Chapter 11 Nursing Care of the Child of

Chapter 11 Nursing Care of the Child of Infection Disease อ. สมาลา สวางจต

ชองทางการแพรกระจายเชอ 1. Contact transmission Ø 1. 1 Direct contact Ø 1. 2 Indirect contact 2. Droplet transmission Ø 3 -6 ฟต Ø Respiratory Ø > 5 micron 3. Airborne transmission Ø Air Ø 1 -5 micron Respiratory

Assessment v. History Ø Contact Ø Vaccine Ø ประวตการเปนโรค v. Clinical sign v. Laboratory

v. Nursing Care of the Child of Infection Disease with vaccine v. Nursing Care of the other Infection Disease

วณโรค (Tuberculosis) อาการและอาการแสดง Ø Exposure/Contact แขงแรง , tuberculin test –ve, Normal CXR, อาจอยระยะฟกตว Ø Latent tuberculin infection: LTBI แขงแรง , tuberculin test –ve, abnormal CXR )พบนอย ( Ø Tuberculosis disease/ Active TB Ø Pulmonary tuberculin Ø Lymph node tuberculosis Ø Neurological tuberculosis Ø Bones and/or joints )พบนอย ( แสดงอาการตามตำแหนง , 50% abnormal CXR

วณโรค (Tuberculosis) การวนจฉย q Hx. Contact q Tuberculin test , ID ททองแขน +ve ฉดยา 48 และ 72 ชม. ตม > 5 mm (low immune) - 10 mm q CXR q. Acid fast Bacilli: AFB ตองมเชอ qเพาะเชอ 5, 000 -10, 000 ตว /ml

การรกษา วณโรค (Tuberculosis) Ø Exposure/Contact Isonacid 3 -6 เดอน Ø Latent tuberculin infection: LTBI Isonacid 3 -6 เดอน Ø Tuberculosis disease/ Active TB 2 เดอนแรก Isonacid , Rifampin, Pyrazinamide และ Ethambutal/ Streptomycin , TB ปอดและตอมนำเหลองให Isonacid, Rifampin ตอ 4 เดอน และใหตอ 10 เดอนในสมองและกระดกและขอ

Nursing Diagnosis 1. Ineffective Airway Clearance related to accumulation of secretions result of damage to the muscles of swallowing. 2. Acute Pain related to injury agents (biological). 3. Risk for Aspiration related to loss of consciousness, swallowing disorders. 4. Ineffective Tissue Perfusion related to damage to transport oxygen through the alveolar and capillary membranes. 5. Risk for Injury related to an increase in muscle coordination (convulsions), irritability. 6. Imbalanced Nutrition, Less Than Body Requirements related to decreased swallowing reflexes, less intake. 7. Risk for Infection related to immune primary, invasive procedures. 8. Impaired Swallowing related to neuromuscular damage swallowing muscles. 9. Impaired Urinary Elimination related to damage to sensory motor. 10. Self Care Deficit related to weakness, illness. 11. Knowledge Deficit: about the disease and treatment related to lack of exposure to sources of information. 12. Impaired Verbal Communication related to decreased blood circulation to the brain.

Nursing Care of the Child of Infection Disease with vaccine (ตอ ) § โรคทสงผล ตอผวหนง § โรคหด (Measles( § โรคหดเยอรมน (German Measles (/Rubella § โรคสกใส (Chicken pox(

Nursing Care of the Child of Infection Disease with vaccine/โรคทสงผลตอ ผวหนง /Measles (ตอ ) complications associated with the disease vอาการจะรนแรงในเดกอายตำกวา 5ป v. Blindness v. Encephalitis (an infection that causes brain swelling) v. Severe diarrhea and related dehydration v. Ear infections, v. Severe respiratory infections such as pneumonia. vอาการจะรนแรงขนในเดกทมภาวะทพโภชนาการ โดยเฉพาะ insufficient vitamin A, หรอเดกทมภมคมกนตำ จาก HIV/AIDS หรอโรคอนๆ WHO, 2017

Nursing Diagnosis Ø Impaired social interaction related to isolation from friends. Ø Risk for impaired skin integrity related to raking pruritus. Ø High risk of infection related to the host and infectious agents. Ø Acute pain related to skin lesions and irritated mucous membranes.

Goal ü Skin will stay clean, dry and intact. ü Mucous membranes will stay moist, discomfort will stay within defined tolerable range by patient. ü Patient will understand purpose of isolation, cooperate and be free of distress.

Nursing Interventions ØIsolation. ØSkin care. ØEye care. ØHydration. ØTemperature control.

Evaluation ü Skin became clean, dry and intact. ü Mucous membranes stayed moist, discomfort will stay within defined tolerable range by the patient. ü Patient understood the purpose of isolation, cooperate and be free of distress

Nursing Care of the other Infection Disease Ø โรคตดเชอไวรสเดงก Ø HIV Ø Skin infection

Nursing Diagnosis Ø Risk for bleeding related to possible impaired liver function. Ø Deficient fluid volume related to vascular leakage. Ø Pain related to abdominal pain and severe headaches. Ø Risk for ineffective tissue perfusion related to failure of the circulatory system. Ø Risk for shock related to dysfunction in the circulatory system.

Nursing Interventions Ø Blood pressure monitoring. Measure blood pressure as indicated. Ø Monitoring pain. Note client report of pain in specific areas, whether pain is increasing, diffused, or localized. Ø Vascular access. Maintain patency of vascular access for fluid administration or blood replacement as indicated. Ø Medication regimen. There must be a periodic review of the medication regimen of the client to identify medications that might exacerbate bleeding problems. Ø Fluid replacement. Establish 24 -hour fluid replacement needs. Ø Managing nose bleeds. Elevate position of the patient and apply ice bag to the bridge of the nose and to the forehead. Ø Trendelenburg position. Place the patient in Trendelenburg position to restore blood volume to the head.

Evaluation ü Absence of signs of bleeding. ü Displayed laboratory results within normal range for individuals. ü Maintained fluid volume at a functional level. ü Reported pain is relieved or controlled. ü Followed prescribed pharmacologic regimen. ü Demonstrated adequate tissue perfusion. ü Displayed hemodynamic stability. ü Afebrile and free from other signs of infection.

ยาตานไวรส 1. Reverse transcriptase inhibitors: รบกวนการทำงานของ transcriptase RT: Zidovudine (AZT), Stavudine (d 4 T), Lamivudine (3 TC), Didanosine (ddl), Tenofovir (TDF) 2. Non- Reverse transcriptase inhibitor: Nevirapine(NVP), Efavirenz(EFV), Etravirine(FCT) 3. Protease inhibitor: Ritovir(RTV), Lopovir 4. Entry inhibitor: Enfuvirtide(T 20), Maraviroc 5. Integrase inhibitor: Raltegravir

Nursing Diagnosis Ø Impaired social interaction related to isolation from friends. Ø Risk for impaired skin integrity related to raking pruritus. Ø High risk of infection related to the host and infectious agents. Ø Acute pain related to skin lesions and irritated mucous membranes.

Goal ü Skin will stay clean, dry and intact. ü Mucous membranes will stay moist, discomfort will stay within defined tolerable range by patient. ü Patient will understand purpose of isolation, cooperate and be free of distress.

Nursing Interventions ØIsolation. ØSkin care. ØHydration. ØTemperature control.

Evaluation ü Skin became clean, dry and intact. ü Mucous membranes stayed moist, discomfort will stay within defined tolerable range by the patient. ü Patient understood the purpose of isolation, cooperate and be free of distress