A nurse is assessing a preschooler who has Kawasaki disease. Which of the following findings should the nurse expect?

Morphine is a potent opioid analgesic frequently used to manage severe pain in school-age children, particularly in postoperative or trauma settings. It works by binding to mu-opioid receptors in the central nervous system to alter the perception of and response to pain. However, morphine also acts as a powerful depressant on the brainstem respiratory centers, making it essential for the nurse to perform continuous or frequent respiratory assessments to ensure the child’s safety during therapy.

Rationale:

A. Hypertension is not a typical adverse effect of morphine administration. In fact, opioids often cause the opposite effect, hypotension, due to the induction of peripheral vasodilation and the suppression of the sympathetic nervous system. A child in severe pain may have a high blood pressure initially, but the administration of morphine should ideally return the blood pressure to a normal range rather than causing it to increase further.

B. Stevens-Johnson syndrome is a rare, life-threatening skin and mucous membrane reaction that is typically associated with certain medications like anticonvulsants, sulfonamides, or allopurinol. It is characterized by a painful red or purplish rash that spreads and blisters. Although any medication can theoretically cause an allergic reaction, morphine is not a known primary trigger for this specific dermatological emergency.

C. Prolonged wound healing is more commonly associated with chronic corticosteroid use, poor nutritional status, or inadequate tissue perfusion. Uncontrolled pain can theoretically cause physiological stress that slows recovery, but morphine itself does not directly impair the cellular processes involved in tissue repair or collagen synthesis. The nurse’s primary concern with morphine is the immediate physiological depression of vital functions.

D. Bradypnea, or an abnormally slow respiratory rate, is the most significant and dangerous adverse effect of morphine. Opioids decrease the sensitivity of the respiratory center to carbon dioxide, which can lead to respiratory depression. In a school-age child, the nurse must monitor the depth and rate of respirations closely, as severe bradypnea can lead to hypoxia and respiratory arrest. This is the priority assessment whenever an opioid is administered.

Carbon monoxide (CO) poisoning occurs when incomplete combustion of carbon-containing fuels produces a colorless, odorless gas that binds to hemoglobin with high affinity, reducing oxygen delivery to tissues. In home environments, especially those with poor ventilation, certain fuel-burning appliances can become significant sources of exposure. Pediatric clients are particularly vulnerable due to higher oxygen demands and developing neurologic systems. Identifying potential household sources is essential in preventing toxicity and related symptoms such as headache, dizziness, and confusion.

Rationale:
A. Kerosene heaters are a common source of carbon monoxide because they rely on combustion of fuel that can produce CO when ventilation is inadequate. In poorly ventilated spaces, incomplete combustion increases CO accumulation, placing household members at risk of hypoxia and neurologic symptoms such as headaches. This makes them a significant hazard in home settings without proper safety measures like CO detectors.

B. Washing machines do not produce carbon monoxide because they operate using electrical power and do not involve combustion. Although they may present other safety risks such as water leakage or electrical hazards, they are not a source of CO exposure. Therefore, they are not relevant to the nurse’s concern in this situation.

C. Refrigerators are electrically powered appliances and do not involve combustion processes that generate carbon monoxide. Even older models may pose mechanical or electrical risks, but they do not contribute to CO poisoning. Thus, they are not considered a potential source in this context.

D. Electric stoves operate using electricity rather than fuel combustion, so they do not produce carbon monoxide. Unlike gas or fuel-burning appliances, they do not generate toxic gases during normal use. Therefore, they are not associated with CO exposure risk in the home environment.