ASSESSMENT NURSING PATHOPHYSIOLOGY PLANNING INTERVENTION RATIONALIZATION EVALUATION

DIAGNOSIS
Objective: Risk For After 8 hours of  Assess for  Provides After 8 hours of
Suffocation St. nursing
Paul College of Ilocos Surin
changes skin information nursing intervention,
 Extreme related to (Member: St. Paul
intervention, theUniversitycolor
System)
from pallor to about increasing the Child’s airway
anxiety, with disease process Child’s airway remains open either
St. Paul Avenue, 2727 Bantay, Ilocos Sur
cyanosis, severe airway
struggle to remains open dyspnea obstruction. naturally or by means
breathe
DEPARTMENT OF NURSING of ET tube
either naturally or and sternal and
by means of ET intercostal retracti  Leads to or tracheostomy.
 Dysphasia laryngospasm
NOVILYN C. PATARAY BSN – II tube ons, lethargy,
 EPIGLOTTIS
Cyanosis or tracheostomy. increased pulse. and airway
ACUTE obstruction.
 Supraglottic  Discourage
edema examining throat  Lying down may
with a tongue cause epiglottis
 Obstruction blade or taking to fall backward,
throat culture causing airway
 Hypoxia obstruction.
unless immediate
emergency
 Promotes
equipment and
oxygenation of
personnel at hand.
tissues and
 Allow to sit up and prevents
avoid lying hypoxemia.
position.
 Establishes
 Monitor airway
oxygenation via if obstruction
pulse oximeter; present
Provide oxygen as and respiratory
prescribed. failure
and asphyxia is
 Endotracheal imminent.
intubation must be
readily available;  Explanations
assist with provide informat
tracheostomy if ion and support
needed or prepare for  parents who
for the procedure are
unfamiliar  with
in surgery.
the care.
 Provide a brief
 Prepares
clear explanation
parents
of
with information
care and all
of what
procedures and
to  expect.
purpose and
procedure for
emergency intubat
ion or