A nurse is caring for a 15-year-old adolescent who has cellulitis of the left lower call.

Exhibits

The nurse is assessing the adolescent 24 hr after the initial visit. How should the nurse interpret the findings?

For each finding, click to specify whether the finding is an Indication of potential improvement or an indication of potential worsening condition. There must be at least 1 selection in every row. There does not need to be a selection in every column.

• IV hydromorphone: This potent opioid analgesic is indicated for managing severe pain during vaso-occlusive crises in sickle cell disease, especially when pain reaches a level of 10/10 despite prior interventions. Rapid IV delivery ensures quicker pain relief.
• Pain: The child’s reported pain escalation from 7 to 10 out of 10, along with swelling and warmth of the knee, strongly indicates severe vaso-occlusive pain, which is a hallmark of sickle cell crisis requiring urgent analgesic management.

Rationale for Incorrect Choices:

• Oxygen at 2 L/min via nasal cannula: The child’s oxygen saturation remains normal at 96% on room air, indicating no current hypoxia. Supplemental oxygen is not necessary unless oxygen saturation drops or respiratory distress develops.
• Oral amoxicillin: There are no clinical signs or lab evidence of infection (e.g., normal WBC count, no fever), so antibiotics are not warranted. Prophylactic antibiotics may be used in certain sickle cell scenarios but are not indicated here.
• Hypoxia: The child maintains normal oxygenation, making hypoxia an unlikely contributing factor to the current presentation. Hypoxia would require both clinical signs (e.g., low SpO₂) and symptoms like shortness of breath.
• Signs of infection: The absence of fever, normal WBC count, and localized pain without erythema or drainage suggest that infection is not present at this time. Pain is due to vaso-occlusion, not infectious origin.

A. Place your nonwashable items in sealed plastic bags for up to 5 days: Sealing nonwashable items in plastic bags for at least 72 hours (3 days) is recommended to kill the mites, since they cannot survive without a human host for more than a few days. Five days is longer than necessary.

B. You will need to give your child a course of corticosteroids: Corticosteroids are not a standard treatment for scabies; instead, topical scabicides like permethrin cream are used. Corticosteroids might be prescribed only if there is severe itching or inflammation, but they do not treat the infestation itself.

C. Your entire home will need to be thoroughly cleaned: While laundering bedding, clothing, and towels used in the last 3 days is necessary, extensive cleaning of the entire home beyond these items is not required to eradicate scabies mites.

D. Any person who has been in close contact with the child needs treatment: Treating close contacts simultaneously is essential to prevent reinfestation and control the spread of scabies, even if they do not yet show symptoms. This is the most critical step in managing scabies outbreaks.