Chapter 40: Nursing Care of a Family when a Child has a Respiratory Disorder

The nurse is caring for a newly admitted 3-year-old child who has been diagnosed with tuberculosis. When reviewing the child's records which finding(s) is consistent with this disease? Select all that apply.

The child has been experiencing night sweats. The child has had recent weight loss. The child and the family were homeless for a period of time in the past 3 months. Tuberculosis is a highly contagious respiratory infection. A child who has been living in crowded locations, who is impoverished, or homeless is at an increased risk. Signs and symptoms of the disease include weight loss, night sweats, anorexia and pain. A child living in a household with parents and one sibling does not have an increased risk for infection. A sore throat is not associated with tuberculosis.

The nurse is caring for a 3-year-old child after a tonsilectomy. Which finding concerns the nurse? Select all that apply.

Throat clearing every 10 minutes and before speaking Change in pulse rate from 88 to 110 beats per minute Respiratory rate change from 26 to 34 breaths per minute

When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I do not understand why there might be bleeding in 1 week or so." What is the most appropriate explanation for the nurse to give this caregiver?

*"Bleeding can occur at this time because the clots dissolve and new tissue is not yet present."* Hemorrhage is the most common complication of a tonsillectomy. Bleeding is most often a concern within the first 24 hours after surgery and up to the 10th postoperative day. Bleeding late postoperatively can occur when the clots dissolve and new tissue is not yet present. A tonsillectomy can be done at any age so stating that bleeding is a complication of age is incorrect. By 10 days postoperatively the child may still have a slight sore throat or have difficulty eating some solid foods so the child has not forgotten about the surgery. The pressure of coughing is most likely to cause bleeding early postoperatively. Salt will not cause bleeding and telling that to a parent is providing false information.

The nurse is reinforcing teaching with the family caregivers of a child diagnosed with tuberculosis who is being treated with the drug rifampin. Which statement made by the caregivers indicates an understanding of this medication?

*"While she is taking this medication, I won't worry if her tears look orange."* Rifampin is tolerated well by children, but causes body fluids such as urine, sweat, tears, and feces to turn orange-red. Drug therapy is continued for 9 to 18 months. After drug therapy has begun, the child or adolescent may return to school and normal activities. Although the urine may be orange-red, this does not indicate bleeding. If bleeding with urination presents, then it should be reported and followed up on.

What is the most common debilitating disease of childhood among those of European descent?

*CF*

The nurse is planning care for a 6-year-old returning from a tonsillectomy and adenoidectomy. Which nursing intervention is most helpful in meeting the client goal of ingestion of 75 cc of fluid each hour?

*Offer pain medication as scheduled* One barrier to the child drinking fluids is that the client is in pain. Offering pain medication as scheduled helps to control pain. Cherry popsicles are not allowed as the coloring could be misinterpreted as blood. Distraction is good, and playing can provide motivation to drink, but not if it is painful. Milkshakes are no longer offered postoperatively as milk products cling to the surgical site.

A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula?

*assess patency of the nares* A nasal cannula is a good delivery device for children because it allows them to eat and talk unobstructed. Because the device is designed for flow through the nares, the patency of the nares should be assessed prior to using the cannula. If the nares are blocked from secretions, suctioning may be required. If there is a defect in the upper airway causing blockage, the nasal cannula may not be an appropriate oxygen delivery device. The oxygen saturation should have been measured and used as a guide for the prescription of oxygen therapy. Adding humidification is a way to keep the upper airways from becoming too dry, but oxygen can be started before humidity is added. Anytime a child is sick enough to require oxygen all respiratory assessments, including lung sounds, should be done. It does not matter, however, what the lung sounds are if the child is in enough distress to require oxygen. The lung sounds can be assessed after oxygen is started.

The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child?

*providing fluids by straw* Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.