Monitor frequently for adverse effects (particularly respiratory effects) of opioid analgesics, as opioids reduce responsiveness of carbon dioxide receptors in the brain’s respiratory center. Use nonpharmacologic measures such as play therapy, games, TV, guided breathing, imagery, hypnosis, or meditation as appropriate: distracts child’s attention from the pain. Use massage, positioning, or heat to relieve pain in a particular area. Use EMLA before needlesticks and conscious sedation with lumbar puncture and bone marrow aspiration to reduce recurrent acute painful episodes associated with frequent blood draws and diagnostic/treatment procedures. Have the child lie flat for 30 minutes after a lumbar puncture and increase fluid intake for 24 hours after the procedure to decrease incidence of headache. NURSING DIAGNOSIS: Impaired oral mucous membranes related to chemotherapy, radiation therapy, immunocompromise, decreased platelet count, malnutrition, or dehydration as evidenced by oral lesions, ulcers, plaques, hyperemia or bleeding, difficulty eating or swallowing, or complaint of oral discomfort Outcome Identification and Evaluation Child will maintain intact, moist mucosa free from redness, ulceration, or debris. Interventions: Restoring Healthy Oral Mucosa Frequently assess oral cavity for redness, lesions, ulcers, plaques, or bleeding to provide baseline for comparison and identify alterations early. Offer ice chips frequently while child is NPO to maintain hydration of mucosa. Use only a soft toothbrush or toothette for dental care, avoiding excessive pressure with brushing, to decrease incidence of bleeding with mouth care. Keep lips lubricated with petroleum jelly or fragrance-free lip balm to maintain moist, hydrated lips. Rinse with salt solution or mouthwash every 1 to 2 hours to keep oral cavity clean and moist. Administer glutamine and/or β-carotene supplements, which have been shown to decrease the incidence and severity of mucositis. Have child swish and spit 1:1 Benadryl/Maalox solution to decrease pain. Administer antifungal solution to prevent or treat oral candidiasis. Avoid spicy, acidic, or very hot or very cold foods to decrease pain. Administer pain medication (usually acetaminophen or codeine) as ordered to decrease pain.
NURSING DIAGNOSIS: Nausea related to adverse effects of chemotherapy or radiation therapy as evidenced by verbalization of nausea, increased salivation, swallowing movements, or vomiting Outcome Identification and Evaluation Child will experience decreased nausea: will verbalize symptom relief and will be free from vomiting. Interventions: Alleviating Nausea and Vomiting Administer antiemetics prior to chemotherapy and as needed thereafter to decrease frequency of nausea. Assess frequency of vomiting and level of hydration to provide baseline data and recognize alterations early.
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