A nurse is admitting an 8-year-old child to the pediatric unit.

Exhibits

A nurse is reviewing the child's electronic medical record (EMR). Which of the following findings should the nurse identity as requiring immediate follow-up? Select the 5 findings that require immediate follow-up.

A. "Wear a face mask when working within 3 feet of a child who is infected.": Influenza is primarily transmitted via large respiratory droplets, which can spread up to 3 feet. Wearing a face mask within this distance helps prevent transmission to healthcare workers and others.

B. "Administer the influenza vaccine every 6 months.": The influenza vaccine is administered annually, not every 6 months. Protection from the vaccine is designed to last through one flu season, and a yearly update is needed due to viral strain changes.

C. "Children should be considered infectious for 14 days after the onset of symptoms.": Most children with influenza are considered infectious from 1 day before symptom onset until about 5–7 days after. 14 days is unnecessary unless the child is severely immunocompromised.

D. "Administer antibacterial medication within 24 hr of the onset of symptoms.": Influenza is a viral infection, so antibacterial medications are ineffective. Antiviral medications, such as oseltamivir, may be considered within 24–48 hours, but antibiotics are not appropriate.

A. Prepare to give oral N-acetylcysteine: N-acetylcysteine is the antidote for acetaminophen toxicity and is most effective when given within 8 hours of ingestion. Since the child ingested a toxic dose 4 hours ago, administering this medication promptly helps prevent severe hepatic injury.

B. Send the child home on increased fluid intake: Simply encouraging fluids does not address acetaminophen toxicity. Without antidote therapy, the child is at significant risk for liver damage, so discharge with fluids would place the child in danger.

C. Perform gastric lavage with activated charcoal: Activated charcoal may be useful if given within 1 hour of ingestion to reduce absorption. At 4 hours post-ingestion, acetaminophen has already been absorbed, making this intervention ineffective.

D. Begin hemodialysis within the next 24 hr: Hemodialysis is rarely indicated in acetaminophen toxicity unless there is massive ingestion, severe liver failure, or extremely high serum levels. The standard and effective treatment at this stage is N-acetylcysteine.