A nurse is caring for a school-age child who has cystic fibrosis.

Exhibits

A nurse is reviewing the child's medical record. Which of the following medications should the nurse expect the provider to prescribe or reconcile from the child’s home medication list? Select all that apply.

Condition Most Likely Experiencing

• Pyloric stenosis causes projectile vomiting, dehydration, and hunger.
• Cystic fibrosis causes chronic respiratory infections, steatorrhea, and failure to thrive.
• The condition that the infant is most likely experiencing is congestive heart failure, which can cause poor weight gain, tachypnea, decreased appetite, and periorbital edema.
• Respiratory syncytial virus bronchiolitis causes wheezing, coughing, and respiratory distress.

Actions to Take

• Digoxin is a medication commonly prescribed to manage congestive heart failure in infants by improving cardiac contractility and reducing heart rate.
• Elevating the head of the bed helps reduce venous return to the heart, thereby decreasing preload and relieving symptoms of congestion in congestive heart failure.
• Contact precautions are not indicated for congestive heart failure, but for infections that are transmitted by direct or indirect contact.
• Chest physiotherapy and postural drainage are not indicated for congestive heart failure, but for conditions that cause excessive mucus production and retention.

Parameters to Monitor

• Number of steatorrhea stools is not relevant for congestive heart failure, but for cystic fibrosis or other malabsorption disorders.
• Monitoring intake and output is crucial in assessing fluid balance, especially in congestive heart failure where fluid retention can lead to volume overload.
• Monitoring respiratory status is essential in congestive heart failure to assess for signs of pulmonary congestion and respiratory distress, such as tachypnea, retractions, and crackles.
• Presence of periorbital edema is not a parameter to monitor, but a sign of fluid overload.

A. Stevens-Johnson syndrome is a severe adverse reaction associated with certain medications but is not typically associated with morphine.
B. Hypertension is not a common adverse effect of morphine; hypotension may occur instead.
C. Prolonged wound healing is not typically associated with morphine use.
D. Bradypnea (slow breathing) is a potential adverse effect of opioid medications such as morphine.