Patient Data

The nurse starts the albuterol nebulizer as prescribed.
Which should the nurse assess after the albuterol nebulizer treatment is complete? Select all that apply.

Brief introduction:

Primary prevention for adolescent mental health focuses on building resilience and protective factors before a crisis occurs. In the wake of a suicide cluster, the goal is to equip students with the cognitive and behavioral tools necessary to navigate emotional distress, thereby reducing the likelihood of maladaptive coping mechanisms and improving overall psychosocial stability.

Rationale:

A. Assessing tobacco use is a component of general health screening, but it does not directly address the acute mental health needs of a community experiencing increased suicide rates. While substance use is a risk factor, screening for tobacco is too narrow a focus to effectively combat the complex emotional drivers of suicidal ideation.

B. Providing handouts for treatment centers is a form of tertiary prevention, aimed at individuals who already have a diagnosed substance use disorder. While important for those in active crisis, it does not provide the general adolescent population with the foundational skills needed to prevent the onset of severe mental health struggles.

C. Exploration of stress self-management techniques is the most effective primary prevention strategy. By teaching adolescents how to identify stressors and use healthy coping mechanisms—such as mindfulness, problem-solving, and seeking social support—the nurse helps them build the emotional regulation skills necessary to handle life's challenges.

D. Showing a video with suicide statistics can be counterproductive and potentially harmful. In a community already experiencing a suicide contagion, focusing on the trends and methods can glamorize the act or increase feelings of hopelessness among vulnerable youth. Teaching should focus on hope and help-seeking rather than the prevalence of death.

Patent ductus arteriosus (PDA) involves a persistent fetal shunt between the aorta and pulmonary artery. It causes left-to-right shunting, leading to increased pulmonary blood flow and potentially life-threatening congestive heart failure.

Rationale for correct choices:

• Manage altered hemodynamics: A patent ductus arteriosus allows oxygenated blood to recirculate through the lungs, which compromises systemic perfusion and cardiac efficiency. The nurse must prioritize monitoring blood pressure and pulse pressure to detect hemodynamic instability. Interventions like indomethacin or ibuprofen are used to facilitate ductal closure and stabilize the infant’s overall circulation.
• Manage pulmonary congestion: The abnormal shunting increases pressure within the pulmonary vasculature, leading to pulmonary edema and impaired gas exchange. This causes the tachypnea and diffuse fluid noted on the chest x-ray in the clinical prompt. Nursing care focuses on optimizing respiratory support and oxygenation while managing the fluid volume shift into the lungs.

Rationale for incorrect choices:

• Minimize systemic fluid overload: While fluid management is important, the primary issue in PDA is the redistribution of blood, not an overall excess of systemic fluid. Most preterm infants require meticulous fluid restriction to prevent worsening of the shunt rather than managing a generalized systemic overload. This choice is less specific than addressing the direct pulmonary consequences of the PDA.
• Maintain nutritional status: Nutritional intake is critical for growth in a 32 week preterm neonate, but it is not the immediate priority compared to cardiopulmonary stability. PDA often causes feeding intolerance due to decreased mesenteric blood flow from the aortic "steal" phenomenon. Respiratory and hemodynamic management must be achieved before the infant can safely tolerate the ordered breast milk volumes.
• Reduce afterload: This is a common strategy for adult heart failure, but it is not the primary focus for managing a preterm shunt. In PDA, the goal is to increase systemic resistance relative to pulmonary resistance to limit the shunt. Afterload reduction could potentially worsen the left-to-right flow by lowering systemic pressure further, which is contraindicated in this specific neonatal pathology.
• Decrease cardiac demands: Minimizing stress and oxygen consumption is a supportive measure, but it does not address the underlying pathophysiology of the anatomical shunt. The infant already exhibits respiratory distress and tachypnea, which are symptoms of the PDA-induced congestion. While keeping the infant in a neutral thermal environment helps, the physiological priority remains managing the hemodynamic and pulmonary shifts.