A client has been prescribed norepinephrine 152 mcg. The concentration of norepinephrine is 8 mg mixed in 250 mL of DSW. How many mL should the nurse administer? Round to the whole number.

Pertussis, or whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis, characterized by paroxysmal coughing and inspiratory "whoops." In infants, the disease is particularly severe due to the risk of apnea, encephalopathy, and secondary pneumonia. Clinical priority is directed toward maintaining airway patency and ensuring adequate oxygenation, as small children possess limited physiological reserves to compensate for acute respiratory distress or hypoxic episodes.

Rationale:

A. A scheduled diagnostic procedure like a gastrointestinal x-ray is a routine event that does not indicate an acute physiological crisis. While the child may be fasting, their status is stable and predictably managed within the standard daily workflow of a pediatric unit. This client does not require immediate, life-saving assessment before those with compromised respiratory function.

B. Routine glucose monitoring for a child with diabetes is a standard part of managing a chronic metabolic condition. Unless the child is displaying signs of severe hypoglycemia or ketoacidosis, such as altered mental status or Kussmaul respirations, they remain a lower priority. The nurse can delegate or perform this task after stabilizing patients with higher acuity.

C. A patient who is 24 hours post-appendectomy is in the recovery phase of a surgical intervention. While they require assessment for bowel sounds and incision integrity, they are typically stable and transitioning to oral intake and ambulation. This client’s needs are predictable and do not take precedence over an infant experiencing an active respiratory infection.

D. The infant with pertussis represents the highest priority due to the potential for sudden airway obstruction or life-threatening apneic spells. Being on supplemental oxygen indicates an impaired gas exchange status that requires frequent, close monitoring of pulse oximetry and respiratory effort. The nurse must assess this child first to ensure the current oxygen delivery is sufficient to prevent cyanosis.

Goodpasture syndrome is a rare, life-threatening autoimmune disorder characterized by the presence of circulating anti-glomerular basement membrane (GBM) antibodies. These antibodies trigger a cytotoxic response that concurrently attacks the alveolar and glomerular basement membranes, leading to pulmonary hemorrhage and rapidly progressive glomerulonephritis. The clinical focus must remain on managing respiratory failure and acute kidney injury to prevent multi-organ collapse.

Rationale:

A. Nephrolithiasis involves the formation of calculi within the urinary tract, causing severe renal colic and microscopic or gross hematuria. While a pain rating of 9 is significant, it represents a non-emergent physiological response to the passage of the stone. This client requires analgesia and hydration but is not at immediate risk of hemodynamic instability or death.

B. Acute post-streptococcal glomerulonephritis (APSGN) is an immune-complex disease that typically presents with smoky-colored urine due to hemolysis of red blood cells. While hematuria and edema are hallmark signs, they are expected manifestations of the inflammatory process following a streptococcal infection. This client is stable and does not take precedence over a client with systemic organ failure.

C. Interstitial cystitis is a chronic inflammatory condition of the bladder wall that causes urinary urgency and suprapubic pain. Although the symptoms are distressing and impact the client's quality of life, they do not constitute an acute emergency. The nurse can manage this client’s discomfort after addressing individuals with potentially fatal complications.

D. Goodpasture syndrome is the priority because it involves alveolar hemorrhage and acute renal failure, which are high-mortality conditions. Pallor and anemia suggest significant internal bleeding, while renal failure indicates a loss of homeostatic regulation. The nurse must assess this client first to monitor for pulmonary compromise and initiate plasmapheresis or immunosuppressive therapy.