ms ncm 104

8/2/2019 MS ncm 104

http://slidepdf.com/reader/full/ms-ncm-104 1/9

Treatment for Diphtheria:

Penicillin is usually effective in treatingrespiratory diphtheria before it releases toxinsin the blood.

Antitoxin can be given in combination withpenicillin.

Skin testing is necessary before theadministration of anti-toxin.

8/2/2019 MS ncm 104


Fractional doses are given in positive (+) cases, withthe following schedule:

0.05 mL (1:20 dilution) –SC

0.05 mL (1:10 dilution) –SC

0.10 mL undiluted –SC

0.20 mL undiluted –SC

0.50 mL undiluted –IM

0.10 mL undiluted –IV

-15 minutes intervals if no reaction noted. If there isany, the remaining dose is given after an hour.

Penicillin 250 mg orally 4x a day or erythromycin 500mg orally 4x a day for 14 days is effective therapy.

8/2/2019 MS ncm 104


Supportive therapy:

maintenance of adequate nutrition. maintenance of adequate fluid and electrolyte

balance.

bed rest

oxygen inhalation

In the presence of laryngeal obstruction,tracheostomy is usually done.

Contacts to a case should receive erythromycin500 mg 4x daily for 7 days.

8/2/2019 MS ncm 104


Nursing Diagnosis:

Risk for suffocation r/t to airway obstructionfrom pseudo membrane formation andinfected, swollen throat structures.

Impaired skin integrity r/t lesions caused bycutaneous diphtheria.

Ineffective airway clearance r/t pseudomembrane formation and swollen throat

structures.

8/2/2019 MS ncm 104


Nursing Care:

Patient must be advised to take full bed rest forat least two weeks. Patient must not bepermitted to bathe by himself. The patientmust avoid exertion during defecation in order

to conserve energy and decrease cardiacworkload.

Soft diet is recommended. Small, frequentfeedings are advised.

Patient must be encourage to drink fruit juicesrich in vitamin C to maintain the alkalinity ofthe blood and increase his/her resistance.

Ice collar must be applied to the neck.

8/2/2019 MS ncm 104


Follow prescribed dosage and correcttechnique in administering antitoxin infections.

Comfort of the patient should always be inmind.

8/2/2019 MS ncm 104


Surgical Management:

Gather the needed equipment, including sterilegloves, hydrogen peroxide, normal salinesolution or sterile water, cotton-tippedapplicators, dressing and will tape.

Provide patient and family instruction on thekey points for tracheostomy care, beginningwith how to inspect the tracheostomy dressingfor moisture or drainage.

Perform hand hygiene. Explain procedure to patient and family as

appropriate.

8/2/2019 MS ncm 104


Put on clean gloves; remove and discard the soileddressing in a biohazard container.

Prepare sterile supplies, including hydrogenperoxide, NSS or sterile water, cotton-tippedapplicators, dressing and tape.

Cleanse the wound and the plate of tracheostomy

tube with sterile cotton-tipped applicatorsmoistened with hydrogen peroxide. Rinse withsterile saline solution.

Soak inner cannula in peroxide or sterile saline, per

manufacturer’s instruction; rinse with salinesolution; and inspect to be sure all dried secretionshave been removed. Dry and insert inner cannulaor replace with a new disposable inner cannula.

8/2/2019 MS ncm 104


Place clean twill tape in position to secure thetracheostomy tube by inserting one enf of the

tape through the side opening of the outercannula. Take the tape around the back of thepatient’s neck and thread it through theopposite opening of the outer cannula. Bring

both ends around so that they meet on onesode of the neck. Tighten the tape until onlytwo fingers can be comfortably inserted underit. Secure with a knot.

Remove old tapes and discard in a biohazardcontainer after the new tape is in place.

ms ncm 104

Documents