8 week old twins

8 week old twins

1. Pertussis

   • persistant cough
     • "Whooping" sound
     • O2 sat 89-90% RA
       • Ph 7.35, CO2 35, PaO290, HCO3 22--ph 7.37, CO2 37, PaO2 85, HCo3 22
   • WBC 31000
     • elevated temps
       • 100.2, 100.5
         • tylenol
   • runny nose

2. Impaired spontaneous ventilation rt cough as evidenced by "whooping" sound, increased fussiness , and abnormal ABGs

   • will reestablish and maintain an effective respiratory pattern
   • maintain a patent airway, assess and report increased s/s respiratory distress, assess and monitor v/s, RR rate and characteristics, cough, breath sounds, evaluate and monitor ABGs, elevate the head of the bed, educate family

3. increased risk for deficient fluid volume rt fever as evidenced by decreased appetite, fever, abnormal abgs, increased irritability

   • maintain appropriate fluid volume
     • IV D10 with lytes
     • moist mucous membranes, stable v/s, afebrile, adequate urinary output, maintain weight
   • implement IV access, monitor nutritional status, review and administer medications, assess skin and mucous membranes, monitor v/s, monitor weight, I&O, educate family on treatments and meds.

4. Impaired gas exchage rt cough as evidenced by abnormal ABGs

   • altered oxygen supply
   • irritibility, cough, decreased appetite, abnormal abgs
   • will demonstrate improved ventilation and adequate oxygenation by abgs and absence of respiraatory distress
   • interventions
     • assess and monitor v/s, respiratory rate rhyth and use of accessory muscles
     • monitor O2 sat
       • administer O2 to keep sats > 92%
     • Auscultate breath sounds
       • note and monitor cough and characteristics
       • monitor and report s/s increased irritability restlessness s/s respiratory distress
     • monitor Labs
       • ABGs, CBC
     • administer meds as ordered