PrepU Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder

The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate?

Airborne precautions

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

Cystic fibrosis

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?

Encourage everyone in the family to use good handwashing techniques.

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition?

Encourage high calorie, high protein snacks.

Which adolescent symptoms are indicative of a reactivation of a secondary tuberculosis? Select all that apply.

Fever Night sweats 6-month weight loss of 8 pounds New expectoration of mucus

The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect?

Increased heart rate and restlessness

The nurse is caring for a child admitted with asthma. Which clinical manifestations would likely have been noted in the child with this diagnosis?

Wheezing

The nurse has administered an intradermal injection of 0.1 ml of purified protein derivative. During which time frame will the nurse evaluate the site for reactions?

Within 48-72 hours Clients who have had a tuberculin skin test will need to return to the facility to have the site evaluated for a reaction within 48 to 72 hours. Redness, swelling, induration, and itching are signs of a positive reaction.

Which infants are at high risk for acquiring the respiratory syncytial virus (RSV) infection? Select all that apply.

The infant of an adult with an upper respiratory infection The infant who has lung disease The infant who had a transplant The infant receiving chemotherapy

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?

"It is okay for our child to do chores such as sweeping the floor." Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement.

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver?

"Pollen is a cause of these symptoms. Allergy medicine may help your child."

Which clinical manifestation of acute nasopharyngitis is more of a concern for the infant than the older child?

Nasal congestion

Which nursing diagnosis would best apply to a child with allergic rhinitis?

Pain related to sinus edema and headache Many children with allergic rhinitis develop sinus headaches from edema of the upper airway. In younger children, the maxillary and ethmoid sinuses are involved. In children aged 10 years and older the frontal sinuses are also involved. The pain comes from mucosal swelling, decreased ciliary movement and a thickened nasal discharge.

A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease?

Pancreas and liver

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 NO STRAWS

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?

Pulmonary functions test

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment?

The child is in tripod position.

The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with:

a bronchodilator and mast cell stabilizers.

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful?

"Exposure to second- or third-hand smoke increases the risk for developing RSV."

A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?

"Has your infant been around any crowds?"

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma?

"I'm going to have this hospital worker take a picture of your lungs." The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The nurse is caring for a child admitted with asthma. Which clinical manifestations would likely have been noted in the child with this diagnosis?

Arterial blood gas (ABG)

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important?

Note any frequent swallowing. (blood) A complication of a tonsillectomy and adenoidectomy is bleeding. If the child is bleeding he or she must be brought to the emergency room immediately. To determine if a child is bleeding, the parents must assess for frequent swallowing.

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child?

Respiratory stridor

The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do?

Seat the child leaning forward and pinch the anterior portion of the nose closed.

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method?

Sprinkled onto the food

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia?

The child attends day care.

The nurse is teaching a child and their parents how best to manage the child's asthma. Which piece of equipment will be most helpful in determining the status of this child's airway?

peak flow meter

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse?

"I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."

In caring for the child with asthma, the nurse recognizes that which nursing diagnosis would be the highest priority in this child's plan of care?

Ineffective airway clearance related to the diagnosis

A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. Complete the following sentence(s) by choosing from the lists of options. The emergency room nurse should first ---- then ---.

Assess airway, administer intravenous (IV) methylprednisolone The nurse should assess the child's airway first. Assessment should always be prioritized using the ABCs (airway, breathing, and circulation).Intravenous (IV) methylprednisolone should be administered promptly to decrease inflammation in the lungs, which will improve air flow.

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet?

Pancreatic enzymes Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.

What is a definitive test for cystic fibrosis?

Sweat chloride The definitive test in diagnosing cystic fibrosis is the sweat chloride test. This test is performed by stimulating a small patch of sweat glands on the inner aspect of the forearm. There must be two positive tests and clinical symptoms to confirm the diagnosis.

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care?

The infant's airway will remain clear and free of mucus.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child?

nonrebreather (face) mask

The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client?

tachycardia