الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 115 |  |  |
| | | from | 115 | | |
Abstract
Respiratory emergencies in children are life threatening.They are dividedintoupperandlower airway obstructions.The upper airway obstruction is caused by blockage above the thoracic inlet as croup and aspiration, that is pronounced during inspiration. Thelower airway obstruction is caused by blockage below the thoracicinletcauses wheezing on expiration than on inspiration such as in asthma. There are many causes of RE in children, including upper and lower airway obstructions.
The aim of the current study was to assess the nursing care provided for children with RE by observation the nurses’ application of systemic approach for assessing the critically ill child through the initial, primary and secondary assessment. The study was conducted at the ED in UHEA. All nurses responsible for providing emergency care for children with RE admitted to the above mentioned setting comprised the study subjects. Their number was 30 nurses.
Two tools were used to collect the necessary data. The tools were developed by the researcher after thorough review of the related literature except for part A of tool two contained the nursing assessment which was adopted from theAHA and the AAP guidelines 2015 on Pediatric Advanced life support, it included three parts namely; initial assessment, primary assessment and secondary assessment. Part B included all the nursing intervention which provided to the children with RE. Every nurse was observed three times while providing nursing care for children with wheezes, croup and aspiration during the morning and the afternoon shifts.
The main results of the present study revealed the following:
• It was found that nearly half of the nurses (53.3%) aged from 20 to less than 25 years, while 10% of them aged from 35 years.
• It was found that 70% of nurses were graduated from technical institute of nursing. While 30% of them got the secondary school diploma.
• As for years of experience, 53.3% of nurses had less than 5 years of experience one third of them(33.3%(had 10 to less than 15 years of experience in the pediatric nursing field.
• As regards attending pediatric RE management courses, 70% of nurses did not attended any training educational courses about RE.
• As regards systemic approach for assessing the critically ill child, all nurses caring for children with wheezes, croup and aspiration did not perform it.
• The nurses’ total performance score in the application of systemic approach for assessing the critically ill child were unsatisfactory.
• There was equally relation among nurses during morning and evening shifts in all items ofsystemic approach for assessing the critically ill child and nurses’ working shifts.
• All nurses caring for children with wheezes, croup and aspiration neither assessed the child’s condition nor provided support to the child and his or her family.
• All nurses prepared nebulizer equipment for cases with wheezes, croup and aspiration such as: nebulizer reservoir, nebulizer cap, face mask, plastic oxygen tubing, oxygen source or compressed air (100% for each).
• All nurses administered the ordered dose of dexamethasone if needed in the case of wheezes, croup or aspiration.
• In cases with wheezes approximately 51.2% of nurses did not wash their hands and 95.3% did not wear non-sterile gloves.
• In moderate to severe wheezes, all nurses administered IV bolus magnesium sulfate slowly over 15-20 minutes incorrectly. In addition to 93.1% of them did not monitor heart rate during magnesium sulfate administration.
• In croup 18.2% of nurses did not wash their hands and all of them did not wear non-sterile gloves before starting the epinephrine nebulizer session.
• Regarding the nursing care given after the epinephrine nebulizer session, all nurses did not perform the following: observation the child for at least 2 hours after giving nebulized epinephrine (no recurrence of stridor).
• Regarding the nursing care given for cases with aspiration in suction attempts, 57.1% of nurses limited the suction attempts to 10 seconds or less.
• Less than three quarters of nurses (71.4%) did not do the following: measuring suction catheter from the tip of the nose to ear lobe for nasal suctioning, insert the catheter on each side of the child’s mouth and over the tongue and apply suction by covering the catheter side opening.
• As for suction withdraw, 57.1% of nurses did not withdraw the catheter with a rotating motion. The results show that all nurses did not give 10-20% oxygen above the base line before and after each suction attempt.
• There were no statistically significant differences evident between nurses’ performance score in the mild wheezes and nurses’ age P = 0.802e, educational qualifications P = 0.789 and years of experience P = 0.455.
• There are statistically significant differences evident between nurses’ performance scorein mild wheezy and attendanceof RE management courses P = 0.003*.
• There were statistically significant differences evident between nurses’ performance score in the moderate to severe wheezes and nurses’ age P = 0.006*, educational qualifications P = 0.003*, years of experience P = 0.029*and attendanceof RE management courses P = 0.005*.
• There were no statistically significant differences evident between nurses’ performance score in the croup and nurses’ age, educational qualifications, years of experience and attendanceof RE management courses.
• There were statistically significant differences evident between nurses’ performance score in the aspiration and nurses’ age P = 0.049*, educational qualifications P = 0.052*,years of experience P = 0.052*.
• All observed nurses in case of aspiration did not attend previous training programs RE management.