1. Teach various treatments: postural drainage, nebulizers, oxygen therapy, breathing exercise.
        2. Encourage child to assume as much responsibility for own care as possible: medications, treatments, diet.
        3. Promote development of healthy attitude toward disease/prognosis (no known cure). Heart/lung transplant may be considered as an option.
        4. Refer to appropriate community agencies for assistance with home care.
        5. Assist with genetic counseling.
        6. Discuss sexual concerns with adolescent.
      2. Goal: promote compliance with treatment regimen.
        1. Encourage child to verbalize anger or frustration at being “different"/body image alterations.
        2. Suggest alternatives to postural drainage, e.g., yoga/standing on head.
        3. Offer “rewards” for compliance: going swimming with friends or other types of peer activities.
    2. Evaluation/outcome criteria:
      1. Child can clear own airway, expectorate sputum.
      2. Child is maintained in infection-free state.
      3. Adequate nutrition is maintained.
      4. Child and family verbalize understanding of the disease.
      5. Child complies with rigors of treatment.
  2. Pediatric respiratory infections
    1. Assessment: general assessment of infant/child with respiratory distress.
      1. Restlessness - earliest sign of hypoxia.
      2. Difficulty sucking/eating - parents may state the infant or child has "poor appetite.”
      3. Expiratory grunt, flaring of nasal alae, retractions.
      4. Changes in vital signs: fever, tachycardia, tachypnea.
      5. Cough: productive/nonproductive.
      6. Wheeze; expiratory/inspiratory.
      7. Hoarseness or aphonic crying.
      8. Dyspnea or prostration.
      9. Dehydration - related to increase in sensible fluid loss and poor PO intake.
      10. Color change (pallor, cyanosis) - later sign of respiratory distress.
    2. Analysis/nursing diagnosis:
      1. Ineffective airway clearance related to infection or obstruction.
      2. Fluid volume deficit related to excessive losses through normal routes, discomfort and inability to swallow.
      3. Anxiety related to hypoxia.
      4. Risk for injury related to spread of infection.
      5. Knowledge deficit related to disease process, infection control, home care, and follow-up.
    3. Nursing care plan/implementation:
      1. Goal: relieve respiratory distress by reducing swelling and edema and liquefying secretions.
        1. Environment: cool, high-humidity mist (oxygen) tent.
        2. Administer oxygen as ordered.
        3. Position: semi-Fowler’s or in infant seat to promote maximum expansion of the lungs; small blanket or diaper roll under neck to keep airway patent; change position at least q2h to prevent pooling of secretions.
        4. Suction/postural drainage pm.
        5. Tape diapers loosely and use only loosefitting clothing to avoid pressure on abdominal organs, which could impinge on diaphragm and impede respirations.
        6. Administer medications: antibiotics, bronchodilators, steroids.
        7. Monitor temperature q4h/prn; reduce fever with acetaminophen, cool sponges, hypothermia blanket.
      2. Goal: observe for potential respiratory failure related to exhaustion or complete airway obstruction.
        1. Place in room near nurses’ station for maximum observation.
        2. Monitor vital signs: qlh during acute phase, then q4h.
        3. Place emergency equipment near bedside prn: endotracheal tube, tracheostomy set.
        4. Monitor closely for signs of impending respiratory failure: increased rapid, shallow respirations, progressive hoarseness/ aphonia, deepening cyanosis.
        5. Report adverse changes in condition stat to physician.
      3. Goal: maintain normal fluid balance.
        1. May be NPO initially to prevent aspiration.
        2. IVs until severe distress subsides and child is able to suck and swallow.
        3. Monitor hydration status: I8<0, urine specific gravity, weight.
        4. When resuming PO fluids - start with sips of clear liquids, advance slowly as tolerated: Pedialyte, clear broth, gelatin, popsicles, fruit juices, ginger ale, cola.
        5. Avoid milk/milk products, which may cause increased mucous production.
      4. Goal: provide calm, secure environment.
        1. During acute distress: remain with child/ family (do not leave unattended).
        2. Keep crying to a minimum to prevent severe hypoxia and to reduce the body’s demand for oxygen.
        3. Avoid painful/intrusive procedures if possible.
        4. Organize nursing care to provide planned periods of uninterrupted rest.
        5. Allow parents to room-in, and encourage their participation in care of their child to keep the child relatively calm and reduce anxiety.
        6. Allow child to keep favorite toy or security object.