Infant with Pneumonia

I had a 3 month old boy in ICU during my last clinical rotation that had pneumonia and respiratory distress. I have to complete a care plan for this patient and I'm having some trouble due to the fact that it is an infant. I know that there are several things you can do for someone with pneumonia but what all could you do for an infant. Does anyone have a sample care plan for an infant with pneumonia or just some ideas that could help me out?

[LoveTheNICU]

I am a TA for the college I currently attend, and tutor for Peds/OB alot, so I thought I'd throw some ideas your way......I would definitely look at the nursing dxs of ineffective airway clearance, ineffective breathing patterns or impaired gas exchange... How were his lung sounds, ABGs, etc? That will help you chose which dx is more appropriate- look at the criteria in your careplanning book. More than one may be completely appropriate. Remember to always put assessment as an intervention on a careplan (ex. Assess lung sounds for rhonchi and rales q4h, or monitor ABG results, things like that). Put all of his meds, including anything RT administered, as intereventions as well. Including RT in a careplan is a good way to be "interdisciplinary", the students where I work have to include at least one intervention that can be classified that way. Be sure to look at the suggestions for interventions in your careplanning book/ peds text and think, "Did I do that for this patient?" It may have been something as simple as getting enough formula, etc for the baby, but can be considered pushing fluids to thin secretions or such. Additionally, look at the dx of interrupted family processes... it is mainly based on providing information and comfort to the parents, and it's one we use frequently in NICU. Keep in mind that when a child is so young, the parents are the patient as well! I hope this helps... feel free to PM me with more questions or to send your careplan along... :) I'd be happy to take a look since I've been staring at Peds careplans for my students here all week anyway... Midterms, ya know

[country_princess84]

thank you, that really helped me a lot.

[MissJoRN, RN]

I know that there are several things you can do for someone with pneumonia but what all could you do for an infant.

OK, I'm an RN, not a student, so written care plans aren't really my strong point, LOL, but babies are. If you told me to care for a 70 y/o with pneumonia I would wonder "what could you do for such a huge person?"

You have an advantage... you already cared for your pt (I remember submitting written careplans first thing in pre-conference before even meeting the pt!) So you have an idea what you can do for an infant since you already did/saw it.

All the adult stuff... scale down and make it age appropriate.

Assessment- Lung sounds (I/E), rate, effort (retractions? where? severity? nasal flaring?) upper airway congestion?, mucus?, temp, HR, color, pulse ox (I cannot stress enough that the number means next to nothing if you haven't already assessed resp effort and rate. Baby bodies compensate. I've started codes on babies who had high sat b/c they working too hard to maintain them and when that body suddenly realized it can't do the exxtra work any more they crash hard and fast) Also (I know you know this) does the HR on your sat monitor match the HR on your cardio monitor (nearly) and the one you auscultated? If not that low sat is probably inaccurate.

History- sick contacts, day care, parents smoke?, pets

DX- (you know much better than me how to write these out, I'm just looking at the NANDA list)

Ineffective airway r/t inflammation, secretions, and anatomy WNL for age (proportionatly narrower and smaller airway, narrower cricoid [why no cuff on ETT], floppy epiglottis, funnel shaped airway [again, the ETT rationale] Remember any airway edema or blockage makes a vastly proportionate difference in a tiny airway

Inef. Breathing pattern m/b incr rate, effort, incr HR

Activity intolerance m/b decr muscle tone, fussiness

Ineff. Nutrition/breastfeeding d/t difficulty organizing breathing and suck/swallowing, incr caloric needs

Risk for Fluid volum deficit or excess d/t inc fluid needs, IVF therapy (delicate balance in babies)

Alt. Body temp r/t fever/infection, age

Something family oriented- caregiver strain, family coping, alt family process, knowledge deficit

Interventions- Neb tx (age appropriate equipment- mask, blowby) O2 (intubated? vent FiO2? mask, blowby, tent, humidified to keep secretions thin?) suctioning (bulb syr, ETT, sxn cannula) Postural therapy (HOB up at rest... keep him from turning sideways or sliding down, good luck LOL, drainage with CPT/ nebs) even if not used keep sxn, O2, and inubation equipment nearby Need to vent/CPAP to ease work of breathing? steroid ordered? (weight appro dose!)

Rest but enc parents to hold if appropriate, ease anxiety about IV tubing, vent tubing, etc. Age appro stimuli/ play (mobiles, music as tol, watch for stress) Assess eye contact, finger grasps, social smile?

Enc small frequent feedings, might use a lactose free formula to cut back on mucoid secretions, IVF- monitor site frequently (!) keep site protected (3 mos old are rmarkable when they are tired of the IV) might give enteral/NG feeds if intubated or unable to tolerate po feeding (then should be intubated!) might b=have orders for a higher calorie formula or formula mixed with pedialyte. Enc nursing/ pumping as appro Assess diapers and fontanelles

Keep room warm, monitor temp, try to keep baby covered, anti pyretic (tylenol at this age) as ordered, look up your mg/kg and check your doses before giving! Same with antibiotics Septic workup?

Family teaching, social work to meet needs prn, baby will probably go home with nebs for a few weeks

(I'm taking RN-BSN classes, can you tell I finished my semester project, LOL too much time on my hands!)