Amanda831

Talk to the family...maybe those meds can be dispensed as a liquid form instead.

I worked on one case where I always had this feeling someone was watching me. Everytime I would lean over the child to suction him, it felt like someone came running up and was looking over my shoulder. I would also hear footsteps even though everyone was asleep and would always think I would see someone out of the corner of my eye. Creeped me out! I was afraid to walk around anywhere in that house! So one day, I finally asked the family about it. The mother told me her husband's grandparents had passes away in that house before they lived there and that another nurse had reported things like this before too. So I'm guessing all the creepy stuff that was happening was the ghosts of the husbands grandparent...weird that I picked up on it before I knew it was an issue.

I've been a pediatric home care nurse for about five years to kids with trachs and vents. While reading your post, the first thing that caught my attention was the nasal flaring and mild retractions. To me, that signals an increased work of breathing. The resp rates you stated seem awfully high to me. Does this baby have a cuffed or uncuffed trach? Does this baby have use of his upper airway? It almost sounds like he's compensating by breathing thru his upper airway...that to me signals that perhaps the trach is plugged or there needs to be more moisture thru the circuit. Also, some kids that have cuffed trachs will breathe easier and at a slower pace if the cuff is inflated, allowing the vent to do most of the work. I know that wasnt your question but I'd thought it was worth mentioning. Now for breathe sounds...when you listen to clear lungs, it will sound almost like Darth Vader, if that makes sense, ha. Rhonchi sounds like a snore and usually signals congestion, in which suctioning would be needed. And you would document which lobes are involved, either upper or lower. Rales usually indicates fluid in the lungs. It would sound like a clicking or popping noise. You usually wont hear rales unless the child has pneunmonia or something like that. Some vent kids will have UAC, upper airway congestion, depending if they have use of their upper airway. Try this website as well...http://www.wilkes.med.ucla.edu/lungintro.htm