A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status?
(Select All that Apply.)

Warm extremities

Wheezing

Nasal flaring

Retraction of sternal muscles

Oxygen saturation 95%

Answer and Explanation

Correct Answer : B,C,D

B. Wheezing is a common symptom of asthma exacerbation and can indicate airway obstruction. Wheezing may worsen during an asthma attack, suggesting deterioration in respiratory status.

C. Nasal flaring is a sign of increased respiratory effort and can occur during respiratory distress. In a child with asthma, nasal flaring may indicate worsening airway obstruction and increased work of breathing, suggesting deterioration in respiratory status.

D. Retraction of sternal muscles, also known as intercostal retractions, occurs when the muscles between the ribs are drawn inward during inspiration, indicating increased effort to breathe. Intercostal retractions are a sign of respiratory distress and can occur in children with asthma during exacerbations, particularly when airway obstruction is severe.

A. Warm extremities are not typically indicative of deterioration in respiratory status in a child with asthma. In fact, warm extremities may suggest adequate peripheral perfusion.

E. An oxygen saturation of 95% is within the normal range for most children and may not necessarily indicate deterioration in respiratory status. However, oxygen saturation should be interpreted in conjunction with other clinical signs and symptoms.

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Correct Answer is D

Explanation

D. This is the correct action to take. A neurovascular check involves assessing the circulation, sensation, and movement in the affected limb. This check helps monitor for complications such as impaired circulation, nerve damage, or compartment syndrome, which can occur after the application of a plaster cast. Regular neurovascular checks are essential for early detection of any issues and appropriate intervention if necessary.

A. Using a hair dryer on a hot setting can cause burns to the skin under the cast. It can also cause the cast material to heat up and potentially cause discomfort or injury to the patient.

B. It's essential to follow the healthcare provider's instructions regarding weight-bearing restrictions, but completely discouraging ambulation can lead to complications such as muscle atrophy, decreased circulation, and increased risk of blood clots.

C. Keeping the client's leg in a dependent position means positioning it lower than the heart. This can increase swelling and exacerbate pain, potentially leading to complications such as compartment syndrome.

A. Sweat chloride test B. Stool fat content analysis C. Sputum culture D. Pulmonary function test

Correct Answer is A

Explanation

A. The sweat chloride test is considered the most definitive diagnostic test for cystic fibrosis. In this test, sweat is collected from the skin and analyzed for chloride content. Elevated levels of chloride in the sweat are indicative of cystic fibrosis. This test is highly sensitive and specific for diagnosing the condition.

B. Stool fat content analysis can help assess pancreatic function and malabsorption, which are common manifestations of cystic fibrosis. However, it is not considered the most definitive test for diagnosing cystic fibrosis. Elevated stool fat content can be suggestive of cystic fibrosis but is not specific to the condition.

C. Sputum culture may be performed to identify respiratory pathogens and guide antibiotic therapy in individuals with cystic fibrosis, but it is not the most definitive test for diagnosing the condition. It helps identify infections and monitor lung health but does not confirm the diagnosis of cystic fibrosis.

D. Pulmonary function tests are used to assess lung function and airflow, which can be affected in individuals with cystic fibrosis. While these tests provide valuable information about lung health, they are not the most definitive test for diagnosing cystic fibrosis. They are used for monitoring disease progression and response to treatment rather than confirming the diagnosis.

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A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? (Select All that Apply.)

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A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status?
(Select All that Apply.)