2513 Exam Blueprint
Modules:
Dosage calc
7 (Chp 34, 38, 40, 41): Interventions for hospitalized peds client, Respiratory, Cardiac Diseases/Disorders
● What are techniques for administration of ear drops (less than 2 versus older than 2)
Turn the child or ask the child to turn onto his or her back or use restraint as necessary. Turn the child’s head to one side. The slant of the ear canal in
children. If the child is younger than 2 years of age, straighten the external ear canal by pulling the pinna down and back. If the child is older than 2
years of age, pull the pinna of the ear up and back. Instill the specified number of drops into the ear canal. Hold the child’s head in the sideways
position to ensure the medication fills the entire ear canal. Praise the child for cooperating during this difficult procedure
● What are tips for helping a child take oral medication?
Available in preparations (liquids, chewables, and meltaways). Determine the child’s ability to swallow pills.
Use the smallest measuring device for doses of liquid medication. Use an oral medication syringe for smaller amounts, and a medication cup for
larger amounts.
Avoid measuring liquid medication in a teaspoon or tablespoon. Use rigid plastic cups instead of paper cups for liquid medications. Avoid mixing
medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste
of the formula.
Hold the infant in a semi-reclining position similar to a feeding position. Hold the small child in an upright position to prevent aspiration. Administer
the medication in the side of the mouth in small amounts. This allows the infant or child to swallow.
Only use the droppers that come with the medication for measurement. Stroke the infant under the chin to promote swallowing while holding cheeks
together. Teach the child to swallow tablets that aren’t available in liquid form and can’t be crushed. Teach in short sessions using verbal instruction,
demonstration, and positive reinforcement. Provide atraumatic care.
Mix the medication in a small amount of sweet nonessential food (applesauce or sherbet). Offer juice, a soft drink, or snack after administration. Add
flavoring to medications as available.
Use a nipple to allow the infant to suck the medication. Reward small child with a prize or sticker afterwards.
Administer medications via a feeding tube. Confirm placement. Use liquid formulation. Do not add medication to the formula bag. If administering
several medications, flush tubing with water after the administration of each medication.
● What are teaching tips for use of a metered-dose inhaler?
A metered-dose inhaler (MDI) is a handheld device that provides a route for medication administration directly to the respiratory tract. The child
inhales while depressing a trigger on the apparatus. For successful use, children need to follow five general rules: shake the canister, exhale deeply,
activate the inhaler and place it in their mouth as they begin to inhale, take a long slow inhalation, and then hold their breath for 5 to 10 seconds.
Caution them to take only one puff at a time, with a 1-minute wait between puffs. Coordinating inhalation with MDI use can be difficult; therefore,
use of an aerochamber (spacer) is generally recommended to prevent deposition on the posterior pharynx. Younger children can use an MDI attached
to an aerochamber with a mask. All children using inhaled corticosteroids need an aerochamber to prevent deposition of the medication in the
mucous membranes of the mouth and pharynx, which can contribute to the development of thrush. Instruct the child and guardians to clean the MDI
and spacer after each use and to have the child rinse out the mouth and expectorate.
-Do not shake the device.
-Take the cover off the mouthpiece.
-Follow the directions of the manufacturer for preparing the medication (turning the wheel of the inhaler).
-Exhale completely. Place the mouthpiece between the lips and take a deep breath through the mouth.
-Hold breath for 5 to 10 seconds.
-Take the inhaler out of the mouth and slowly exhale through pursed lips. Resume normal breathing.
-If more than one puff is prescribed, wait the length of time directed before administering the second puff.
-Remove the canister and rinse the inhaler, cap, and spacer once a day with warm running water. Dry the inhaler before reuse.
● What’s important to know about the newborn/infant nose and breathing? What assessments are important? p. 932
Infants are obligate nose breathers. They cannot coordinate mouth breathing, so they become disturbed when the nose is temporarily blocked to
check for patency; do this only momentarily to avoid discomfort. Most newborns have milia (i.e., small white papules) on the surface of the nose,
which are of no consequence and disappear without treatment.
,Observe the nose for flaring of the nostrils (a sign of a need for oxygen). Using an otoscope light, observe the mucous membrane of the nose for
color—it should be pink; pale suggests allergies, and redness suggests infection. Note and describe any discharge. Document the septum is in the
midline because a displaced septa such as those that occur after facial injuries can interfere with respiration and make nasal intubation in emergencies
difficult. Gently press one nostril closed and ask the child to inhale. Repeat on the opposite side to ensure both sides of the nose are patent; that is, no
choanal atresia or membrane obstructing the posterior nares exists. Sinuses do not fully develop until about 6 years.
● What are signs of dehydration? (see below)
-Mild
WEIGHT LOSS 3% to 5% in infants, 3% to 4% in children
MANIFESTATIONS: Behavior, mucous membranes, anterior fontanel, pulse, and blood pressure within expected findings, Capillary refill greater
than 2 seconds, Possible slight thirst
-Moderate
WEIGHT LOSS 6% to 9% in infants, 6% to 8% in children
MANIFESTATIONS: Capillary refill between 2 and 4 seconds, Possible thirst and irritability, Pulse slightly increased with normal to orthostatic
blood pressure, Dry mucous membranes and decreased tears and skin turgor, Slight tachypnea, Normal to sunken anterior fontanel on infants
-Severe
WEIGHT LOSS Greater than 10% in infants, 10% in children
MANIFESTATIONS: Capillary refill greater than 4 seconds, Tachycardia present, and orthostatic blood pressure can progress to shock,Extreme
thirst, Very dry mucous membranes and tented skin, Hyperpnea, No tearing with sunken eyeballs, Sunken anterior fontanel
●What are interventions for mild/moderate versus severe dehydration from gastroenteritis? pp. 1062-1063;
https://www.aafp.org/afp/2009/1001/p692.html
NURSING ACTIONS
-Oral rehydration is attempted first for mild and moderate cases of dehydration.
Mild: 50 mL/kg rehydration fluid within 4 hr
Moderate: 100 mL/kg rehydration fluid within 4 hr
Replacement of diarrhea losses with 10 mL/kg each stool
-Administer parenteral fluid therapy as prescribed. Initiate when a child is unable to drink enough oral fluids to correct fluid losses, and those with
severe dehydration or continued vomiting.
-Isotonic solution at 20 mL/kg IV bolus with possible repeat for isotonic and hypotonic dehydration. Hypertonic dehydration: rapid fluid replacement
is contraindicated because of the risk of cerebral edema. Administer maintenance IV fluids as prescribed. Avoid potassium replacement until kidney
function is verified.
-Assess capillary refill. Assess vital signs. Monitor weight. Maintain accurate I&O.
● What are therapeutic interventions to manage croup (bronchiolitis)?
Cool moist air combined with a corticosteroid, such as dexamethasone, or racemic epinephrine, given by nebulizer, usually reduces inflammation and
produces effective bronchodilation to open the airway. The provider may prescribe dexamethasone for home administration but racemic epinephrine
needs to be administered in a healthcare setting.
● What are symptoms of streptococcal pharyngitis and complications/risks?
Group A β-hemolytic streptococcus is the organism most frequently involved in bacterial pharyngitis in children, particularly those between the ages
of 5 and 15 years. Onset is abrupt and characterized by pharyngitis, headache, fever and abdominal pain. Tonsils and pharynx can be inflamed and
covered with exudate, usually appears by second day of illness.
Streptococcal infections are generally more severe and present more suddenly than viral infections. The back of the throat and palatine tonsils are
usually markedly erythematous (bright red); the tonsils are enlarged, and there may be a white exudate in the tonsillar crypts. Petechiae may be
present on the palate. A child typically appears ill, with a fever, sore throat, headache, stomach ache, and difficulty swallowing. Other respiratory
symptoms are generally absent, such as cough, congestion, rhinorrhea, or conjunctivitis. A rapid antigen test and/or throat culture should be done to
confirm the presence of the Streptococcus bacteria. These findings may vary depending on the child’s age and make it difficult to distinguish it from
a viral illness. Some children may develop a sandpaper-like rash (scarlatiniform rash) on the body.
Although rare, streptococcal infections can lead to acute rheumatic fever and glomerulonephritis if not treated.
● What are post-tonsillectomy nursing cares?
POSTOPERATIVE NURSING ACTIONS
, Positioning: Place in position to facilitate drainage. Elevate head of bed when child is fully awake.
Assessment: Assess for evidence of bleeding, which includes frequent swallowing, clearing the throat, restlessness, bright red emesis, tachycardia,
and/or pallor. Assess the airway and vital signs. Monitor for difficulty breathing related to oral secretions, edema, and/or bleeding.
Comfort measures: Administer liquid analgesics or tetracaine lollipops as prescribed. Provide an ice collar. Offer ice chips or sips of water to keep
throat moist. Administer pain medication on a regular schedule.
Diet: Encourage clear liquids and fluids after a return of the gag reflex, avoiding red-colored liquids, citrus juice, and milk-based foods initially.
Advance the diet with soft, bland foods.
Instruction: Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site. Avoid straws as they can damage the surgical
site Alert guardians that there can be clots or blood-tinged mucus in vomitus.
● What are signs/clinical manifestations/assessment findings in a child with pneumonia?
Bacterial pneumonia: Streptococcus pneumoniae, Group A streptococci, Staphylococcus aureus, Mycoplasma catarrhalis, Mycoplasma pneumoniae
Assessment: High fever, Cough that can be unproductive or productive of white sputum, Tachypnea, Retractions and nasal flaring, Chest pain,
Dullness with percussion, Adventitious breath sounds (rhonchi, fine crackles), Pale color that progresses to cyanosis, Irritability, restless, lethargic,
Abdominal pain, diarrhea, lack of appetite, and vomiting.
Children may often appear acutely ill, with high fever, tachycardia, chest or abdominal pain, chills, and signs of respiratory distress. Breath sounds
are often diminished, and crackles (rales) may be present. Dullness on percussion indicates total consolidation. Chest radiography will often reveal
consolidation, and laboratory studies will indicate leukocytosis.
Bacterial pneumonia treatment: Encourage rest. Administer IV antibiotics. Promote increased oral intake. Monitor I&O. Administer antipyretics for
fever. CPT and postural drainage can be helpful. Administer IV fluids. Administer oxygen. Monitor continuous oximetry
● What are signs/symptoms and treatments of viral pneumonia?
Viral pneumonia is generally caused by viral infections of the upper respiratory tract. Symptoms begin as an upper respiratory tract infection and may
progress to diminished breath sounds and fine rales on auscultation. Antibiotic therapy is not effective against viral infections. Rest and antipyretics
are used for treatment. Similar to bacterial pneumonia, fatigue often occurs following the acute phase of illness.
Viral pneumonia treatment: Administer oxygen with cool mist. Monitor continuous oximetry. Administer antipyretics for fever. Monitor I&O. CPT
and postural drainage
● What are treatments and teaching topics for management of cystic fibrosis?
NURSING CARE TREATMENT:
Assess lung sounds and respiratory status. Vital signs with oxygen saturation. Obtain IV access. Use of a peripherally inserted central catheter or IV
port allows for home IV antibiotic therapy. Obtain sputum for culture and sensitivity. Provide support to the child and family.
-Pulmonary management: Assist in providing airway clearance therapy (ACT) to promote expectoration of pulmonary secretions. Usually prescribed
twice a day in the morning and evening. Avoid ACT immediately before or after meals. Several methods of ACT are available. Chest physiotherapy
(CPT) with postural drainage as prescribed (manual or mechanical percussion). Positive expiratory therapy (PEP) uses a device (a flutter mucus
clearance device) to encourage the client to breathe with forceful exhalations. Active-cycle-of-breathing techniques (“huffing” or forced expiration),
are encouraged. Autogenic drainage uses an electronic chest vibrator or handheld percussor along with breathing techniques. High-frequency chest
compression uses a mechanical chest device combined with nebulization therapy. Administer aerosol therapy as prescribed (bronchodilator, human
deoxyribonuclease). Often recommended prior to ACT. Administer IV or aerosolized antibiotics. Encourage physical aerobic exercise. Provide
oxygen as prescribed (assess for carbon dioxide retention). Monitor for hemoptysis or pneumothorax.
-Gastrointestinal management: Provide a well-balanced diet high in protein and calories. Give three meals a day with snacks. Encourage oral fluid
intake. Administer pancreatic enzymes within 30 min of eating a meal or snack. Administer water soluble vitamin supplements: multivitamin;
vitamins A, D, E, and K. Administer laxatives or stool softeners for constipation. Polyethylene-glycol electrolyte solution is administered orally or
via nasogastric tube. Administer histamine-receptor antagonist and motility medications for GERD. Administer possible formula supplements in
addition to breastfeedings or via gastric tube. Encourage to add salt to food during hot weather- (dehydration). Consult a dietitian. Children should
receive regular nutritional evaluations.
-Endocrine management: Cystic fibrosis related diabetes (CFRD) necessitates monitoring of blood glucose levels. Administer insulin. Oral glycemic
medications are not effective for CFRD.
Medications:
Respiratory medications: Short-acting beta2 agonists (albuterol). Cholinergic antagonists (anticholinergics [ipratropium bromide]).
Fluticasone propionate/salmeterol. NURSING ACTIONS: Monitor for tremors and tachycardia when the child is taking albuterol. Observe for dry
mouth when the child is taking ipratropium. CLIENT EDUCATION: Understand how to properly use an MDI, PEP, or nebulizer. Rinse mouth after
fluticasone propionate/salmeterol.
Modules:
Dosage calc
7 (Chp 34, 38, 40, 41): Interventions for hospitalized peds client, Respiratory, Cardiac Diseases/Disorders
● What are techniques for administration of ear drops (less than 2 versus older than 2)
Turn the child or ask the child to turn onto his or her back or use restraint as necessary. Turn the child’s head to one side. The slant of the ear canal in
children. If the child is younger than 2 years of age, straighten the external ear canal by pulling the pinna down and back. If the child is older than 2
years of age, pull the pinna of the ear up and back. Instill the specified number of drops into the ear canal. Hold the child’s head in the sideways
position to ensure the medication fills the entire ear canal. Praise the child for cooperating during this difficult procedure
● What are tips for helping a child take oral medication?
Available in preparations (liquids, chewables, and meltaways). Determine the child’s ability to swallow pills.
Use the smallest measuring device for doses of liquid medication. Use an oral medication syringe for smaller amounts, and a medication cup for
larger amounts.
Avoid measuring liquid medication in a teaspoon or tablespoon. Use rigid plastic cups instead of paper cups for liquid medications. Avoid mixing
medication with formula or putting it in a bottle of formula because the infant might not take the entire feeding, and the medication can alter the taste
of the formula.
Hold the infant in a semi-reclining position similar to a feeding position. Hold the small child in an upright position to prevent aspiration. Administer
the medication in the side of the mouth in small amounts. This allows the infant or child to swallow.
Only use the droppers that come with the medication for measurement. Stroke the infant under the chin to promote swallowing while holding cheeks
together. Teach the child to swallow tablets that aren’t available in liquid form and can’t be crushed. Teach in short sessions using verbal instruction,
demonstration, and positive reinforcement. Provide atraumatic care.
Mix the medication in a small amount of sweet nonessential food (applesauce or sherbet). Offer juice, a soft drink, or snack after administration. Add
flavoring to medications as available.
Use a nipple to allow the infant to suck the medication. Reward small child with a prize or sticker afterwards.
Administer medications via a feeding tube. Confirm placement. Use liquid formulation. Do not add medication to the formula bag. If administering
several medications, flush tubing with water after the administration of each medication.
● What are teaching tips for use of a metered-dose inhaler?
A metered-dose inhaler (MDI) is a handheld device that provides a route for medication administration directly to the respiratory tract. The child
inhales while depressing a trigger on the apparatus. For successful use, children need to follow five general rules: shake the canister, exhale deeply,
activate the inhaler and place it in their mouth as they begin to inhale, take a long slow inhalation, and then hold their breath for 5 to 10 seconds.
Caution them to take only one puff at a time, with a 1-minute wait between puffs. Coordinating inhalation with MDI use can be difficult; therefore,
use of an aerochamber (spacer) is generally recommended to prevent deposition on the posterior pharynx. Younger children can use an MDI attached
to an aerochamber with a mask. All children using inhaled corticosteroids need an aerochamber to prevent deposition of the medication in the
mucous membranes of the mouth and pharynx, which can contribute to the development of thrush. Instruct the child and guardians to clean the MDI
and spacer after each use and to have the child rinse out the mouth and expectorate.
-Do not shake the device.
-Take the cover off the mouthpiece.
-Follow the directions of the manufacturer for preparing the medication (turning the wheel of the inhaler).
-Exhale completely. Place the mouthpiece between the lips and take a deep breath through the mouth.
-Hold breath for 5 to 10 seconds.
-Take the inhaler out of the mouth and slowly exhale through pursed lips. Resume normal breathing.
-If more than one puff is prescribed, wait the length of time directed before administering the second puff.
-Remove the canister and rinse the inhaler, cap, and spacer once a day with warm running water. Dry the inhaler before reuse.
● What’s important to know about the newborn/infant nose and breathing? What assessments are important? p. 932
Infants are obligate nose breathers. They cannot coordinate mouth breathing, so they become disturbed when the nose is temporarily blocked to
check for patency; do this only momentarily to avoid discomfort. Most newborns have milia (i.e., small white papules) on the surface of the nose,
which are of no consequence and disappear without treatment.
,Observe the nose for flaring of the nostrils (a sign of a need for oxygen). Using an otoscope light, observe the mucous membrane of the nose for
color—it should be pink; pale suggests allergies, and redness suggests infection. Note and describe any discharge. Document the septum is in the
midline because a displaced septa such as those that occur after facial injuries can interfere with respiration and make nasal intubation in emergencies
difficult. Gently press one nostril closed and ask the child to inhale. Repeat on the opposite side to ensure both sides of the nose are patent; that is, no
choanal atresia or membrane obstructing the posterior nares exists. Sinuses do not fully develop until about 6 years.
● What are signs of dehydration? (see below)
-Mild
WEIGHT LOSS 3% to 5% in infants, 3% to 4% in children
MANIFESTATIONS: Behavior, mucous membranes, anterior fontanel, pulse, and blood pressure within expected findings, Capillary refill greater
than 2 seconds, Possible slight thirst
-Moderate
WEIGHT LOSS 6% to 9% in infants, 6% to 8% in children
MANIFESTATIONS: Capillary refill between 2 and 4 seconds, Possible thirst and irritability, Pulse slightly increased with normal to orthostatic
blood pressure, Dry mucous membranes and decreased tears and skin turgor, Slight tachypnea, Normal to sunken anterior fontanel on infants
-Severe
WEIGHT LOSS Greater than 10% in infants, 10% in children
MANIFESTATIONS: Capillary refill greater than 4 seconds, Tachycardia present, and orthostatic blood pressure can progress to shock,Extreme
thirst, Very dry mucous membranes and tented skin, Hyperpnea, No tearing with sunken eyeballs, Sunken anterior fontanel
●What are interventions for mild/moderate versus severe dehydration from gastroenteritis? pp. 1062-1063;
https://www.aafp.org/afp/2009/1001/p692.html
NURSING ACTIONS
-Oral rehydration is attempted first for mild and moderate cases of dehydration.
Mild: 50 mL/kg rehydration fluid within 4 hr
Moderate: 100 mL/kg rehydration fluid within 4 hr
Replacement of diarrhea losses with 10 mL/kg each stool
-Administer parenteral fluid therapy as prescribed. Initiate when a child is unable to drink enough oral fluids to correct fluid losses, and those with
severe dehydration or continued vomiting.
-Isotonic solution at 20 mL/kg IV bolus with possible repeat for isotonic and hypotonic dehydration. Hypertonic dehydration: rapid fluid replacement
is contraindicated because of the risk of cerebral edema. Administer maintenance IV fluids as prescribed. Avoid potassium replacement until kidney
function is verified.
-Assess capillary refill. Assess vital signs. Monitor weight. Maintain accurate I&O.
● What are therapeutic interventions to manage croup (bronchiolitis)?
Cool moist air combined with a corticosteroid, such as dexamethasone, or racemic epinephrine, given by nebulizer, usually reduces inflammation and
produces effective bronchodilation to open the airway. The provider may prescribe dexamethasone for home administration but racemic epinephrine
needs to be administered in a healthcare setting.
● What are symptoms of streptococcal pharyngitis and complications/risks?
Group A β-hemolytic streptococcus is the organism most frequently involved in bacterial pharyngitis in children, particularly those between the ages
of 5 and 15 years. Onset is abrupt and characterized by pharyngitis, headache, fever and abdominal pain. Tonsils and pharynx can be inflamed and
covered with exudate, usually appears by second day of illness.
Streptococcal infections are generally more severe and present more suddenly than viral infections. The back of the throat and palatine tonsils are
usually markedly erythematous (bright red); the tonsils are enlarged, and there may be a white exudate in the tonsillar crypts. Petechiae may be
present on the palate. A child typically appears ill, with a fever, sore throat, headache, stomach ache, and difficulty swallowing. Other respiratory
symptoms are generally absent, such as cough, congestion, rhinorrhea, or conjunctivitis. A rapid antigen test and/or throat culture should be done to
confirm the presence of the Streptococcus bacteria. These findings may vary depending on the child’s age and make it difficult to distinguish it from
a viral illness. Some children may develop a sandpaper-like rash (scarlatiniform rash) on the body.
Although rare, streptococcal infections can lead to acute rheumatic fever and glomerulonephritis if not treated.
● What are post-tonsillectomy nursing cares?
POSTOPERATIVE NURSING ACTIONS
, Positioning: Place in position to facilitate drainage. Elevate head of bed when child is fully awake.
Assessment: Assess for evidence of bleeding, which includes frequent swallowing, clearing the throat, restlessness, bright red emesis, tachycardia,
and/or pallor. Assess the airway and vital signs. Monitor for difficulty breathing related to oral secretions, edema, and/or bleeding.
Comfort measures: Administer liquid analgesics or tetracaine lollipops as prescribed. Provide an ice collar. Offer ice chips or sips of water to keep
throat moist. Administer pain medication on a regular schedule.
Diet: Encourage clear liquids and fluids after a return of the gag reflex, avoiding red-colored liquids, citrus juice, and milk-based foods initially.
Advance the diet with soft, bland foods.
Instruction: Discourage coughing, throat clearing, and nose blowing in order to protect the surgical site. Avoid straws as they can damage the surgical
site Alert guardians that there can be clots or blood-tinged mucus in vomitus.
● What are signs/clinical manifestations/assessment findings in a child with pneumonia?
Bacterial pneumonia: Streptococcus pneumoniae, Group A streptococci, Staphylococcus aureus, Mycoplasma catarrhalis, Mycoplasma pneumoniae
Assessment: High fever, Cough that can be unproductive or productive of white sputum, Tachypnea, Retractions and nasal flaring, Chest pain,
Dullness with percussion, Adventitious breath sounds (rhonchi, fine crackles), Pale color that progresses to cyanosis, Irritability, restless, lethargic,
Abdominal pain, diarrhea, lack of appetite, and vomiting.
Children may often appear acutely ill, with high fever, tachycardia, chest or abdominal pain, chills, and signs of respiratory distress. Breath sounds
are often diminished, and crackles (rales) may be present. Dullness on percussion indicates total consolidation. Chest radiography will often reveal
consolidation, and laboratory studies will indicate leukocytosis.
Bacterial pneumonia treatment: Encourage rest. Administer IV antibiotics. Promote increased oral intake. Monitor I&O. Administer antipyretics for
fever. CPT and postural drainage can be helpful. Administer IV fluids. Administer oxygen. Monitor continuous oximetry
● What are signs/symptoms and treatments of viral pneumonia?
Viral pneumonia is generally caused by viral infections of the upper respiratory tract. Symptoms begin as an upper respiratory tract infection and may
progress to diminished breath sounds and fine rales on auscultation. Antibiotic therapy is not effective against viral infections. Rest and antipyretics
are used for treatment. Similar to bacterial pneumonia, fatigue often occurs following the acute phase of illness.
Viral pneumonia treatment: Administer oxygen with cool mist. Monitor continuous oximetry. Administer antipyretics for fever. Monitor I&O. CPT
and postural drainage
● What are treatments and teaching topics for management of cystic fibrosis?
NURSING CARE TREATMENT:
Assess lung sounds and respiratory status. Vital signs with oxygen saturation. Obtain IV access. Use of a peripherally inserted central catheter or IV
port allows for home IV antibiotic therapy. Obtain sputum for culture and sensitivity. Provide support to the child and family.
-Pulmonary management: Assist in providing airway clearance therapy (ACT) to promote expectoration of pulmonary secretions. Usually prescribed
twice a day in the morning and evening. Avoid ACT immediately before or after meals. Several methods of ACT are available. Chest physiotherapy
(CPT) with postural drainage as prescribed (manual or mechanical percussion). Positive expiratory therapy (PEP) uses a device (a flutter mucus
clearance device) to encourage the client to breathe with forceful exhalations. Active-cycle-of-breathing techniques (“huffing” or forced expiration),
are encouraged. Autogenic drainage uses an electronic chest vibrator or handheld percussor along with breathing techniques. High-frequency chest
compression uses a mechanical chest device combined with nebulization therapy. Administer aerosol therapy as prescribed (bronchodilator, human
deoxyribonuclease). Often recommended prior to ACT. Administer IV or aerosolized antibiotics. Encourage physical aerobic exercise. Provide
oxygen as prescribed (assess for carbon dioxide retention). Monitor for hemoptysis or pneumothorax.
-Gastrointestinal management: Provide a well-balanced diet high in protein and calories. Give three meals a day with snacks. Encourage oral fluid
intake. Administer pancreatic enzymes within 30 min of eating a meal or snack. Administer water soluble vitamin supplements: multivitamin;
vitamins A, D, E, and K. Administer laxatives or stool softeners for constipation. Polyethylene-glycol electrolyte solution is administered orally or
via nasogastric tube. Administer histamine-receptor antagonist and motility medications for GERD. Administer possible formula supplements in
addition to breastfeedings or via gastric tube. Encourage to add salt to food during hot weather- (dehydration). Consult a dietitian. Children should
receive regular nutritional evaluations.
-Endocrine management: Cystic fibrosis related diabetes (CFRD) necessitates monitoring of blood glucose levels. Administer insulin. Oral glycemic
medications are not effective for CFRD.
Medications:
Respiratory medications: Short-acting beta2 agonists (albuterol). Cholinergic antagonists (anticholinergics [ipratropium bromide]).
Fluticasone propionate/salmeterol. NURSING ACTIONS: Monitor for tremors and tachycardia when the child is taking albuterol. Observe for dry
mouth when the child is taking ipratropium. CLIENT EDUCATION: Understand how to properly use an MDI, PEP, or nebulizer. Rinse mouth after
fluticasone propionate/salmeterol.
