Sabtu, 14 Mei 2011
Nursing Children with ARI
A. Definition
Acute respiratory infections (ARI) is an acute inflammation of the upper or lower respiratory tract infections caused by microorganisms or bacteria, viruses, or reketsia without or accompanied by inflammation of the lung parenchyma.
ARI is the inclusion mikroorgamisme (bacteria, viruses, rickets) into the respiratory tract that causes symptoms that can last up to 14 days.
B. Signs and Symptoms
- The common cold
- Exit and clear liquid secretions from the nose
- Sometimes sneezing
- Sore throat
- Cough
- Headache
- Discharge becomes thick
- Fever
- Nausea
- Vomiting
- Anorexia
C. Etiology
ARI etiology of more than 300 types of bacteria, viruses, and fungi.Bacteria of the genus causes include streptococci, staphylococci, pnemokokus, hemofilus, Bordetella, and korinebacterium. The virus causes such as class mikovirus, adenovirus, koronavirus, pikornavirus, mycoplasmal, herpesvirus.
Bacteria and viruses are the most frequent cause of respiratory infection such as staphylococcal and streptococcal bacteria and influenza viruses in outdoor air will enter and stick to the upper respiratory tract of the throat and nose.
Usually the bacteria and virus attacks children under 2 years of age who weakened immune or not perfect. Transition dry season to rainy season also raises the risk of respiratory infection.
Several other factors are expected to contribute to the occurrence of ARI in children is the low intake of antioxidants, the status of malnutrition, and poor environmental sanitation.
D. Spread of Disease
At ARI, known 3 ways the spread of infection, namely:
1. Through areosol (fine particles) is soft, mainly because of coughing
2. Through areosol more severe, occurs when coughing and sneezing
3. Through direct contact or indirectly from objects that have been contaminated by microorganisms.
E. ARI Disease Levels
1. Light
Cough without fast breathing or less than 40 times per minute, stuffy or runny nose, red throat, runny ears.
2. Medium
Cough and fast breathing without stridor, red eardrum, ear discharge of less than 2 weeks. Purulent pharyngitis with enlarged lymph nodes neck tenderness (cervical adentis).
3. Weight
Cough with fast breathing and stridor, gray membrane on the pharynx, seizures, apnea, severe dehydration or sleep continues, there is no cyanosis.
4. Very Serious
Cough with fast breathing, stridor and cyanosis, and not to drink.
F. Risk Factors
Risk factors that influence the occurrence of ARI:
1. Age
Children with younger age, likely to suffer from respiratory disease or greater when compared with older children because of lower body resistance.
2. Immunization Status
Annak with complete immunization status, body resistance is better than children who did not complete immunization status.
3. Environmental
Environment where the air is not good, like air pollution in major cities and cigarette smoke can cause respiratory disease in children.
G. Prevention
The things that can be done to prevent the occurrence of respiratory disease in children include:
1. Ensuring that children receive good nutrition, such as by way of providing food to children that contain enough nutrients.
2. Providing a complete immunization to the child for resistance to both diseases.
3. Maintain personal and environmental hygiene to keep them clean.
4. Preventing child associated with ARI clients. One way is to use the cover nose and mouth when in direct contact with family members or people who are suffering from respiratory disease.
H. Nursing
1. Assessment
Medical history:
- The main complaint (fever, cough, runny nose, sore throat)
- History of present illness (the condition of the client when checked)
- History advance disease (whether clients have experienced illnesses like that happened now)
- The family disease history (is there any family members who never experienced pain like illness clients)
- Social History (neighborhood clients)
À Physical examination focused on the assessment of the respiratory system
a. Inspection
- Nasal-pharyngeal mucous membrane looks red
- Tonsil appear reddish and edema
- There was no productive cough
- There is no scarring on the neck
- No visible use of additional respiratory muscles, breathing nostrils.
b. Palpation
- The presence of fever
- Palpable enlargement of lymph glands in the neck / tenderness in the cervical lymph nodes
- There is a palpable thyroid gland enlargement
c. Percussion
- Sounds normal lung (resonance)
d. Auscultation
- Vesicular breath sound / no sound on both sides of lung ronchi
2. Nursing Diagnosis
1) Increased body temperature b.d infection process
Objectives: Normal body temperature ranges from 36 to 37.5 ° C
Intervention:
a. Observation of vital signs
b. Encourage client / family to compress on the head / axilla
c. Encourage clients to use the clothes are thin and can absorb sweat like cotton clothing.
d. Set air circulation
e. Encourage client to drink plenty of ± 2000 - 2500 ml / day
f. Instruct the client rest in bed during the phase of febrile illness.
g. Collaboration with physicians:
- In therapy, antimicrobial drugs
- Antipiretika
Rationalization:
a. Regular monitoring of vital signs to determine the development of further treatment
b. By providing compression, there will be a process of conduction / heat transfer material with an intermediary.
c. Hilanganya process heat will be impeded to the thick clothing and will not absorb sweat.
d. Provision of clean air
e. Fluid needs increase because of evaporation increased body
f. Bed rest to reduce metabolism and heat
g. To control respiratory infections and reduce the heat
2) The imbalance nutrition: less than body requirements bd anorexia
Objectives:
- Clients can achieve the planned BB BB leads to normal.
- Clients can tolerate the recommended dietary
- Does not show signs of malnutrition
Intervention:
a. Review dietary habits, input-output and weigh BB every day.
b. Give eat smaller meals but often and in warm conditions.
c. Increase bed rest
d. Collaboration: consult a nutritionist to provide a diet based on client needs.
Rationalization:
a. Useful for determining the caloric needs, formulate goals and evaluation BB keadekuatan nutrition plan.
b. To ensure adequate nutrition / increase the total calories
c. Appetite can be stimulated in the situation relaxed, clean, and fun.
d. To reduce the metabolic needs
e. Method of feeding and caloric needs based on the situation or individual needs to provide maximum nutrition.
3) Pain bd acute inflammation of the mucous membrane of the pharynx and tonsils
Objective: The pain is reduced / controlled
Intervention:
a. Thorough pain, note its intensity (with a scale of 0 - 10), factors that aggravate or relieve pain, location, duration, and characteristics.
b. Encourage clients to avoid the allergen / irritant to dust, chemicals, smoke rokkok, and resting / minimize speak when a voice hoarse.
c. Suggest to gargle warm water
d. Collaboration: give drugs as indicated (oral steroids, IV, and inhalation, and analgesics)
Rationalization:
a. Identify characteristics and factors related pain is something that is very important to select appropriate interventions and to evaluate the effectiveness of the therapy given.
b. Reduce bertambahberatnya disease
c. Increasing circulation in the throat area and reduce the sore throat.
d. Corticosteroids are used to prevent allergic reactions / inhibit histamine expenditure in respiratory inflammation. Analgesics to reduce pain.
4) High risk of transmission of infection is not strong bd secondary defense (an infection of immune suppression)
Objective: The transmission does not occur, no complications occurred
Intervention:
a. Limit visitors as indicated
b. Keep a balance between rest and activity
c. Cover mouth and nose if you want to sneeze
d. Increase endurance, especially children under age 2 years, the elderly, and people with chronic disease. Consumption of vitamin C, A and the minerals zinc or anti-oxidants when body condition dropped / reduced food intake.
e. Collaboration administration of drugs according to culture results
Rationalization:
a. Reduce the potential exposure to infectious diseases
b. Lowering consumption / demand balance of O ₂ and improve the client's defense against infection, improve healing.
c. Preventing the spread of pathogens through the fluid
d. Malnutrition can affect public health and lowered resistance to infection.
e. Can be given to the specific organism identified by culture and sensitivity or administered prophylactically because of high risk.
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