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Ati n400 pediatric exam e. W
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Guardian reports 3 loose stools. Skin warm, dry, and with decreased pigmentation for ethnicity. Listless, currently refuses breakfast Drooling noted Reports sore throat Rhinorrhea noted with erythema around base of nose. Respirations even with intercostal retractions. Scattered rhonchi to bilateral anterior bases Productive cough with yellow sputum. Abdomen soft, non- distended Bowel sounds active in all 4 quadrants. Facial grimacing noted with light palpation abdomen.
0900
Lethargic. Scattered rhonchi to bilateral anterior bases. Productive cough with yellow/green sputum. Intercostal retractions noted with thick nasal discharge, yellow in color Vomited 75 mL of yellow emesis
A nurse is planning care for a preschooler who has bronchiolitis
For each body system below, click to specify the potential nursing intervention that would be appropriate for the care of the child. Each body system may support more than
1 potential nursing intervention.
|
Body System |
Potential Nursing Intervention |
|
Respiratory |
Administer decongestant Administer humidified oxygen Perform endotracheal suctioning |
|
Gastrointestinal |
Administer promethazine Use thickened fluid at mealtimes Obtain stool specimen |
|
Cardiovascular |
Initiate IV access to administer IV fluids Offer oral rehydration solution 10 ml every 3 min Administer aspirin for fever |
Explanation
Rationale:
Respiratory
Administer humidified oxygen: The child’s oxygen saturations are <90–92% with increasing work of breathing (intercostal retractions, tachypnea). Guidelines recommend giving supplemental oxygen when saturations are persistently <90%. The goal is to reverse hypoxemia, reduce work of breathing, and prevent fatigue; humidification improves comfort and secretion clearance.
Administer decongestant: Oral/OTC decongestants and “cold medicines” are not recommended in bronchiolitis (no meaningful benefit; potential harm like tachycardia, agitation). Many pediatric pathways explicitly list OTC cold meds as not indicated for bronchiolitis.
Perform endotracheal suctioning: Deep or endotracheal suctioning is invasive and reserved for an intubated child or impending airway failure. In bronchiolitis, routine deep suctioning can worsen outcomes (association with longer length of stay); if suctioning is needed, use gentle nasal suction with saline to relieve obstruction. This child is not intubated; prioritise oxygen, positioning, and superficial nasal suction.
Gastrointestinal
Obtain stool specimen: The child has acute diarrhea (3 loose stools), fever, and evolving systemic illness (lethargy, hypotension). When diarrhea accompanies fever or signs of sepsis/dehydration, guidelines support stool testing to evaluate for enteric pathogens (e.g., Salmonella, Shigella, Campylobacter, STEC, Yersinia, C. difficile).
Administer promethazine: Promethazine carries boxed warnings for respiratory depression and is contraindicated in young children; it can also sedate a child who already has respiratory compromise, dangerous in bronchiolitis. Ondansetron (if needed) is preferred over promethazine for pediatric vomiting, but here the priority is fluids and airway protection.
Use thickened fluid at mealtimes: Thickened feeds are for documented oropharyngeal dysphagia/aspiration, not for acutely ill, lethargic, tachypneic, drooling children at aspiration risk. With current vomiting and poor airway protection, oral trials should wait until the child is safer.
Cardiovascular
Initiate IV access to administer IV fluids: The child shows clinical dehydration with hypotension (88/54), tachycardia, lethargy, vomiting, and poor oral intake, consistent with moderate–severe dehydration/compensated shock. Pediatric resuscitation recommends rapid isotonic crystalloid boluses (10–20 mL/kg) with frequent reassessment; IV therapy is indicated when the child cannot tolerate PO or is hemodynamically unstable.
Offer oral rehydration solution 10 mL every 3 min: Small, frequent ORS is great for mild–moderate dehydration without ongoing emesis, but it is not appropriate in children who are lethargic, vomiting, drooling, hypoxic, or hypotensive, due to aspiration risk and the need for faster intravascular volume repletion. IV fluids first; consider NG/PO rehydration only after stabilization.
Administer aspirin for fever: Aspirin is contraindicated for routine fever control in children due to the risk of Reye syndrome, especially with viral illnesses. Use acetaminophen/ibuprofen (if not contraindicated) after stabilization.
What is the most important advice a nurse should give to parents to prevent the spread of conjunctivitis in their child?
A nurse has completed discharge teaching for the caregivers of an infant who has been in the hospital after a near SUID(Sudden Unexplained Infant Death) experience. Which of the following statements by the caregivers indicates an understanding of the teaching?
When interviewing parents or caregivers of a child admitted to the hospital, what is an important step for nurses to take?
A nurse is caring for a 5-year-old child who has a new diagnosis of diabetes mellitus and is distressed after an insulin injection. Which of the following play activities should the nurse recognize as therapeutic in helping the child deal with the injection?
A client is prescribed a heparin infusion to run at 750 units/hr. The heparin is supplied as 25.000 units/250 mL. At what rate should the nurse set the infusion pump? (Do not use a trailing zero. Round to the tenth place. Do not use a trailing zero)
Explanation
Rationale:
Ordered dose = 750 units/hr
Available concentration = 25,000 units in 250 mL
Set up a proportion:
25,000 units : 250 mL = 750 units : X mL
Cross multiply:
25,000 × X = 750 × 250
25,000X = 187,500
X = 187,500 ÷ 25,000 = 7.5 mL/hr
Which of the following is a contraindication for immunizations in children?
The pediatric nurse needs to administer Amoxicillin to a 15-month-old. To ensure that medication administration is less traumatic for this young child, the nurse should:
A school-aged child in the hospital may benefit from therapeutic play in which of the following situations? When the child is
A nurse understands which of the following statements is correct related to the nutrition of the preschool aged child? The child will:
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