A nurse is caring for a 5-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize as therapeutic in helping the child deal with the injection?

Rationale:
A. Pancreatic enzymes should be given with all meals and snacks, either swallowed whole or sprinkled on a small amount of acidic soft food (like applesauce), to aid in digestion.
B. Bulky, frequent stools usually indicate under-dosing, not over-dosing.
C. Antibiotics do not contraindicate enzyme administration.
D. Enzymes must be taken with food, not between meals, to be effective.

Rationale:

Respiratory

Administer humidified oxygen: The child’s oxygen saturations are <90–92% with increasing work of breathing (intercostal retractions, tachypnea). Guidelines recommend giving supplemental oxygen when saturations are persistently <90%. The goal is to reverse hypoxemia, reduce work of breathing, and prevent fatigue; humidification improves comfort and secretion clearance.

Administer decongestant: Oral/OTC decongestants and “cold medicines” are not recommended in bronchiolitis (no meaningful benefit; potential harm like tachycardia, agitation). Many pediatric pathways explicitly list OTC cold meds as not indicated for bronchiolitis.

Perform endotracheal suctioning: Deep or endotracheal suctioning is invasive and reserved for an intubated child or impending airway failure. In bronchiolitis, routine deep suctioning can worsen outcomes (association with longer length of stay); if suctioning is needed, use gentle nasal suction with saline to relieve obstruction. This child is not intubated; prioritise oxygen, positioning, and superficial nasal suction.

Gastrointestinal

Obtain stool specimen: The child has acute diarrhea (3 loose stools), fever, and evolving systemic illness (lethargy, hypotension). When diarrhea accompanies fever or signs of sepsis/dehydration, guidelines support stool testing to evaluate for enteric pathogens (e.g., Salmonella, Shigella, Campylobacter, STEC, Yersinia, C. difficile).

Administer promethazine: Promethazine carries boxed warnings for respiratory depression and is contraindicated in young children; it can also sedate a child who already has respiratory compromise, dangerous in bronchiolitis. Ondansetron (if needed) is preferred over promethazine for pediatric vomiting, but here the priority is fluids and airway protection.

Use thickened fluid at mealtimes: Thickened feeds are for documented oropharyngeal dysphagia/aspiration, not for acutely ill, lethargic, tachypneic, drooling children at aspiration risk. With current vomiting and poor airway protection, oral trials should wait until the child is safer.

Cardiovascular

Initiate IV access to administer IV fluids: The child shows clinical dehydration with hypotension (88/54), tachycardia, lethargy, vomiting, and poor oral intake, consistent with moderate–severe dehydration/compensated shock. Pediatric resuscitation recommends rapid isotonic crystalloid boluses (10–20 mL/kg) with frequent reassessment; IV therapy is indicated when the child cannot tolerate PO or is hemodynamically unstable.

Offer oral rehydration solution 10 mL every 3 min: Small, frequent ORS is great for mild–moderate dehydration without ongoing emesis, but it is not appropriate in children who are lethargic, vomiting, drooling, hypoxic, or hypotensive, due to aspiration risk and the need for faster intravascular volume repletion. IV fluids first; consider NG/PO rehydration only after stabilization.

Administer aspirin for fever: Aspirin is contraindicated for routine fever control in children due to the risk of Reye syndrome, especially with viral illnesses. Use acetaminophen/ibuprofen (if not contraindicated) after stabilization.