NU373 Week 3 HESI Case Study: Respiratory Syncytial Virus (RSV) Bronchiolitis - 21 questions

The nurse completes the initial demonstration, and the parent performs a successful return demonstration. The client's parent asks the nurse, "What if I can't remove any mucous when I suction my baby's nose?" How should the nurse respond? o "The amount of mucous is less important than your baby's behavior after the treatment." o "You will need to suction your baby again until you obtain at least a spoonful of mucous." o "Continue to insert additional saline nasal drops until the mucous can be removed." o "Call your baby's HCP if you are unable to remove any mucous when suctioning."

o "The amount of mucous is less important than your baby's behavior after the treatment." · If the client is able to breathe more easily and is able to feed successfully, the amount of mucous removed is immaterial.

The parent says they feel comfortable with the suctioning procedure. Two days later, the client is ready for discharge in the morning. The parent states they are fearful their baby may become ill again and asks the nurse what can be done to prevent that from happening. How should the nurse respond? o "There is no way to prevent illness." o "Use of proper hand hygiene and avoiding contact with the sick can reduce the risk of infections." o "Keep your baby in the house away from all visitors until the immune system is strong enough to provide protection." o "Have people who come in contact with your baby wear a mask."

o "Use of proper hand hygiene and avoiding contact with the sick can reduce the risk of infections." · The CDC has indicated that hand washing is one of the most effective measures for protection from illness. Staying away from persons known to be ill also reduces that risk.

The client and parent are escorted to the medical pediatric unit. The parent states, "I cannot believe this is happening. I feel like the worst parent in the world. Is there anything that I can do to help my child?" Which statement by the nurse reflects the philosophy of family-centered care? o "Don't worry, I am going to take good care of your baby." o "Would you like to speak to the chaplain about your concerns?" o "You're tired. Why don't you go home, and let us take care of your baby." o "While you hold your baby, we can talk about the diagnosis and care."

o "While you hold your baby, we can talk about the diagnosis and care." · Discussing the client's diagnosis and plan of care enables the parent to be a part of the care-giving process. Encouraging the parent to hold the client furthers the parent's participation in care. These are all part of the philosophy of family-centered care.

Soon after, the healthcare professional (HCP) evaluates the client and determines a diagnosis of respiratory syncytial virus (RSV). The HCP prescribes the following: NPO Salbutamol MDI with spacer and mask 2 puffs once, assess for effect and report to HCP Prednisone 4mg/ml every 12 hours by mouth Oxygen to maintain oxygen saturations over 92% Nebulized 3% hypertonic sodium chloride as needed Suction as needed IV fluids dextrose 0.05% and sodium chloride 0.45% at 100 mL per kg every 24 hrs The client weighs 12 pounds. Fill in the blank. How many milliliters per hour will the nurse program the IV pump to run at? (Enter numerical value only. If rounding is necessary, round to the whole number.)

o 23 · Convert weight in pounds to kilograms and multiple by 100 mL; then divide by 24 hours for hourly flow rate. 12 lbs /2.2 kg = 5.45 kg × 100 mL ÷ 24 hours = 22.7 mL/hour. 23 mL per hour is acceptable.

The client is placed in a mist tent that will deliver the ribavirin over an 18-hour period during the day. The parent asks the nurse if the infant could have any type of toy or activity so as to not feel so alone while in the tent. What type of toy should the nurse recommend? o A stuffed bear. o A musical mobile. o A plastic doll. o Plastic blocks.

o A musical mobile. · Infants in this age group love to look at mobiles and hear music. A crib toy that can be washed, such as a mobile, is a good choice.

While the client is being prepared for transfer, the ED nurse calls the medical unit and gives report to the charge nurse. The charge nurse reviews the current staff assignments to determine who should be assigned the care of the client. Which staff member should the charge nurse assign to care for the client? o An RN caring for a 6-year-old who is receiving chemotherapy. o An LPN caring for a 14-year-old following an appendectomy. o An RN caring for a 9-month-old with pneumonia. o An LPN caring for an infant in a hip spica cast.

o An RN caring for a 9-month-old with pneumonia. · The RN has the expertise needed to make the frequent assessments that are required. In addition, assigning clients with similar diagnoses to the same nurse is most appropriate.

The client is tachypneic and continues to receive oxygen at 0.5 L/minute via nasal cannula. The HCP also prescribes cardiac telemetry to start upon the client's arrival at the pediatric medical unit. Which staff member should be assigned to transport the infant to the pediatric unit? o A new graduate nurse starting an ED internship. o An experienced unlicensed assistive personnel (UAP) who is certified in cardiopulmonary resuscitation (CPR). o An experienced pediatric registered nurse (RN) floated to the ED for the day. o A licensed practical nurse (LPN) who is orienting to the ED.

o An experienced pediatric registered nurse (RN) floated to the ED for the day. · The experienced pediatric nurse who has knowledge of the care of children with respiratory illness is the staff member that should be assigned to transport a sick infant.

The pulse oximeter begins to ding and the nurse notices that the client's oxygen saturation level on room air is 90%. Which action should the nurse take? o Reassess in 30 minutes. o Notify the HCP. o Document the findings. o Apply oxygen by nasal cannula titrated to maintain oxygen saturations over 92%.

o Apply oxygen by nasal cannula titrated to maintain oxygen saturations over 92%. · After applying the nasal cannula, the nurse should monitor the client for a positive respiratory response to oxygen therapy, and titrate the oxygen to a level that will allow saturations to be maintained above 92%. Always follow hospital policies for oxygen administration, titration, and weaning. If the infant's oxygen level does not improve to 94% or greater within 15 minutes, the HCP should be notified.

The client, a 6-week-old infant, is brought to the emergency department (ED) by ambulance, accompanied by a parent. The emergency medical technician (EMT) reported to the nurse that the client had a 2-day history of cold symptoms and became limp and cyanotic. The parent attempted cardiopulmonary resuscitation (CPR), as instructed by 911. Upon arrival of the ambulance, the EMT stabilized the client prior to transport to the hospital. The nurse enters the room to find the client crying in the parent's arms. The nurse and the parent work together to calm the client and then the nurse auscultates the client's lungs. Coarse bilateral wheezes are detected, but the client does not appear in acute distress at this time. What action should the nurse take next? o Perform nasal suctioning. o Continue respiratory assessment. o Call the emergency response team. o Document assessment findings.

o Continue respiratory assessment. · The nurse should complete the respiratory assessment, as this will provide important baseline information for the healthcare provider (HCP).

After the client has had many unsuccessful IV attempts, the IV therapy team is called, and they decide to start the IV in the infant's scalp. What should the nurse do next to best promote atraumatic care and to get the IV in place in a timely fashion? o Place EMLA cream on several potential IV sites. o Ask the parent to step out of the room to increase their comfort. o Give the client oral sucrose solution on a nipple to suck on during the procedure. o Place the infant supine and utilize a papoose restraining device.

o Give the client oral sucrose solution on a nipple to suck on during the procedure. · It has been shown that an infant sucking during painful, invasive procedures reduces pain. The use of an oral sucrose solution also reduces the painful experience for the infant and is the most atraumatic intervention.

After clarifying the prescriptions and stabilizing the client's oxygen saturation level to 94%, the nurse prepares to transport the infant to the pediatric unit. Which nursing diagnosis has the highest priority for the client? o Ineffective airway clearance. o Activity intolerance. o Risk for fluid volume deficit. o Interrupted family processes.

o Ineffective airway clearance. · The pathophysiology of RSV includes edema of the bronchioles and thick secretions that can block the airways, causing obstruction and hyperinflation. Because these factors can lead to increased respiratory effort and possibly respiratory failure, this diagnosis has the highest priority.

The nurse continues the assessment. Which assessment finding exhibited by the client warrants immediate intervention by the nurse? o Rectal temperature of 100.0 °F (37.8 °C). o Capillary refill < 2 seconds. o Minimal response to stimuli. o Anterior fontanel is soft and flat.

o Minimal response to stimuli. · A change in the client's level of consciousness is a significant indicator of poor oxygenation and requires immediate intervention by the nurse.

The client's primary nurse has a preceptor student. The nurse asks the student about signs and symptoms of respiratory distress. Which findings should the nurse confirm are indications of respiratory distress in an infant? Select all that apply. o Nasal flaring. o Restlessness. o Oxygen saturation level of 98%. o Respiratory rate of 30 breaths per minute. o Retractions.

o Nasal flaring. · Nasal flaring is sign of respiratory distress in the pediatric client. o Restlessness. · Restlessness is an early sign of respiratory distress in the pediatric client. o Retractions. · This is a sign of respiratory distress in the pediatric client.

Oxygen is applied via nasal cannula at 0.5 L/minute, and the saturation level is maintained at 94%. The nurse reviews the client's prescriptions. Which order should the nurse question prior to administration? o IV dextrose 5% and sodium chloride 0.45%. o Nebulized 3% hypertonic sodium chloride. o Oral Prednisone. o Salbutamol

o Oral Prednisone. · Corticosteroids are not indicated for a client who has bronchiolitis. The appropriate use of corticosteroids remains controversial.

The nurse understands which are considered late signs of respiratory distress? Select all that apply. o Irritability. o Peripheral cyanosis. o Bradypnea. o Tachycardia. o Stupor.

o Peripheral cyanosis. · This is a late sign of respiratory distress. o Bradypnea. · This is a late sign of respiratory distress. o Stupor. · This is a late sign of respiratory distress.

Which techniques should the nurse use to assess for respiratory distress? Select all that apply. o Place a pulse oximeter on a big toe of the client's foot. o Inspect the chest wall for symmetry and retractions. o Percuss for hyperresonance. o Inspect oral mucosa for dryness. o Count the client's pulse and respiratory rates.

o Place a pulse oximeter on a big toe of the client's foot. · The nurse should use a pulse oximeter to measure the client's oxygen saturation level. A decreased oxygen saturation level is a sign of respiratory compromise. The foot is the preferred site for a pulse oximeter because infants are apt to scratch themselves with the probe if it is placed on the hand. Fingers are not used because they are too small to support the probe. The infant's foot should be kept warm, with a sock if necessary, to ensure accurate measurement. o Inspect the chest wall for symmetry and retractions. · Respiratory distress can be seen as an asymmetrical chest wall expansion, intercostal retractions, and nasal flaring. o Percuss for hyperresonance. o Count the client's pulse and respiratory rates. · Tachycardia and tachypnea can both be signs of respiratory distress.

Later in the day, the nurse hears the client's alarm go off and goes to the client's room. The nurse assesses the client, who is grunting, and has nasal flaring and retractions. The client's respiratory rate is 62 beats/minute, and oxygen saturation level is 82%. Which action should the nurse take? Select all that apply. o Reposition the client in an elevated position. o Vigorously stimulate the child. o Begin chest compressions. o Notify the HCP. o Activate the hospital rapid response team to come to the bedside.

o Reposition the client in an elevated position. · Repositioning the client in an elevated position allows for better expansion of the lung fields and improved oxygenation. o Notify the HCP. · The HCP should be informed that the child is experiencing increased respiratory distress so that the HCP can give to direct further orders. o Activate the hospital rapid response team to come to the bedside. · The child is exhibiting signs of severe respiratory compromise. The rapid response team should be notified and available to assist with this child to stabilize the airway and to prevent a full blown code.

The client's condition continues to deteriorate. The HCP arranges for the infant to be transferred to the pediatric intensive care unit (PICU). After assessing the client, the HCP decides to administer ribavirin by aerosol. Which precautions should the PICU nurse initiate while the client is receiving this medication? o Contact isolation. o Restrict pregnant caregivers. o Fall precautions. o Restrict family visitation.

o Restrict pregnant caregivers. · Ribavirin is known to be teratogenic in animals and potentially harmful to the human fetus. Pregnant caregivers should be excluded from contact with this client while the client is being treated with ribavirin.

Three days later, the client's condition improves, and the client is transferred back to the pediatric unit. The client is scheduled for discharge in 2 days if the client remains stable. The client's parent is anxious to learn how to care for the infant at home. The nurse begins by teaching the parent about nasal suctioning because the symptoms of cough and nasal congestion will persist for up to 2 weeks after the acute phase of the illness. After gathering exam gloves and a bulb syringe, the nurse should include what other equipment when gathering supplies to teach the parent to perform nasal suction? o Oxygen tank with a facemask. o #8 french suction kit. o Sodium chloride drops. o 3 mL of sterile water.

o Sodium chloride drops. · Sodium chloride drops can be used to loosen secretions prior to suction.

The client is experiencing increasing respiratory distress. The nurse notes that the client is nasal flaring and is having substernal retractions. The nurse suctions the client's mouth and nasal passages with a bulb syringe to clear secretions. The parent attempts to bottle feed the client. The nurse observes that the client has difficulty sucking and keeps spitting out the nipple. The nurse notes that the client still has thick nasal secretions and that the respiratory rate has increased to 50 breaths per minute with her sucking effort. Which action should the nurse take? o Cut a bigger hole in the nipple. o Suction the infant's nose again. o Send the infact for a chest x-ray. o Call the HCP to obtain further medication prescriptions.

o Suction the infant's nose again. · Due to the posterior soft palate covering the oropharynx and the tongue's close proximity with the hard and soft palate, infants this age are obligate nose breathers. When the nose is congested they cannot form a seal to suck. Consequently, their respiratory effort increases as they attempt to breathe through congested nasal passages and suck at the same time.

The IV line is placed successfully in a peripheral vein in the right lateral side of the scalp and secured with a tegaderm adhesive and tape. The nurse assesses that the IV flushes well and is patent. Which would the nurse expect to see if the IV infiltrated? Select all that apply. One, some, or all options may be correct. o Bruising. o Heat. o Swelling. o Pain. o Redness.

o Swelling. · Swelling will be noted with an infiltrated IV. o Pain. · Pain may be seen when the IV has infiltrated. o Redness. · Erythema is noted around an infiltrated IV.