A father brings his preschool aged child to the clinic because of a sore throat for the past two days and currently has a temperature of 103° F (39.4°C). The child is pale around the mouth and has flushed cheeks. The nurse processes a positive rapid strep test as prescribed. Which information should the nurse provide to the child's parent? Select all that apply.

Rationale for Correct Choices:

• Heart rate 128 beats/minute, sinus tachycardia: The elevated heart rate of 128 beats/minute suggests tachycardia, which could indicate hypovolemia or shock, especially given the traumatic nature of the injury. This warrants immediate attention to prevent cardiovascular compromise.
• Temperature 96.9° F (36.1° C): A low temperature is concerning in trauma patients and could indicate hypothermia, which worsens in a critical setting. It should be monitored closely and actively managed, especially in the ICU setting.
• Blood pressure 90/79 mm Hg, pulse pressure less than 40 mm Hg: A pulse pressure of less than 40 mm Hg can be a sign of insufficient perfusion and is concerning in trauma. The low blood pressure in combination with the narrowed pulse pressure suggests the possibility of hemorrhagic shock, which requires immediate intervention to stabilize blood volume.
• Ecchymosis noted on the abdomen around the dressing: Ecchymosis around the abdominal dressing, combined with the history of trauma and CT findings of liver and spleen lacerations with peritoneal blood, strongly indicates ongoing internal bleeding.
• Capillary refill is 6 seconds: Delayed capillary refill is a sign of poor peripheral perfusion, which can be indicative of hypovolemic shock or other circulatory compromise. This finding should be addressed promptly to assess circulatory status and address underlying causes.
• No urine noted in the indwelling urinary catheter: The absence of urine output is a critical finding, especially in a trauma patient. It may indicate renal hypoperfusion due to low blood pressure, which can lead to acute kidney injury.

Rationale for Incorrect Choices:

• Respiratory rate 14 breaths/minute: A respiratory rate of 14 breaths/minute is within the normal range for an adult. There are no signs of respiratory distress, so it does not require urgent attention at this time.
• Oxygen saturation 100% on 40% fraction of inspired oxygen (FiO2): The oxygen saturation is 100%, which is within the normal range. The use of 40% FiO2 is appropriate for intubated patients, and no immediate intervention is needed for oxygenation at this time.
• Surgical dressing is clean and dry: The surgical dressing being clean and dry suggests there is no active bleeding at the moment, it does not require urgent intervention unless there are signs of worsening or internal bleeding.
• Lung sounds are clear and equal bilaterally: Clear lung sounds indicate that there are no immediate respiratory issues such as fluid buildup or obstruction. This is a positive finding and does not require urgent attention at this time.

A. Diabetes mellitus: While diabetes mellitus can affect circulation and healing, it is not a direct contraindication for the use of lidocaine. However, monitoring for effects on circulation and neuropathy may be necessary in diabetic patients.

B. Heart block: Lidocaine is a local anesthetic that can have systemic effects, especially on the cardiovascular system. It can cause conduction abnormalities, including heart block, so it is crucial to assess for this condition before administering lidocaine to avoid exacerbating cardiac issues.

C. Gastric ulcers: Lidocaine's effects are primarily cardiac and neurological, and it does not have a known adverse effect on gastric ulcers that would require pre-administration review. This condition is more relevant for oral medications that can irritate the gastric mucosa.

D. Glaucoma: Lidocaine does not have a significant effect on intraocular pressure or glaucoma. The main concern with lidocaine is its effect on the heart and nervous system, rather than its impact on eye conditions.