A nurse is reinforcing teaching with a parent of a child who has a new prescription for a budesonide inhaler. Which of the following adverse reactions should the nurse include in the teaching?

Rationale for Correct Choices:

• Dextrose 5% in sodium chloride with 20 mEq potassium chloride/L at 75 mL/hr: The prescription for dextrose 5% with potassium chloride at 20 mEq/L should be clarified because the child's potassium level is elevated at 6.2 mEq/L (normal range is 3.4 to 4.7 mEq/L). Administering additional potassium could worsen hyperkalemia, which could lead to dangerous complications like arrhythmias.
• Laboratory values: The child's potassium level is already high, and adding more potassium via IV fluids could increase the risk of severe hyperkalemia. The nurse should clarify this prescription to avoid potential harm.

Rationale for Incorrect Choices:

• Piperacillin and tazobactam 4g IV every 8 hr: This antibiotic is appropriate for treating pneumonia in a child with cystic fibrosis. No issues with laboratory values or contraindications are present in this case, so clarification is unnecessary.
• Dornase alfa 2.5 mg inhalation every day: Dornase alfa is used to break down mucus in the lungs of children with cystic fibrosis, and it is prescribed appropriately for this patient. The child’s current condition and medications do not warrant clarification for this prescription.
• Pancrelipase 8,000 units with meals: Pancrelipase is indicated for the child’s cystic fibrosis to assist with digestion, and the prescribed dosage seems appropriate for the child’s weight and condition.
• Albuterol nebulizer 2.5 mg inhalation every 4 hr: Albuterol is used for airway clearance, which is appropriate for managing the child's respiratory symptoms. No clarification is needed for this prescription based on the current findings.
• Vital signs: While the child's heart rate and temperature are elevated, they are within expected ranges for the child’s condition (fever, pneumonia, and cystic fibrosis). There is no immediate need for clarification of medications based on vital signs alone.
• Scheduled therapapy: The child is scheduled for chest physiotherapy and airway clearance therapy, which are standard treatments for cystic fibrosis and pneumonia. There is no issue with the scheduled therapies that requires clarification of the medications.
• Diet: The child has been prescribed a high-protein, high-fat diet to support nutritional needs, especially important in cystic fibrosis. The diet does not require any clarification in relation to the prescribed medications.
• Pre-existing conditions: The child’s pre-existing condition of cystic fibrosis is already taken into account in the prescribed treatments, and no adjustment is needed based on the conditions present.

• Maintain infant in supine position: Given the infant's respiratory distress, including labored breathing, retractions, and nasal flaring, placing the infant in a supine position could worsen respiratory difficulties. The infant should be kept upright or in a semi-Fowler’s position to promote optimal breathing.
• Prepare the infant for a chest x-ray: A chest x-ray is crucial to assess the infant’s respiratory status and potential cardiac issues to identify any underlying causes of the symptoms, such as pneumonia, wheezing, cough, and labored breathing.
• Maintain infant on continuous pulse oximetry: Continuous pulse oximetry is essential for monitoring the infant's oxygen saturation levels. The infant is already on supplemental oxygen, and continuous monitoring will ensure that the oxygen levels are maintained and help identify any worsening of the respiratory condition.
• Monitor intake and output: Given the infant's poor feeding (consuming only half a bottle in the past 24 hours), monitoring intake and output is crucial to assess hydration status and nutritional needs. Decreased intake and output can indicate dehydration or worsening of the infant's condition.
• Initiate a peripheral IV line: Due to the infant’s poor feeding and the possibility of dehydration, establishing a peripheral IV line will allow for proper hydration and the administration of fluids or medications, as necessary, for the infant’s condition.
• Offer small, frequent feedings: Offering small, frequent feedings is appropriate for an infant with respiratory distress and decreased appetite. This can reduce the risk of aspiration and help ensure the infant receives adequate nutrition despite the difficulty with feeding.