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Thrush Case Study

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by

Sha'bra Smith

on 26 February 2015

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Transcript of Thrush Case Study

Thrush Case Study

By:Sha'bra Smith and Melanie McCullough
Objectives Presentation

1. By the end of this presentation students should learn medical interventions for Thrush.
2. During this presentation students will be able to identify symptoms of Oral Thrush.
3. Students will be able to be able to list 2 nursing interventions for oral thrush.

Patient Scenario
Comprehensive Patients Scenario
Demographic Data-
European American, Yolanda Murray Myers
Mother: Female age 22
Student and part time waitressing IHOP
Lives with boyfriend
Receives federal aid from government
Health History-
Recurrent bacteria vaginitis was on Diflucan
No known allergens
Immunizations up to date
Birth Control
No history of smoking
Drinks moderately
Baby History-
Christian Anthony Myers
Immunizations up to date
Born 6 pounds on Dec. 17, 2014
Women’s Health Center in Greensboro NC
No congenital defects
Cultural Factors- Christian
Psychosocial Factors- unprotected sex, stress related to living situation with no financial help, minimal support from family member that dislikes the child’s father, stress from school, and postpartum depression
Presented with cracked nipples that do not heal, soreness more intense when baby feeds, with clothing a burning sensation to nipples, patient irritable wit feeding, tried to wipe whiteness for mouth that did not seem to go away.

Erickson's Stage of Growth and Development
Pathophysiology
Thrush occurs when there is a imbalance in the normal flora involving and overproduction of Acute Pseudomembranous Candidosis which is a yeast-fungal bacteria in the oral mucosa.
Clinical Manifestations
cracked skin in corner of mouth
whitish patches on the lips, tongues, or inside the cheeks (look like cottage cheese) that can be wiped away
may have diaper rash
Diagnostic Test and Associate Lab Test

visual observation
Potassium Hydroxide test for oral thrush :sample of skin is taken from the mouth by lightly scraping the white patches
Fungal culture: when thrush is not responding to medication
Throat culture or Endoscopic exam for thrush in the esophagus
Nursing Diagnosis
Impaired oral mucous membranes related to overgrowth of infective agent, as evidence by thick white patches on tongue and interrupted feedings

Ineffective management of therapeutic regimen related to knowledge deficit of the prescribed regimen as evidence by the mother stating, "I did not know I needed to put the Nystatin in his mouth 4 times a day after meal time".

Nursing Interventions
Prevent spread of infection
Good Hygiene
Administer Nystatin after feeding, with an applicator or syringe; cover medicine over entire oral mucosa and then deposit in the mouth to be swallowed by the infant to treat any gastrointestinal lesions
Rinse the infant's mouth with plain water after feedings and medication administration
Teach: boil pacifiers for 20 minutes per day, boil reusable nipples and bottlers for at least 20 minutes after thoroughly washing ]
If mother is breastfeeding, simultaneously treat the infant and mother if either one is infected
-wash nipples with plain water and dry thoroughly
-adhere to medication regimen
-wash clothing thoroughly to prevent spread



Treatment of the infection
-Nystatin oral and topical
-Gentian violet as second line agent when bacteria resistant to Nystatin
Impact of Illness of Growth and Development
Increased Irritability due to pain and irritation to mucous membrane
Inability for mother baby bonding time during breastfeeding due to pain during breastfeeding
reluctant to feed due to pain or discomfort
Physician Orders

Nystatin 2ml PO QID give 1ml in each side of mouth Prescriprion for topical nystatin written for mother's use
Age: 3 months
Trust vs. Mistrust
Trust of self, of others, and of the world.
Infants trust that their feedings, comfort, situation, and caring needs will be met.
Quality of the relationship between the parent and the child is important
Mutual regulation of frustration should occur if it fails mistrust mistrust begins
Failure to learn delayed gratification leads to mistrust
If delay is prolonged infants get frustrated and mistrust others
Need physical comfort and security
Primary narcissism
Tactile stimulation is important

Reference List
Bennett, C., Tabrizi, S., Garland, S., Fisher, J., Cooklin, A., Cullinane, M., Payne, M., ... Amir, L. (2011). The role of micro-organisms ( Staphylococcus aureus and Candida albicans ) in the pathogenesis of breast pain and infection in lactating women: study protocol. Bmc Pregnancy and Childbirth, 11, 1, 1-11.
Jones, W., & Breward, S. (2010). Thrush and breastfeeding. Identifying and treating thrush in breastfeeding mothers and babies. Community Practitioner : the Journal of the Community Practitioners' & Health Visitors' Association, 83, 10, 42-3.
Moorhead, A. M., Amir, L. H., O'Brien, P. W., & Wong, S. ( 2011). A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeeding Review : Professional Publication of the Nursing Mothers' Association of Australia, 19, 3, 25-9.
Thrush in babies | BabyCenter. (n.d.). Retrieved February 19, 2015, from http://www.babycenter.com/0_thrush-in-babies_92.bc
Wong, D. L., Hockenberry, M. J., & Wilson, D. (2011). Wong's nursing care of infants and children. St. Louis, Mo: Mosby/Elsevier.


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