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

Exhibits

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Body System	Intervention
Immune	a. Administer acetaminophen b. Have the child wear a mask c. Administer a dose of montelukast d. Encourage oral fluids
Respiratory	a. Administer albuterol nebulizer b. Evaluate the child’s peak flow c. Initiate chest percussions d. Have the child sit upright in a position of comfort

Choice A Reason: Administer acetaminophen

Administering acetaminophen is a common intervention for reducing fever. In this case, the child’s temperature has risen significantly from 37.3°C (99.1°F) at 0900 to 39.9°C (103.8°F) at 1300. A fever of 39.9°C is considered high and can cause discomfort and other complications if not managed. Acetaminophen is an antipyretic medication that helps lower body temperature and provides relief from fever. It is important to monitor the child’s temperature and ensure it returns to a normal range, which is typically around 36.5°C to 37.5°C (97.7°F to 99.5°F) for school-age children.

Choice B Reason: Have the child wear a mask

Having the child wear a mask is a preventive measure to reduce the spread of respiratory infections. While this intervention is important in certain contexts, such as during flu season or in the presence of contagious illnesses, it is not directly related to managing an acute asthma exacerbation. Masks can help prevent the spread of infections, but they do not address the immediate respiratory distress and wheezing observed in the child. Therefore, this choice is not the most appropriate intervention for the current situation.

Choice C Reason: Administer a dose of montelukast

Montelukast is a leukotriene receptor antagonist used for long-term management of asthma and allergic rhinitis. It helps reduce inflammation and prevent asthma attacks. However, montelukast is not typically used for immediate relief during an acute asthma exacerbation. It is more effective as a maintenance medication taken regularly to control chronic asthma symptoms. In this scenario, the child requires immediate relief from respiratory distress, making montelukast an inappropriate choice for acute intervention.

Choice D Reason: Encourage oral fluids

Encouraging oral fluids is a supportive measure to ensure the child remains hydrated. Hydration is important for overall health and can help thin mucus secretions, making it easier for the child to breathe. However, while hydration is beneficial, it is not the primary intervention needed to address the acute respiratory distress and wheezing observed in the child. Therefore, this choice alone is not sufficient to manage the current asthma exacerbation.

Respiratory system

Choice A Reason: Administer albuterol nebulizer

Administering an albuterol nebulizer is the most appropriate intervention for managing an acute asthma exacerbation. Albuterol is a short-acting beta-agonist that works by relaxing the muscles around the airways, allowing them to open up and improve airflow. This medication provides quick relief from symptoms such as wheezing, shortness of breath, and chest tightness. In this case, the child is experiencing respiratory distress and wheezing, making albuterol the most effective choice for immediate relief. The normal respiratory rate for school-age children is 18-25 breaths per minute, and the child’s rate of 26 breaths per minute indicates respiratory distress.

Choice B Reason: Evaluate the child’s peak flow

Evaluating the child’s peak flow involves measuring the maximum speed at which the child can exhale. This assessment helps determine the severity of the asthma exacerbation and the effectiveness of the treatment. Peak flow measurements can guide clinical decisions and adjustments to the child’s asthma management plan. However, during an acute asthma attack, the priority is to provide immediate relief from symptoms. While peak flow evaluation is valuable for ongoing asthma management, it is not the primary intervention needed to address the acute respiratory distress and wheezing observed in the child.

Choice C Reason: Initiate chest percussions

Initiating chest percussions involves rhythmic tapping on the chest to help loosen and mobilize mucus in the airways. This technique can be beneficial for individuals with conditions that cause excessive mucus production, such as cystic fibrosis. However, in the context of an acute asthma exacerbation, the primary concern is bronchoconstriction and inflammation, not mucus clearance. The child requires interventions that directly address airway constriction, such as bronchodilators. Therefore, while chest percussions may be helpful in certain situations, they are not the most appropriate intervention for managing acute asthma symptoms.

Choice D Reason: Have the child sit upright in a position of comfort

Having the child sit upright in a position of comfort can help improve breathing by allowing the lungs to expand more fully. This position can reduce the work of breathing and provide some relief from respiratory distress. While this intervention is supportive and can be beneficial, it is not sufficient on its own to manage an acute asthma exacerbation. The child requires pharmacological interventions, such as bronchodilators, to relieve bronchoconstriction and improve airflow. Therefore, while sitting upright is helpful, it should be combined with other interventions for optimal management of acute asthma symptoms.

Choice A reason:

Bradycardia: Bradycardia, or a slow heart rate, is not typically associated with diabetes insipidus. Diabetes insipidus primarily affects the body’s ability to regulate fluid balance, leading to excessive urination and thirst. Bradycardia is more commonly related to conditions affecting the heart or the autonomic nervous system.

Choice B reason:

Hyperglycemia: Hyperglycemia, or high blood sugar, is a hallmark of diabetes mellitus, not diabetes insipidus. Diabetes insipidus is characterized by the kidneys’ inability to concentrate urine, leading to large volumes of dilute urine and increased thirst3. Hyperglycemia is not a symptom of diabetes insipidus.

Choice C reason:

Dehydration: Dehydration is a common and significant finding in diabetes insipidus. Due to the excessive loss of water through urine, individuals with diabetes insipidus often experience severe thirst and dehydration if they do not consume enough fluids to compensate for the loss. This is a key symptom that helps differentiate diabetes insipidus from other conditions.

Choice D reason:

Polyphagia: Polyphagia, or excessive hunger, is typically associated with diabetes mellitus, particularly when blood sugar levels are high and the body’s cells are not receiving adequate glucose. In diabetes insipidus, the primary symptoms are related to fluid imbalance, such as excessive urination (polyuria) and thirst (polydipsia), rather than hunger.