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

For each potential condition, click to specify if the child's assessment findings are consistent with Hodgkin Lymphoma, Bacterial Meningitis, or Acute Lymphoblastic Leukemia (ALL). Each finding may support more than 1 disease process.

Condition most likely experiencing:

Pelvic Inflammatory Disease (PID)

Actions the nurse should take:

1. Place the adolescent on bedrest in semi-Fowler’s position
2. Administer acetaminophen 650 mg PO every 6 Hr PRN pain

Parameters to monitor:

1. Temperature greater than 38.3°C (100.9°F)
2. Rebound tenderness

Rationale:

Pelvic Inflammatory Disease (PID). The client’s history of multiple sexual partners, mucopurulent cervical discharge, pelvic pain, and fever strongly suggests PID, a bacterial infection often caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhea.

Urinary tract infection. UTIs typically present with dysuria, urgency, frequency, and suprapubic pain, which are not noted here.

Ectopic pregnancy. The client’s last menstrual period was 7 days ago, making pregnancy unlikely. PID symptoms differ from ectopic pregnancy, which presents with unilateral lower abdominal pain and possibly vaginal bleeding.

Acute appendicitis. Appendicitis typically causes right lower quadrant pain, nausea, vomiting, and rebound tenderness, which are not the primary symptoms here.

Place the adolescent on bedrest in semi-Fowler’s position – This promotes drainage of infected fluids and reduces the risk of abscess formation.

Administer acetaminophen 650 mg PO every 6 Hr PRN pain – This helps manage the pain associated with PID.

Temperature greater than 38.3°C (100.9°F) – A rising temperature may indicate worsening infection or sepsis.

Rebound tenderness – Can indicate peritoneal irritation, which may suggest complications such as peritonitis or an abscess.

Instruct the adolescent about the use of sitz baths. Sitz baths are used for perineal discomfort but are not a standard intervention for PID.

Administer an enema. An enema is unnecessary and could worsen the infection if peritonitis is present.

Vaginal bleeding. Vaginal bleeding is not a common symptom of PID.

Irritation of the phrenic nerve. Phrenic nerve irritation is associated with diaphragmatic irritation, such as in gallbladder disease or ruptured ectopic pregnancy.

Presence of a Cullen sign. Cullen’s sign (bluish discoloration around the umbilicus) is a sign of intra-abdominal hemorrhage, often seen in ruptured ectopic pregnancy or pancreatitis, not PID.

A. "I will offer my child 20 grams of carbohydrates every 2 hours." During illness, children with diabetes should continue to eat, but it's more important to focus on maintaining adequate fluid intake and monitoring blood glucose levels. Carbohydrate intake may vary depending on the child's appetite and glucose levels, but 20 grams of carbohydrates every 2 hours may not be necessary for every child.

B. "I will increase the amount of fluids I offer my child." During illness, it is crucial to maintain hydration in children with diabetes to prevent dehydration, which can be exacerbated by fever, vomiting, or diarrhea. Fluids help maintain glucose stability and prevent complications such as diabetic ketoacidosis (DKA).

C. "I will withhold my child's dose of insulin when his appetite is poor.” Insulin should not be withheld even if the child's appetite is poor, as this can lead to hyperglycemia and diabetic ketoacidosis (DKA). Insulin needs should be adjusted based on blood glucose levels, not appetite.

D. "I will monitor my child's blood glucose levels every 8 hours." Blood glucose levels should be monitored more frequently, especially during illness. Typically, it's recommended to check every 2-4 hours to ensure the child’s blood glucose is within a safe range and to detect any changes that require adjustment in insulin therapy.