Respiratory Pediatric
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interven- tions should the nurse include in the plan of care? Select all that apply. 1. Place the infant in a private room. 2. Ensure that the infant's head is in a flexed position. 3. Wear a mask at all times when in contact with the infant. 4.Place the infant in a tent that delivers warm humidified air. 5. Position the infant on the side, with the head lower than the chest. 6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.
1, 6 Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precau- tions during care (wearing gloves and a gown) reduces nosoco- mial transmission of RSV. Amask is unnecessary. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmis- sion of the infection. An infant with RSVshould be isolated in a private room or in a room with another infant with RSV infec- tion. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the dia- phragm. Cool humidified oxygen is delivered to relieve dys- pnea, hypoxemia, and insensible water loss from tachypnea.
The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indica- tion that the child may be experiencing airway obstruction? 1. The child exhibits nasal flaring and bradycardia. 2. The child is leaning forward, with the chin thrust out.. 3. The child has a low-grade fever and complains of a sore throat. 4. The child is leaning backward, supporting him- self or herself with the hands and arms.
2 Rationale: Epiglottitis is a bacterial form of croup. A primary concern is that it can progress to acute respiratory distress. Clin- ical manifestations suggestive of airway obstruction include tri- pod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, the use of acces- sory muscles for breathing, and the presence of stridor. Option 4 is an incorrect position. Options 1 and 3 are incorrect because epiglottitis causes tachycardia and a high fever. Test-Taking Strategy: Focus on the subject, manifestations of airway obstruction in a child with epiglottitis. Eliminate option 1 first because tachycardia rather than bradycardia would occur in a child experiencing respiratory distress. Eliminate option 3 next, knowing that a high fever occurs with epiglottitis. From the remaining options, visualize the descriptions in each and determine which position would best assist a child experienc- ing respiratory distress.
The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a room with another child with RSV. 3. Leave the infant in the present room because RSV is not contagious. 4. Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.
2 Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is trans- ferred by the hands. Use of contact and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precau- tions are unnecessary.
Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators
A A short-acting beta 2 -adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. Inhaled corticosteroids are used for long-term, routine control of asthma. Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. A long-acting bronchodilator would not relieve acute symptoms
The nurse should assess a child who has had a tonsillectomy for which of the following as the priority? a.Frequent swallowing b.Inspiratory stridor c.Swelling of the throat d.Abnormal lung sounds
A Frequent swallowing is indicative of postoperative bleeding. Inspiratory stridor is characteristic of croup. The nurse assesses the throat for clots or bleeding, not swelling. Lung sounds are assessed on every postoperative patient
A nurse is caring for four infants. Which one should the nurse assess first? a.Nasal flaring b.Respiratory rate of 55 breaths/min c.Irregular respiratory pattern d.Abdominal breathing
A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. A respiratory rate of 55 breaths/min is a normal assessment for an infant. Irregular respirations are normal in the infant. Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.
A 5-year-old is brought to the emergency department with coups drooling and croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What action by the nurse takes priority? a. Prepare intubation equipment and call the provider. b. Examine the child's oropharynx and call the provider c. Obtain a throat culture for respiratory syncytial virus(RSVO d. Obtain vital signs and listen to breath sounds
A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a provider, because it could trigger airway obstruction. A throat culture could precipitate a complete respiratory obstruction. Vital signs can be assessed after emergency equipment is readied.
The nurse is assessing a child for epiglottitis. What findings are consistent with this condition? (Select all that apply.) a.Drooling b.Dysphagia c.Dysphonia d.Distressed inspiratory efforts e.Decreased oxygenation
A, B, C, D The cardinal signs of epiglottitis are drooling, dysphagia, dysphonia, and distressed inspiratory efforts. While the child may develop decreased oxygenation if the airway is severely compromised, this is not a cardinal sign.
13. Which assessment finding after tonsillectomy should be reported to the surgeon? a.Vomiting bright red blood b.Pain at surgical site c.Pain on swallowing d.The ability to only take small sips of liquids
ANS: A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the surgeon. It is normal for the child to have pain at the surgical site and pain with swallowing after tonsillectomy. Small sips of liquid are preferred.
Which statement made by parents of a child with cystic fibrosis indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a."Enzymes will improve my child's breathing." b."I should give the enzymes 1 hour after meals." c."Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."
C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. Pancreatic enzymes do not affect the respiratory system. Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. Wheezing is not a reason to stop taking enzyme replacements
What information should the nurse teach workers at a daycare center about RSV? a.RSV is transmitted through particles in the air. b.RSV can live on skin or paper for up to a few seconds after contact. c.RSV can survive on nonporous surfaces for about 60 minutes. d.Frequent handwashing can decrease the spread of the virus.
D Meticulous handwashing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour. RSV can live on cribs and other nonporous surfaces for up to 6 hours
