A nurse is planning a staff in-service about infection control measures to prevent the spread of influenza in school-age children. Which of the following instructions should the nurse include?

Condition most likely experiencing:

Pelvic Inflammatory Disease (PID)

Actions the nurse should take:

1. Place the adolescent on bedrest in semi-Fowler’s position
2. Administer acetaminophen 650 mg PO every 6 Hr PRN pain

Parameters to monitor:

1. Temperature greater than 38.3°C (100.9°F)
2. Rebound tenderness

Rationale:

Pelvic Inflammatory Disease (PID). The client’s history of multiple sexual partners, mucopurulent cervical discharge, pelvic pain, and fever strongly suggests PID, a bacterial infection often caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhea.

Urinary tract infection. UTIs typically present with dysuria, urgency, frequency, and suprapubic pain, which are not noted here.

Ectopic pregnancy. The client’s last menstrual period was 7 days ago, making pregnancy unlikely. PID symptoms differ from ectopic pregnancy, which presents with unilateral lower abdominal pain and possibly vaginal bleeding.

Acute appendicitis. Appendicitis typically causes right lower quadrant pain, nausea, vomiting, and rebound tenderness, which are not the primary symptoms here.

Place the adolescent on bedrest in semi-Fowler’s position – This promotes drainage of infected fluids and reduces the risk of abscess formation.

Administer acetaminophen 650 mg PO every 6 Hr PRN pain – This helps manage the pain associated with PID.

Temperature greater than 38.3°C (100.9°F) – A rising temperature may indicate worsening infection or sepsis.

Rebound tenderness – Can indicate peritoneal irritation, which may suggest complications such as peritonitis or an abscess.

Instruct the adolescent about the use of sitz baths. Sitz baths are used for perineal discomfort but are not a standard intervention for PID.

Administer an enema. An enema is unnecessary and could worsen the infection if peritonitis is present.

Vaginal bleeding. Vaginal bleeding is not a common symptom of PID.

Irritation of the phrenic nerve. Phrenic nerve irritation is associated with diaphragmatic irritation, such as in gallbladder disease or ruptured ectopic pregnancy.

Presence of a Cullen sign. Cullen’s sign (bluish discoloration around the umbilicus) is a sign of intra-abdominal hemorrhage, often seen in ruptured ectopic pregnancy or pancreatitis, not PID.

A. "Two separate samples will be collected to ensure accuracy of the test results." For accuracy, the sweat chloride test is typically done with two separate samples to confirm the diagnosis of cystic fibrosis. The results are compared to ensure consistency.

B. "It will take approximately 3 hours to complete the test." The sweat chloride test typically takes around 30 to 60 minutes, not 3 hours. The process of stimulating sweat production and collecting it is usually brief.

C. "Your child will need to receive sedation to minimize pain during the test." The sweat chloride test is non-invasive and does not require sedation. It involves the application of a sweat-stimulating chemical, and the child may feel mild discomfort but does not require sedation.

D. "Your child should avoid eating and drinking 6 hours prior to the test." There are no specific fasting requirements before a sweat chloride test, although the child may be asked to stay well-hydrated to help produce sweat during the test.