A child with Kawasaki Disease is admitted to the pediatric unit. To promote comfort, the nurse should do which of the following?

Choice A rationale

Bradypnea, which is an abnormally slow respiratory rate, is not a typical initial or hallmark sign of developing heart failure in a child. Instead, tachypnea (an increased respiratory rate) is commonly observed as the body attempts to compensate for pulmonary congestion or decreased cardiac output, making bradypnea an unlikely finding.

Choice B rationale

Inability to sweat, known as anhidrosis, is usually associated with conditions affecting the nervous system or sweat glands, such as certain genetic disorders or severe dehydration. This symptom is not a characteristic clinical manifestation of heart failure, which primarily involves impaired cardiac function and circulatory congestion leading to respiratory and edema symptoms.

Choice C rationale

Acral edema, which is swelling of the hands and feet, is a classic sign of systemic venous congestion resulting from the failing heart's inability to effectively pump blood forward. This pooling of fluid in the periphery is a key indicator that a child with a congenital heart defect may be developing new or worsening right-sided heart failure.

Choice D rationale

Splenomegaly, or enlargement of the spleen, is a nonspecific finding often seen in chronic venous congestion from heart failure, but also in many other conditions, including infections and hematological disorders. It is not one of the most common or earliest signs of heart failure in a child, which often presents first with signs like tachypnea, poor feeding, or periorbital edema.

Choice A rationale

Prohibiting the mother's presence during a pediatric emergency until a social worker completes an investigation is an unnecessary and emotionally detrimental action, which disregards the principles of family-centered care. Immediate involvement of the social worker is not the priority during the acute resuscitation phase, and separating the parent increases distress and psychological trauma for both the parent and child.

Choice B rationale

While allowing a parent to observe is an improvement over total exclusion, simply placing the mother in a corner to observe privately provides minimal active support. Family support during a crisis requires active intervention, clear communication, and emotional presence from the healthcare team, not just physical allowance to be present in the room.

Choice C rationale

The most appropriate type of family support in a crisis includes honest, frequent communication delivered by a designated primary nurse or team member who can stay with the parent. This communication strategy keeps the parent informed, reduces anxiety, builds trust, and allows the parent to feel included and supported during a traumatic and often terrifying resuscitation.

Choice D rationale

Identifying a grief counselor may be a necessary step if the child's prognosis is poor or after the immediate crisis has passed, but the most immediate and appropriate action during an active resuscitation is to provide emotional support and direct communication from the care team. The need for a grief counselor is secondary to the immediate psychological need for presence and information.