A school nurse is preparing to support children who have a chronic illness in a middle school setting. The nurse should be aware of which of the following challenges chronically a children may face? (Select All that Apply)

A. The child's parents express concerns about seizure management during sleep, and the neurologist works to adjust the child's medication to decrease the incidence of nighttime seizures. This is an example of collaborative goal setting because the healthcare team listens to parental concerns and works together to modify treatment to improve the child’s seizure management. The neurologist, parents, and possibly the pediatrician are involved in decision-making, ensuring a team-based approach to care.

B. The child remains seizure-free after six months of taking a lower dosage of medication after a dose change by the provider. This is not collaborative goal setting because it describes an outcome rather than a team-based decision-making process. The provider adjusted the medication, but there is no mention of discussion or input from multiple members of the healthcare team or the child and parents.

C. The child expresses a desire to participate in a team sport at school, and the team determines which sports are safe and any necessary safety precautions with the child and parents. This is collaborative goal setting because it involves the child, parents, and healthcare team working together to find safe and appropriate activities. The discussion ensures that the child’s personal goals are supported while prioritizing their safety.

D. The nurse checks the child at each visit for mental health concerns and relays their assessment findings to the parents, child life specialist, and pediatrician. This is an example of collaborative care because the nurse shares important assessment findings with the interdisciplinary team. By involving the pediatrician and child life specialist, the team can address the child’s mental health in addition to their physical condition.

E. The child's parents receive suggestions about complementary therapies from a family member and begin using them for their own child. This is not an example of collaborative goal setting because the healthcare team was not involved in the decision-making process. Effective collaboration requires input from qualified professionals, ensuring that treatments are safe and evidence-based.

Eczema (Atopic Dermatitis)

• Discomfort level: Pain 3/10 (more likely due to itching than infection)
• History of mosquito bites and prolonged scratching
• No fever (Temperature 37°C/98.6°F)
• Multiple scabs and lesions from scratching

Cellulitis

• Redness, warmth, and swelling on the left lower leg
• History of skin breakdown (scratching increases infection risk)
• Lesions present (Possible infection due to prolonged scratching)

Rationale:

Eczema (Atopic Dermatitis):

Eczema is a chronic inflammatory skin condition that causes itching, dryness, and irritation, often triggered by allergens or skin trauma. The child’s history of mosquito bites and excessive scratching aligns with eczema, as scratching worsens skin irritation and can lead to scabbed lesions. The absence of fever and a mild pain level (3/10) suggest this is primarily an inflammatory response rather than an infection.

Cellulitis:

Cellulitis is a bacterial skin infection that develops when bacteria enter through a break in the skin, often causing redness, warmth, swelling, and pain. The redness, warmth, and swelling on the left lower leg indicate possible early cellulitis, likely caused by bacteria introduced through scratching. However, the absence of fever and only mild pain suggest it may not be a severe infection yet.