The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the parent would elicit information about the cause of this disease?

A. Have the child sit with her head tilted forward and hold pressure on her nose for 10 min. Tilting the head forward helps prevent blood from flowing down the throat and causing nausea or choking. Applying pressure to the nose for 10 minutes helps to stop the bleeding.
B. Place the child in a sitting position and tilt her head back. Tilted head back can cause blood to flow down the throat and potentially cause aspiration or choking. It's not recommended in managing nosebleeds.
C. Apply ice at the opening of the nares for 5 min and then re-check for bleeding. While cold compresses can help constrict blood vessels, direct pressure and maintaining a forward head position are more effective for stopping nosebleeds.
D. Place the child in a supine position with a pillow under her head. Supine position can cause blood to flow down the throat and is not recommended in managing nosebleeds due to the risk of aspiration.

i. Pain:

Priority: Pain is a critical factor that needs immediate attention, especially since the adolescent reports a high pain level of 9/10, which indicates severe discomfort. Unmanaged pain can lead to increased stress, anxiety, and potentially worsen the patient’s condition. The adolescent is guarding the abdomen, which indicates severe pain possibly due to an underlying issue such as appendicitis or another serious abdominal pathology. The right lower quadrant pain and positive obturator sign suggest an acute abdomen, which could be life-threatening and requires urgent attention.

ii. Heart rate:

Priority: After addressing pain, the nurse should focus on the heart rate, which is elevated at 124 beats per minute (tachycardia). Tachycardia in this context could be a response to pain or an indication of infection, dehydration, or another serious underlying condition. Given that the temperature is slightly elevated (38°C or 100.4°F), there is a possibility of an infectious process, which could be contributing to both pain and the elevated heart rate.

Other Considerations:

• Nausea: Addressing nausea is important but secondary to the more urgent need to manage severe pain and evaluate cardiovascular stability.
• Bowel Movement: The last bowel movement was yesterday, and the patient does not report significant changes in bowel habits, making this less urgent than the acute symptoms.
• WBC Count: While it’s important to assess WBC count to check for infection, it’s part of a broader diagnostic workup that follows after addressing immediate symptoms.
• Decreased Appetite: This is a symptom of the underlying condition but is not as immediate a concern as pain and heart rate in the acute setting.