Primary Nursing Diagnosis

Impaired gas exchange related to increased alveolar capillary permeability

OUTCOMES. Respiratory status: Gas exchange and ventilation; Symptom control behavior; Comfort level; Treatment behavior: Illness or injury

INTERVENTIONS. Respiratory monitoring; Energy management; Airway management; Anxiety reduction; Oxygen therapy; Airway suctioning; Airway insertion and stabilization; Cough enhancement; Mechanical ventilation

828 Rocky Mountain Spotted Fever

^ PLANNING AND IMPLEMENTATION Collaborative

If the patient needs to have a tick removed, wear gloves and place gentle traction on the tick with either tweezers or the fingers. Do not crush the tick because inhaling the bacteria may lead to disease exposure. Do not apply noxious chemicals onto the tick. Because the patient may be further injured if a match is used on the tick, do not apply a match to the skin to remove the tick. Patients who have severe cases of Rocky Mountain spotted fever are admitted to the hospital, possibly to the intensive care unit. Central parenteral administration of fluids and antibiotics is often necessary, and the patient may also be monitored with a pulmonary artery catheter if she or he is hemodynamically unstable.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Antibiotics

Varies with drug; administered for 7-14 days, depending on patient and drug

Doxycycline, 100 mg q 12 hr IV or PO for 7 days or 2 days after becoming afebrile; Tetracycline hydrochloride for patients over the age of 8 orally or parenterally in four divided doses; chloramphenicol for patients less than 8 years of age or in adults with severe disease who have central nervous system involvement

Kill the microorganism and fight infection

Other Drugs: Symptom management—Antipyretics are usually necessary for temperature control, and analgesia is used to control discomfort. Usually, the physician avoids prescribing aspirin because of the added risk of platelet dysfunction.

Independent

Nursing care focuses on increasing comfort, monitoring for complications, and educating the patient. Implement nonpharmacologic strategies to manage discomfort, such as tepid sponge baths for fever, frequent linen changes for excessive diaphoresis, and age-appropriate diversions for discomfort. Teach the patient guided imagery, deep-breathing techniques, and music therapy to manage pain and boredom. Provide age-appropriate activities for young adults, such as television, radio, compact discs, and videos, to help them pass the time and to take their minds off discomfort. To conserve the patient's energy during a time of increased metabolic demand, assist with activities of daily living and space all caregiving activities with periods of rest to decrease the patient's oxygen expenditure.

Monitor the patient's skin rash for signs of infection, such as sloughing, redness, warmth, and purulent drainage. Help the patient move in bed to positions of comfort every hour or 2, and pad the elbows and heels to prevent skin breakdown. Provide mouth care every 4 hours, and offer the patient mentholated lotions to decrease the itching that is associated with the rash. If possible, maintain a cool room temperature the help the patient control the itching. When patient's condition has stabilized, discuss methods to avoid tick bites in the future. Encourage the patient to avoid tick-infested areas. If the patient chooses to be out of doors in such an area, teach him or her to wear protective clothing (long pants, tucked-in shirt, laced boots) and to inspect the entire body every 4 hours for ticks. If a tick bite occurs, explain that the tick should be removed with a tweezers by steady traction and then discarded immediately without crushing.

Rocky Mountain Spotted Fever 829

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