changes in or loss of vision if the eye is affected– Rash that is erythematous, vesicular, pustular, or
crusting (depending on the stage)– Rash that usually lasts several weeks– Low-grade fever
• Subjective Data– Paresthesia– Pain that is unilateral and extends horizontally along a
dermatome• Objective Data
– Vesicular, unilateral rash (the rash and lesions occuron the skin area innervated by the infected nerve)
– Changes in or loss of vision if the eye is affected– Rash that is erythematous, vesicular, pustular, or
crusting (depending on the stage)– Rash that usually lasts several weeks– Low-grade fever
Nursing Care• Assess/Monitor
– Pain– Condition of lesions– Presence of fever– Neurologic complications– Indications of infection
• Use an air mattress or bed cradle for painprevention/control of affected areas.
• Isolate the client until the vesicles have crusted over.• Isolate the client until the vesicles have crusted over.• Maintain strict wound care precautions
• Assess/Monitor– Pain– Condition of lesions– Presence of fever– Neurologic complications– Indications of infection
• Use an air mattress or bed cradle for painprevention/control of affected areas.
• Isolate the client until the vesicles have crusted over.• Isolate the client until the vesicles have crusted over.• Maintain strict wound care precautions
• Assess/Monitor– Pain– Condition of lesions– Presence of fever– Neurologic complications– Indications of infection
• Use an air mattress or bed cradle for painprevention/control of affected areas.
• Isolate the client until the vesicles have crusted over.• Isolate the client until the vesicles have crusted over.• Maintain strict wound care precautions
• Assess/Monitor– Pain– Condition of lesions– Presence of fever– Neurologic complications– Indications of infection
• Use an air mattress or bed cradle for painprevention/control of affected areas.
• Isolate the client until the vesicles have crusted over.• Isolate the client until the vesicles have crusted over.• Maintain strict wound care precautions
Nursing Care• The virus can be transmitted through direct contact,
causing chickenpox.• Avoid exposing the client to infants, pregnant women
who have not had chickenpox, and clients who areimmunocompromised.
• Moisten dressings with cool tap water or 5% aluminumacetate (Burow’s solution) and apply to the affectedskin for 30 to 60 min, four to six times per day asprescribed.
• Use lotions, such as calamine lotion, or recommendoatmeal baths to help relieve itching and discomfort.
• Administer medications as prescribed.
• The virus can be transmitted through direct contact,causing chickenpox.
• Avoid exposing the client to infants, pregnant womenwho have not had chickenpox, and clients who areimmunocompromised.
• Moisten dressings with cool tap water or 5% aluminumacetate (Burow’s solution) and apply to the affectedskin for 30 to 60 min, four to six times per day asprescribed.
• Use lotions, such as calamine lotion, or recommendoatmeal baths to help relieve itching and discomfort.
• Administer medications as prescribed.
• The virus can be transmitted through direct contact,causing chickenpox.
• Avoid exposing the client to infants, pregnant womenwho have not had chickenpox, and clients who areimmunocompromised.
• Moisten dressings with cool tap water or 5% aluminumacetate (Burow’s solution) and apply to the affectedskin for 30 to 60 min, four to six times per day asprescribed.
• Use lotions, such as calamine lotion, or recommendoatmeal baths to help relieve itching and discomfort.
• Administer medications as prescribed.
• The virus can be transmitted through direct contact,causing chickenpox.
• Avoid exposing the client to infants, pregnant womenwho have not had chickenpox, and clients who areimmunocompromised.
• Moisten dressings with cool tap water or 5% aluminumacetate (Burow’s solution) and apply to the affectedskin for 30 to 60 min, four to six times per day asprescribed.
• Use lotions, such as calamine lotion, or recommendoatmeal baths to help relieve itching and discomfort.
• Administer medications as prescribed.
Medications
• Analgesics (NSAIDs, narcotics) enhance clientcomfort.
• If started soon after the rash appears, antiviralagents, such as acyclovir (Zovirax), can decreasethe severity of the infection and shorten theclinical course.
• Recommend zoster vaccine live (Zostavax) forclients 50 and over to prevent shingles.
• This vaccine does not treat active shinglesinfections.
• Analgesics (NSAIDs, narcotics) enhance clientcomfort.
• If started soon after the rash appears, antiviralagents, such as acyclovir (Zovirax), can decreasethe severity of the infection and shorten theclinical course.
• Recommend zoster vaccine live (Zostavax) forclients 50 and over to prevent shingles.
• This vaccine does not treat active shinglesinfections.
• Analgesics (NSAIDs, narcotics) enhance clientcomfort.
• If started soon after the rash appears, antiviralagents, such as acyclovir (Zovirax), can decreasethe severity of the infection and shorten theclinical course.
• Recommend zoster vaccine live (Zostavax) forclients 50 and over to prevent shingles.
• This vaccine does not treat active shinglesinfections.
• Analgesics (NSAIDs, narcotics) enhance clientcomfort.
• If started soon after the rash appears, antiviralagents, such as acyclovir (Zovirax), can decreasethe severity of the infection and shorten theclinical course.
• Recommend zoster vaccine live (Zostavax) forclients 50 and over to prevent shingles.
• This vaccine does not treat active shinglesinfections.
Complications
• Postherpetic neuralgia• Characterized by pain that persists for longer
than 1 month following resolution of thevesicular rash.
• Tricyclic antidepressants may be prescribed.• Postherpetic neuralgia is common in adults
older than 60 years of age.
• Postherpetic neuralgia• Characterized by pain that persists for longer
than 1 month following resolution of thevesicular rash.
• Tricyclic antidepressants may be prescribed.• Postherpetic neuralgia is common in adults
older than 60 years of age.
• Postherpetic neuralgia• Characterized by pain that persists for longer
than 1 month following resolution of thevesicular rash.
• Tricyclic antidepressants may be prescribed.• Postherpetic neuralgia is common in adults
older than 60 years of age.
• Postherpetic neuralgia• Characterized by pain that persists for longer
than 1 month following resolution of thevesicular rash.
• Tricyclic antidepressants may be prescribed.• Postherpetic neuralgia is common in adults
older than 60 years of age.
Rubeola (Measles)– Description
• Paramyxovirus virus• Transmission: Airborne, direct contact with infectious
droplets, transplacental– Assessment
• Coryza (common cold), cough, conjunctivitis; Koplik’sspots in buccal mucosa
– Interventions• Airborne droplet precautions if child hospitalized
– Quiet activities and bed rest– Administer antipyretics as prescribed– Cool mist vaporizer as prescribed
Rubeola (Measles)– Description
• Paramyxovirus virus• Transmission: Airborne, direct contact with infectious
droplets, transplacental– Assessment
• Coryza (common cold), cough, conjunctivitis; Koplik’sspots in buccal mucosa
– Interventions• Airborne droplet precautions if child hospitalized
– Quiet activities and bed rest– Administer antipyretics as prescribed– Cool mist vaporizer as prescribed
Rubeola (Measles)– Description
• Paramyxovirus virus• Transmission: Airborne, direct contact with infectious
droplets, transplacental– Assessment
• Coryza (common cold), cough, conjunctivitis; Koplik’sspots in buccal mucosa
– Interventions• Airborne droplet precautions if child hospitalized
– Quiet activities and bed rest– Administer antipyretics as prescribed– Cool mist vaporizer as prescribed
Rubeola (Measles)– Description
• Paramyxovirus virus• Transmission: Airborne, direct contact with infectious
droplets, transplacental– Assessment
• Coryza (common cold), cough, conjunctivitis; Koplik’sspots in buccal mucosa
– Interventions• Airborne droplet precautions if child hospitalized
– Quiet activities and bed rest– Administer antipyretics as prescribed– Cool mist vaporizer as prescribed
Roseola (Exanthema Subitum)– Description
• Human herpesvirus type 6• Children under 3 years of age are typically more prone
to develop this infection.• The peak age for development is 6 to 15 months.• The incubation period is 5 to 15 days.
– Assessment• The child displays a high fever for 3 to 4 days, but
appears well.• Rash with presence of rose-colored macules that
blanche (develop after fever)– Interventions
• Supportive home care
Roseola (Exanthema Subitum)– Description
• Human herpesvirus type 6• Children under 3 years of age are typically more prone
to develop this infection.• The peak age for development is 6 to 15 months.• The incubation period is 5 to 15 days.
– Assessment• The child displays a high fever for 3 to 4 days, but
appears well.• Rash with presence of rose-colored macules that
blanche (develop after fever)– Interventions
• Supportive home care
Roseola (Exanthema Subitum)– Description
• Human herpesvirus type 6• Children under 3 years of age are typically more prone
to develop this infection.• The peak age for development is 6 to 15 months.• The incubation period is 5 to 15 days.
– Assessment• The child displays a high fever for 3 to 4 days, but
appears well.• Rash with presence of rose-colored macules that
blanche (develop after fever)– Interventions
• Supportive home care
Roseola (Exanthema Subitum)– Description
• Human herpesvirus type 6• Children under 3 years of age are typically more prone
to develop this infection.• The peak age for development is 6 to 15 months.• The incubation period is 5 to 15 days.
– Assessment• The child displays a high fever for 3 to 4 days, but
appears well.• Rash with presence of rose-colored macules that
blanche (develop after fever)– Interventions
• Supportive home care
Roseola
Rubella (German Measles)– Description
• Rubella virus• Transmission: Airborne or direct contact with infectious
droplets; transplacental; indirectly via articles freshlycontaminated with nasopharyngeal secretions or urine
– Assessment• Pink-red macular rash; begins on face, spreads to entire
body in 1 to 3 days; petechial spots on soft palate– Interventions
• Isolate infected child from pregnant women• Supportive home care• All women of childbearing age should have rubella titer
drawn to determine if they have adequate antibodies
Rubella (German Measles)– Description
• Rubella virus• Transmission: Airborne or direct contact with infectious
droplets; transplacental; indirectly via articles freshlycontaminated with nasopharyngeal secretions or urine
– Assessment• Pink-red macular rash; begins on face, spreads to entire
body in 1 to 3 days; petechial spots on soft palate– Interventions
• Isolate infected child from pregnant women• Supportive home care• All women of childbearing age should have rubella titer
drawn to determine if they have adequate antibodies
Rubella (German Measles)– Description
• Rubella virus• Transmission: Airborne or direct contact with infectious
droplets; transplacental; indirectly via articles freshlycontaminated with nasopharyngeal secretions or urine
– Assessment• Pink-red macular rash; begins on face, spreads to entire
body in 1 to 3 days; petechial spots on soft palate– Interventions
• Isolate infected child from pregnant women• Supportive home care• All women of childbearing age should have rubella titer
drawn to determine if they have adequate antibodies
Rubella (German Measles)– Description
• Rubella virus• Transmission: Airborne or direct contact with infectious
droplets; transplacental; indirectly via articles freshlycontaminated with nasopharyngeal secretions or urine
– Assessment• Pink-red macular rash; begins on face, spreads to entire
body in 1 to 3 days; petechial spots on soft palate– Interventions
• Isolate infected child from pregnant women• Supportive home care• All women of childbearing age should have rubella titer
drawn to determine if they have adequate antibodies
Rubella screen
• A positive maternal titer indicates that a significantantibody titer has developed in response to a priorexposure to the Rubivirus.
• All children of pregnant women should receive theirimmunizations according to schedule.
• Rubella vaccine is not given during pregnancy becausethe live attenuated virus may cross the placenta andpresent a risk to the developing fetus.
• The female client who received a rubella vaccine needto use a contraception method for at least 2 to 3months afterward.
• A positive maternal titer indicates that a significantantibody titer has developed in response to a priorexposure to the Rubivirus.
• All children of pregnant women should receive theirimmunizations according to schedule.
• Rubella vaccine is not given during pregnancy becausethe live attenuated virus may cross the placenta andpresent a risk to the developing fetus.
• The female client who received a rubella vaccine needto use a contraception method for at least 2 to 3months afterward.
• A positive maternal titer indicates that a significantantibody titer has developed in response to a priorexposure to the Rubivirus.
• All children of pregnant women should receive theirimmunizations according to schedule.
• Rubella vaccine is not given during pregnancy becausethe live attenuated virus may cross the placenta andpresent a risk to the developing fetus.
• The female client who received a rubella vaccine needto use a contraception method for at least 2 to 3months afterward.
• A positive maternal titer indicates that a significantantibody titer has developed in response to a priorexposure to the Rubivirus.
• All children of pregnant women should receive theirimmunizations according to schedule.
• Rubella vaccine is not given during pregnancy becausethe live attenuated virus may cross the placenta andpresent a risk to the developing fetus.
• The female client who received a rubella vaccine needto use a contraception method for at least 2 to 3months afterward.
Mumps– Paramyxovirus : Direct contact or droplet spread from
infected person– Assessment
• Parotid gland swelling , Jaw and ear pain with chewing• Orchitis may occur
– Interventions– Droplet precautions, Bed rest till parotid gland swelling
subsides• Heat and/or cold therapy to neck as prescribed• Avoid foods that require intense chewing (pain)• The most common complication of mumps is aseptic
meningitis. (virus present in the cerebrospinal fluid)• Common signs include nuchal rigidity, lethargy, and
vomiting.
Mumps– Paramyxovirus : Direct contact or droplet spread from
infected person– Assessment
• Parotid gland swelling , Jaw and ear pain with chewing• Orchitis may occur
– Interventions– Droplet precautions, Bed rest till parotid gland swelling
subsides• Heat and/or cold therapy to neck as prescribed• Avoid foods that require intense chewing (pain)• The most common complication of mumps is aseptic
meningitis. (virus present in the cerebrospinal fluid)• Common signs include nuchal rigidity, lethargy, and
vomiting.
Mumps– Paramyxovirus : Direct contact or droplet spread from
infected person– Assessment
• Parotid gland swelling , Jaw and ear pain with chewing• Orchitis may occur
– Interventions– Droplet precautions, Bed rest till parotid gland swelling
subsides• Heat and/or cold therapy to neck as prescribed• Avoid foods that require intense chewing (pain)• The most common complication of mumps is aseptic
meningitis. (virus present in the cerebrospinal fluid)• Common signs include nuchal rigidity, lethargy, and
vomiting.
Mumps– Paramyxovirus : Direct contact or droplet spread from
infected person– Assessment
• Parotid gland swelling , Jaw and ear pain with chewing• Orchitis may occur
– Interventions– Droplet precautions, Bed rest till parotid gland swelling
subsides• Heat and/or cold therapy to neck as prescribed• Avoid foods that require intense chewing (pain)• The most common complication of mumps is aseptic
meningitis. (virus present in the cerebrospinal fluid)• Common signs include nuchal rigidity, lethargy, and
vomiting.
Points to remember• Contraindications of the measles, mumps, and
rubella (MMR) vaccine include:-– severe allergic reaction to a previous dose or vaccine
component (gelatin, neomycin, eggs)– Pregnancy– known immunodeficiency.
• The nurse should take a thorough history of theallergy to a previous MMR and report this to thephysician.
• If it is the first MMR, the physician should beaware of the egg sensitivity before administeringthe vaccine
• Contraindications of the measles, mumps, andrubella (MMR) vaccine include:-– severe allergic reaction to a previous dose or vaccine
component (gelatin, neomycin, eggs)– Pregnancy– known immunodeficiency.
• The nurse should take a thorough history of theallergy to a previous MMR and report this to thephysician.
• If it is the first MMR, the physician should beaware of the egg sensitivity before administeringthe vaccine
Pertussis (Whooping Cough)– Description
• Caused by Bordetella pertussis• Transmission: Direct contact, droplet spread,
contamination from freshly contaminated objects– Assessment
• Respiratory infection with whooping cough– Interventions
• Isolate child during catarrhal stage; if hospitalized, usedroplet precautions
• Administer antimicrobial therapy as prescribed• Reduce environmental factors that could elicit coughing
episodes• Provide suctioning, humidification, oxygen as
prescribed
Pertussis (Whooping Cough)– Description
• Caused by Bordetella pertussis• Transmission: Direct contact, droplet spread,
contamination from freshly contaminated objects– Assessment
• Respiratory infection with whooping cough– Interventions
• Isolate child during catarrhal stage; if hospitalized, usedroplet precautions
• Administer antimicrobial therapy as prescribed• Reduce environmental factors that could elicit coughing
episodes• Provide suctioning, humidification, oxygen as
prescribed
Pertussis (Whooping Cough)– Description
• Caused by Bordetella pertussis• Transmission: Direct contact, droplet spread,
contamination from freshly contaminated objects– Assessment
• Respiratory infection with whooping cough– Interventions
• Isolate child during catarrhal stage; if hospitalized, usedroplet precautions
• Administer antimicrobial therapy as prescribed• Reduce environmental factors that could elicit coughing
episodes• Provide suctioning, humidification, oxygen as
prescribed
Pertussis (Whooping Cough)– Description
• Caused by Bordetella pertussis• Transmission: Direct contact, droplet spread,
contamination from freshly contaminated objects– Assessment
• Respiratory infection with whooping cough– Interventions
• Isolate child during catarrhal stage; if hospitalized, usedroplet precautions
• Administer antimicrobial therapy as prescribed• Reduce environmental factors that could elicit coughing
episodes• Provide suctioning, humidification, oxygen as
prescribed
Diphtheria– Description
• Caused by Corynebacterium diphtheriae• Transmission: Direct contact with infected persons,
carrier, or contaminated articles– Assessment
• Dense, pseudomembrane of throat; lymphadenitis;purulent nasal drainage
– Interventions• Ensure strict isolation, if hospitalized• Administer diphtheria antitoxin as prescribed• Administer antimicrobial therapy as prescribed• Provide suctioning, humidification, oxygen as
prescribed
Diphtheria– Description
• Caused by Corynebacterium diphtheriae• Transmission: Direct contact with infected persons,
carrier, or contaminated articles– Assessment
• Dense, pseudomembrane of throat; lymphadenitis;purulent nasal drainage
– Interventions• Ensure strict isolation, if hospitalized• Administer diphtheria antitoxin as prescribed• Administer antimicrobial therapy as prescribed• Provide suctioning, humidification, oxygen as
prescribed
Diphtheria– Description
• Caused by Corynebacterium diphtheriae• Transmission: Direct contact with infected persons,
carrier, or contaminated articles– Assessment
• Dense, pseudomembrane of throat; lymphadenitis;purulent nasal drainage
– Interventions• Ensure strict isolation, if hospitalized• Administer diphtheria antitoxin as prescribed• Administer antimicrobial therapy as prescribed• Provide suctioning, humidification, oxygen as
prescribed
Diphtheria– Description
• Caused by Corynebacterium diphtheriae• Transmission: Direct contact with infected persons,
carrier, or contaminated articles– Assessment
• Dense, pseudomembrane of throat; lymphadenitis;purulent nasal drainage
– Interventions• Ensure strict isolation, if hospitalized• Administer diphtheria antitoxin as prescribed• Administer antimicrobial therapy as prescribed• Provide suctioning, humidification, oxygen as
prescribed
Scarlet Fever– Description
• Caused by group A beta-hemolytic streptococci• Transmission: Direct contact with infected person,
droplet spread, indirectly by contaminated articles,ingestion of contaminated milk, foods
– Assessment• Abrupt high fever; enlarged lymph nodes in neck;
sandpaper-like rash on body, except face, blanches withpressure (Schultz-Charlton sign) except in areas of deepcreases and joints (Pastia’s sign); white strawberrytongue; enlarged tonsils
– Interventions• Institute respiratory precautions until 24 hours after
initiation of therapy• Encourage fluid intake• Supportive therapy
Scarlet Fever– Description
• Caused by group A beta-hemolytic streptococci• Transmission: Direct contact with infected person,
droplet spread, indirectly by contaminated articles,ingestion of contaminated milk, foods
– Assessment• Abrupt high fever; enlarged lymph nodes in neck;
sandpaper-like rash on body, except face, blanches withpressure (Schultz-Charlton sign) except in areas of deepcreases and joints (Pastia’s sign); white strawberrytongue; enlarged tonsils
– Interventions• Institute respiratory precautions until 24 hours after
initiation of therapy• Encourage fluid intake• Supportive therapy
Scarlet Fever– Description
• Caused by group A beta-hemolytic streptococci• Transmission: Direct contact with infected person,
droplet spread, indirectly by contaminated articles,ingestion of contaminated milk, foods
– Assessment• Abrupt high fever; enlarged lymph nodes in neck;
sandpaper-like rash on body, except face, blanches withpressure (Schultz-Charlton sign) except in areas of deepcreases and joints (Pastia’s sign); white strawberrytongue; enlarged tonsils
– Interventions• Institute respiratory precautions until 24 hours after
initiation of therapy• Encourage fluid intake• Supportive therapy
Scarlet Fever– Description
• Caused by group A beta-hemolytic streptococci• Transmission: Direct contact with infected person,
droplet spread, indirectly by contaminated articles,ingestion of contaminated milk, foods
– Assessment• Abrupt high fever; enlarged lymph nodes in neck;
sandpaper-like rash on body, except face, blanches withpressure (Schultz-Charlton sign) except in areas of deepcreases and joints (Pastia’s sign); white strawberrytongue; enlarged tonsils
– Interventions• Institute respiratory precautions until 24 hours after
initiation of therapy• Encourage fluid intake• Supportive therapy
Erythema Infectiosum (Fifth Disease)– Description
• Human parvovirus B19• Transmission unknown; possibly respiratory secretions or
blood– Assessment
• Rash develops as erythema of face; maculopapular redspots symmetrically distributed on extremities.
• Intense fiery red edematous rash on the cheeks, whichgives an appearance that the child has been slapped.
– Interventions• Child not usually hospitalized• Pregnant women should avoid infected person• Supportive care, including administration of antipyretics,
anti-inflammatories, analgesics as prescribed
Erythema Infectiosum (Fifth Disease)– Description
• Human parvovirus B19• Transmission unknown; possibly respiratory secretions or
blood– Assessment
• Rash develops as erythema of face; maculopapular redspots symmetrically distributed on extremities.
• Intense fiery red edematous rash on the cheeks, whichgives an appearance that the child has been slapped.
– Interventions• Child not usually hospitalized• Pregnant women should avoid infected person• Supportive care, including administration of antipyretics,
anti-inflammatories, analgesics as prescribed
Erythema Infectiosum (Fifth Disease)– Description
• Human parvovirus B19• Transmission unknown; possibly respiratory secretions or
blood– Assessment
• Rash develops as erythema of face; maculopapular redspots symmetrically distributed on extremities.
• Intense fiery red edematous rash on the cheeks, whichgives an appearance that the child has been slapped.
– Interventions• Child not usually hospitalized• Pregnant women should avoid infected person• Supportive care, including administration of antipyretics,
anti-inflammatories, analgesics as prescribed
Erythema Infectiosum (Fifth Disease)– Description
• Human parvovirus B19• Transmission unknown; possibly respiratory secretions or
blood– Assessment
• Rash develops as erythema of face; maculopapular redspots symmetrically distributed on extremities.
• Intense fiery red edematous rash on the cheeks, whichgives an appearance that the child has been slapped.
– Interventions• Child not usually hospitalized• Pregnant women should avoid infected person• Supportive care, including administration of antipyretics,
anti-inflammatories, analgesics as prescribed
Infectious Mononucleosis– Description
• Epstein-Barr virus• Transmission: Direct intimate contact
– Assessment• Fever; flu-like symptoms; lymphadenopathy;
hepatosplenomegaly; discrete macular rash may appearover trunk
– Interventions• Bed rest, supportive care• Administer analgesics as prescribed• Monitor closely for splenic rupture
Infectious Mononucleosis– Description
• Epstein-Barr virus• Transmission: Direct intimate contact
– Assessment• Fever; flu-like symptoms; lymphadenopathy;
hepatosplenomegaly; discrete macular rash may appearover trunk
– Interventions• Bed rest, supportive care• Administer analgesics as prescribed• Monitor closely for splenic rupture
Infectious Mononucleosis– Description
• Epstein-Barr virus• Transmission: Direct intimate contact
– Assessment• Fever; flu-like symptoms; lymphadenopathy;
hepatosplenomegaly; discrete macular rash may appearover trunk
– Interventions• Bed rest, supportive care• Administer analgesics as prescribed• Monitor closely for splenic rupture
Infectious Mononucleosis– Description
• Epstein-Barr virus• Transmission: Direct intimate contact
– Assessment• Fever; flu-like symptoms; lymphadenopathy;
hepatosplenomegaly; discrete macular rash may appearover trunk
– Interventions• Bed rest, supportive care• Administer analgesics as prescribed• Monitor closely for splenic rupture
Rocky Mountain Spotted Fever– Description
• Caused by Rickettsia rickettsii• Transmission: Bite of infected tick
– Assessment• Fever; anorexia; malaise; maculopapular or petechial
rash, primarily on extremities– Interventions
• Teach child, parents protective measures against tickbites
• Administer antibiotics as prescribed (doxycycline orchloramphenicol.
• Teach family preventive measures such as wearing longsleeves and pants in tick-prone areas
Rocky Mountain Spotted Fever– Description
• Caused by Rickettsia rickettsii• Transmission: Bite of infected tick
– Assessment• Fever; anorexia; malaise; maculopapular or petechial
rash, primarily on extremities– Interventions
• Teach child, parents protective measures against tickbites
• Administer antibiotics as prescribed (doxycycline orchloramphenicol.
• Teach family preventive measures such as wearing longsleeves and pants in tick-prone areas
Rocky Mountain Spotted Fever– Description
• Caused by Rickettsia rickettsii• Transmission: Bite of infected tick
– Assessment• Fever; anorexia; malaise; maculopapular or petechial
rash, primarily on extremities– Interventions
• Teach child, parents protective measures against tickbites
• Administer antibiotics as prescribed (doxycycline orchloramphenicol.
• Teach family preventive measures such as wearing longsleeves and pants in tick-prone areas
Rocky Mountain Spotted Fever– Description
• Caused by Rickettsia rickettsii• Transmission: Bite of infected tick
– Assessment• Fever; anorexia; malaise; maculopapular or petechial
rash, primarily on extremities– Interventions
• Teach child, parents protective measures against tickbites
• Administer antibiotics as prescribed (doxycycline orchloramphenicol.
• Teach family preventive measures such as wearing longsleeves and pants in tick-prone areas
Immunizations– Guidelines
• In United States, immunizations begin at birth• If premature, give full dose at appropriate chronological age
– General contraindications and precautions• Do not give live viruses to severely immuno compromised infants,
children• Do not give if infectious process is present; delay until infection
has subsided– Guidelines for administration
• Administer in vastus lateralis, deltoid muscle• If moderate to severe localized reaction to previous immunization,
consult with physician about splitting dosage into two half-doses,if appropriate
• Educate parents about administering acetaminophen (Tylenol) asprescribed for localized reaction and mild fever
Immunizations– Guidelines
• In United States, immunizations begin at birth• If premature, give full dose at appropriate chronological age
– General contraindications and precautions• Do not give live viruses to severely immuno compromised infants,
children• Do not give if infectious process is present; delay until infection
has subsided– Guidelines for administration
• Administer in vastus lateralis, deltoid muscle• If moderate to severe localized reaction to previous immunization,
consult with physician about splitting dosage into two half-doses,if appropriate
• Educate parents about administering acetaminophen (Tylenol) asprescribed for localized reaction and mild fever
Immunizations– Guidelines
• In United States, immunizations begin at birth• If premature, give full dose at appropriate chronological age
– General contraindications and precautions• Do not give live viruses to severely immuno compromised infants,
children• Do not give if infectious process is present; delay until infection
has subsided– Guidelines for administration
• Administer in vastus lateralis, deltoid muscle• If moderate to severe localized reaction to previous immunization,
consult with physician about splitting dosage into two half-doses,if appropriate
• Educate parents about administering acetaminophen (Tylenol) asprescribed for localized reaction and mild fever
Immunizations– Guidelines
• In United States, immunizations begin at birth• If premature, give full dose at appropriate chronological age
– General contraindications and precautions• Do not give live viruses to severely immuno compromised infants,
children• Do not give if infectious process is present; delay until infection
has subsided– Guidelines for administration
• Administer in vastus lateralis, deltoid muscle• If moderate to severe localized reaction to previous immunization,
consult with physician about splitting dosage into two half-doses,if appropriate
• Educate parents about administering acetaminophen (Tylenol) asprescribed for localized reaction and mild fever
Reactions to Vaccine– Local reactions
• Redness, swelling, tenderness at injection site– Minimizing local reactions
• Administer acetaminophen (Tylenol) asprescribed
– Anaphylactic reactions• Monitor and treat, if appropriate, for evidence
of respiratory distress, cardiovascularcompromise
Reactions to Vaccine– Local reactions
• Redness, swelling, tenderness at injection site– Minimizing local reactions
• Administer acetaminophen (Tylenol) asprescribed
– Anaphylactic reactions• Monitor and treat, if appropriate, for evidence
of respiratory distress, cardiovascularcompromise
Reactions to Vaccine– Local reactions
• Redness, swelling, tenderness at injection site– Minimizing local reactions
• Administer acetaminophen (Tylenol) asprescribed
– Anaphylactic reactions• Monitor and treat, if appropriate, for evidence
of respiratory distress, cardiovascularcompromise
Reactions to Vaccine– Local reactions
• Redness, swelling, tenderness at injection site– Minimizing local reactions
• Administer acetaminophen (Tylenol) asprescribed
– Anaphylactic reactions• Monitor and treat, if appropriate, for evidence
of respiratory distress, cardiovascularcompromise
