After completing the prescriptions, the nurse is reassessing the infant.

The nurse is caring for the infant with a patent ductus arteriosus and is evaluating the effectiveness of the intravenous (IV) furosemide. Which findings does the nurse expect as an intended effect of the furosemide? Select all that apply.

Brief introduction:

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects both upper and lower motor neurons, leading to muscle weakness, atrophy, and eventually respiratory failure. As the disease progresses, it often involves the bulbar muscles, which control swallowing and speech. Dysphagia (difficulty swallowing) in ALS patients significantly increases the risk of silent aspiration and aspiration pneumonia, as the cough reflex eventually weakens and the airway becomes unprotected during meals.

Rationale:

A. While supplemental liquid feedings may eventually be necessary to maintain caloric intake, they do not address the immediate safety risk of coughing during the current meal. In fact, thin liquids are often more difficult to swallow safely than thickened liquids or soft solids for patients with bulbar involvement.

B. Assisting the client to lie down while eating is highly dangerous and increases the risk of aspiration. Patients with dysphagia must remain in a high-Fowler’s position (upright) during and for at least 30 minutes after meals to allow gravity to assist the passage of food and prevent reflux.

C. The tucked-chin position is a compensatory technique that narrows the airway entrance and widens the vallecular space, allowing food to pass more safely into the esophagus. For a client who is coughing (a sign of potential aspiration), this is the most effective immediate intervention to protect the tracheal opening while they continue to feed themselves.

D. Assistive feeding devices (like specialized spoons or plates) help with manual dexterity and independence if the client has hand weakness, but they do not improve the physiological safety of the swallow. The priority here is not the ability to hold the utensil, but the prevention of bolus entry into the lungs.

Brief introduction:

Asthma management focuses on reducing airway inflammation and preventing future acute exacerbations. Once the client is stabilized with a patent airway and improved oxygenation, the nurse must address environmental triggers and physiological recovery. Effective nursing care transitions from emergency intervention to maintenance, ensuring the patient maintains adequate ventilation-perfusion balance while gradually returning to baseline respiratory function without excessive supplemental support.

Rationale:

A. Identifying and avoiding asthma triggers is essential for long-term management and preventing readmission. Common triggers include exercise, cold air, or recent viral infections, as seen in this client's history. Discussing these factors helps the client develop a self-management plan to recognize early signs of worsening airway constriction.

B. Discussing aggressive treatments is unnecessary because the client is currently showing improvement with standard therapy. Her breath sounds are now clear, and her oxygen saturation has reached 98% with minimal support. Initiating conversations about invasive interventions like intubation is clinically inappropriate for a patient who is successfully stabilizing.

C. Allowing a position of comfort, such as the high-Fowler position, optimizes lung expansion and reduces the work of breathing. Proper positioning prevents diaphragmatic compression, which is vital for a client recovering from subcostal retractions and respiratory distress. This non-invasive support facilitates continued airway patency and patient comfort throughout the shift.

D. Positive pressure ventilation is indicated for respiratory failure or severe distress unresponsive to initial pharmacological therapy. Since the client's oxygen saturation is now 98% and wheezing has resolved, she no longer meets the clinical criteria for such an aggressive respiratory support measure. Her current status indicates successful response to nebulized albuterol.

E. Obtaining a sputum culture is not indicated as there is no evidence of purulent secretions or pneumonia. While she had a cold, asthma is a chronic inflammatory condition, not a primary bacterial infection requiring immediate culture and sensitivity testing. Priority is placed on airflow dynamics rather than microbiological testing in this scenario.

F. Continuous or frequent monitoring of oxygen saturation is vital to ensure the client does not desaturate as the albuterol effect wears off. Because asthma can involve recurrent bronchospasm, the nurse must ensure the client maintains a saturation >94%. This objective data guides the titration of supplemental oxygen throughout the recovery period.

G. Weaning supplemental oxygen is appropriate when the saturation is stable at 98% on nasal cannula. The goal is to return the client to room air while maintaining adequate tissue oxygenation levels. Gradually reducing the flow rate allows the nurse to assess if the client’s own respiratory effort is sufficient.

H. Deep tracheal suctioning is an invasive procedure for patients unable to clear secretions, usually those who are intubated. This client is conscious, talking, and has clear lung fields, making such a painful and risky procedure entirely unnecessary. Tracheal suctioning can actually trigger further bronchospasm in a sensitive asthma patient.