Pediatric Emergency Nursing #5

1. An adolescent, with chronic asthma, who has been hospitalized several times during the winter with severe asthmatic exacerbations confides, "I wish I could stay here in the hospital because every time that I go home, I get sick again!" The pediatric nurse's best response is:

“I think that you should consider participating on a swim team to improve your pulmonary function."

“Let's talk about preventing and managing your asthma on a daily basis at home."

“Why don't I speak with your parents about what they are doing at home to help control your asthma?"

“Your insurance company does not pay for any additional days of hospitalization that are not medically necessary."

The goal with asthma should be to manage it at home to prevent future attacks. An asthma action plan should be developed while in the hospital, and continued by the patient and the doctor to avoid future exacerbations.

Explanation

The goal with asthma should be to manage it at home to prevent future attacks. An asthma action plan should be developed while in the hospital, and continued by the patient and the doctor to avoid future exacerbations.

2. After receiving an immunization for diphtheria, tetanus, and pertussis, a child develops swelling and tenderness at the injection site, a low-grade fever, and malaise. The pediatric ED nurse informs the child's parents that:

The reaction is severe enough that they should bring the child to an emergency department

They should delay future immunizations until the child is seen by an allergist.

This is a mild reaction, and teaches them how to manage it.

This is an appropriate reaction, and instructs them to do nothing.

A severe reaction would present as Anaphylaxis. An appropriate reaction would be mild warmth over the site. This reaction is moderate and can be managed with Tylenol and Benadryl.

Explanation

A severe reaction would present as Anaphylaxis. An appropriate reaction would be mild warmth over the site. This reaction is moderate and can be managed with Tylenol and Benadryl.

3. In infants with hydrocephalus, the early signs of ventricular shunt malfunction are:

A high-pitched cry, colic, and pupillary changes

A tense fontanelle, vomiting, and irritability.

Anorexia, and changes in pulse and respiration.

Headaches, lethargy, and a loss of appetite.

These symptoms show increased intracranial pressure. Changes in heart rate and respiration would be a late sign. The other choices are not indicative of ICP.

Explanation

These symptoms show increased intracranial pressure. Changes in heart rate and respiration would be a late sign. The other choices are not indicative of ICP.

4. A pediatric ED nurse, who is caring for a 12-year-old patient with septic shock, perceives a potential complication of fluid resuscitation upon noting:

A heart rate of 50 beats/min

A temperature of 102o F (38.8o C).

Complaints of leg pain.

Rales and rhonchi by auscultation.

Pulmonary edema should be monitored for closely as in septic shock, fluids can third space and leak into the lungs causing hypoxia and respiratory distress. The pt should receive additional fluids less rapidly and the practitioner may choose to move on to vasopressor therapy.

Explanation

Pulmonary edema should be monitored for closely as in septic shock, fluids can third space and leak into the lungs causing hypoxia and respiratory distress. The pt should receive additional fluids less rapidly and the practitioner may choose to move on to vasopressor therapy.

5. Which initial question directed to the parent assists the pediatric nurse in obtaining a patient's health history?

“Are your child's immunizations up to date?"

“Is your child allergic to anything?"

“What brings you here today?"

“What is the child's problem?"

SAMPLE history starts out by asking about Signs and Symptoms, then Allergies, Medications, Past history, Last food or drink consumed and Events leading up to the illness or chief complaint. Asking why they are here will give the RN a broad idea which they may then focus on and get more specific information.

Explanation

SAMPLE history starts out by asking about Signs and Symptoms, then Allergies, Medications, Past history, Last food or drink consumed and Events leading up to the illness or chief complaint. Asking why they are here will give the RN a broad idea which they may then focus on and get more specific information.