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

The nurse notes a 3-year-old child is restless, has a respiratory rate of 55 breaths/minute, and has an oxygen saturation of 90%. Which action will the nurse take first? Request a breathing treatment. Notify the primary health care provider. Consult respiratory therapy. Apply oxygen via a facemask.

Apply oxygen via a facemask. Oxygen is the most indicated treatment and is needed to increase low partial pressure of oxygen (PaO2) levels in the blood. The child is showing signs of hypoxemia and needs oxygen. The nurse will notify the health care provider after administering oxygen. Respiratory therapy and breathing treatments may be needed based on the child's response to oxygen.

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? "Infants are less affected by RSV than older children." "RSV season occurs primarily April through September." "Exposure to second- or thirdhand smoke increases the risk for developing RSV." "Early initiation of antibiotics can lessen the severity of the infection."

"Exposure to second- or thirdhand smoke increases the risk for developing RSV." An infant exposed to second- or thirdhand smoke is at risk for developing RSV. RSV season runs from September through April. Current treatment recommendations for RSV do not include antibiotics. Infants are susceptible to RSV much more than older children.

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 Sweat sodium chloride test Purified protein derivative test Blood culture and sensitivity

Pulmonary functions test Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection.

Which electrolyte does the client with cystic fibrosis need in abundance? Magnesium Chlorine Potassium Sodium

Sodium Dietary intake of sodium is encouraged due to increased sodium losses. Clients are especially encouraged to eat salty pretzels, potato chips, etc. during hot weather or when sodium losses are anticipated.

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 will attain oxygen saturation of 90% on room air. The infant's airway will remain clear and free of mucus. The infant will have decreased nasal stuffiness. The infant's breathing will be less labored.

The infant's airway will remain clear and free of mucus. Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.

A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child? obtain oxygen saturation levels administer oxygen notify the health care provider elevate the head of the bed

elevate the head of the bed The child who is experiencing increased work of breathing should be placed in a position to better open the airway and provide more room for lung expansion. Generally this is accomplished by elevating the head of the bed. If this does not improve the work of breathing, then administering oxygen should be done. The oxygen saturation should be measured because it will provide information as to the severity of the respiratory problem, but this measurement will not directly help the child. The health care provider should be notified if the child continues to deteriorate.

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important? Allow the child an age-appropriate, quiet plan. Provide acetaminophen for pain. Stress regular fluid consumption. Note any frequent swallowing.

Note any frequent swallowing. 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. All of the other discharge instructions are appropriate, but noting any frequent swallowing is the priority.

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? partial rebreather mask nonrebreather (face) mask Venturi mask oxygen hood

nonrebreather (face) mask A nonrebreather (face) mask provides 95% oxygen concentration. An oxygen hood provides up to 80% to 90% oxygen concentration. This delivery method is used only for infants. A partial rebreather mask provides 50% to 60% oxygen concentration. A Venturi mask provides 24% to 50% oxygen concentration.

After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma? dust mites indoor molds shellfish pet dander

shellfish Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds, pet dander, and dust mites are common asthma triggers.

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma? A peak flow meter An incentive spirometer A nebulizer An inhaler

A peak flow meter The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the client to begin medications before symptoms actually are noticeable. A nebulizer and inhaler treat symptoms. An incentive spirometer is used for lung expansion, especially after surgery.

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? monitoring oxygen saturation by pulse oximeter suctioning secretions from the airway administering analgesics as ordered administering oxygen as ordered

suctioning secretions from the airway The priority intervention is suctioning secretions to provide a patent airway. Administering oxygen as ordered, monitoring oxygen saturation by pulse oximeter, and administering analgesics as ordered would be secondary interventions.

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? increased appetite tachycardia bronchial muscle relaxation hypoactivity

tachycardia Adverse reactions of albuterol, a bronchodilator, include tachycardia, nervousness, tremors, hyperactivity, malaise, palpitations, increased appetite, hypokalemia, and muscle cramps. The expected action of albuterol is to relax bronchial, uterine, and vascular smooth muscle by stimulating beta-2 receptors. While tachycardia and increased appetite are both adverse reactions, tachycardia happens abruptly following the first dose and can be alarming for clients. It is a priority for the nurse to provide education on this over a slower, less concerning change.

The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which laboratory/diagnostic tools would most likely be used to help diagnose this child? Purified protein derivative test Sweat sodium chloride test Pulmonary functions test Blood culture and sensitivity

Purified protein derivative test Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

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 Using a nebulizer Through a gastrostomy tube Directly into the vein

Sprinkled onto the food Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler [MDI], which is a hand-held plastic device that delivers a premeasured dose.

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 was a postmaturity date infant. The child attends day care. The child has diabetes. The child is a triplet.

The child attends day care. Attending day care is a known risk factor for pneumonia. Being a triplet is a factor for bronchiolitis. Prematurity rather than postmaturity is a risk factor for pneumonia. Diabetes is a risk factor for influenza.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? The child's hospital history The triggers in the environment The child's diet The child's weight

The triggers in the environment When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

What is a symptom of bacterial pharyngitis? symptoms have gradual onset white blood cell (WBC) count in normal range fever rhinitis

fever Bacterial pharyngitis is most often caused by group A streptococcus. Fever is a symptom of bacterial pharyngitis. Other symptoms are an elevated WBC count, abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. It must be treated with an antibiotic. Penicillin is the drug of choice. Symptoms of rhinitis, a normal WBC count, and slow onset are indicative of viral pharyngitis.

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? Not before 24 hours After 1 week Within 15 minutes Within 48 to 72 hours

Within 48 to 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.

A 2-year-old child has had a common cold for 4 days. The caregiver calls the nurse in the emergency department at 2 a.m. on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; the child seems blue around the mouth. The nurse would appropriately recommend what action to the caregiver? "Bundle the child up and take the child out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief." "Bring the child to the emergency room immediately." "Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there is no relief in an hour." "Turn on all of the hot water taps in the bathroom and close the door. Take the child into the steam-filled room for 15 minutes. If there is no relief, bring the child to the emergency room."

"Bring the child to the emergency room immediately." Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104° F (40° C) to 105° F (40.6° C). As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory distress can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child's bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to see the physician.

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? "Our family dog will need to go live with a grandparent." "It is okay for our child to do chores such as sweeping the floor." "We will both enroll in smoking cessation classes." "We will keep an albuterol inhaler with our child at all times."

"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 inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.

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? "Your child needs to avoid peanuts until further testing is completed." "Pollen is a cause of these symptoms. Allergy medicine may help your child." "Penicillin is the treatment of choice. Be sure your child takes the entire prescribed amount." "When bathing, your child needs to use a mild soap, free of dye and fragrance."

"Pollen is a cause of these symptoms. Allergy medicine may help your child." The allergens that usually cause allergic rhinitis (hay fever) are pollens or molds rather than foods or drugs. Over-the-counter or prescription allergy medications may help provide relief for these clients when taken. Peanuts and soap are not associated with allergic rhinitis. Antibiotics are used to treat bacterial infections, not allergic responses in clients.

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? Standard precautions Airborne precautions Contact precautions Droplet precautions

Airborne precautions Airborne precautions should be initiated for any client with suspected tuberculosis. Clients with suspected TB are placed away from other hospitalized clients in a single-occupancy room. Airborne precautions are implemented over droplet precautions as the bacilli can remain in the air and inhaled by others. Standard and contact precautions do not involve protecting the respiratory system.

Which nursing diagnosis would best apply to a child with allergic rhinitis? Risk for infection related to blocked eustachian tubes Pain related to sinus edema and headache Ineffective tissue perfusion related to frequent nosebleeds Disturbed self-esteem related to inherited tendency for illness

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. Nosebleeds are not common with either allergic rhinitis or sinusitis nor are either of these inherited. The eustachian tubes would cause symptoms of otitis, not of the nasal passage.

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation? Adenoidectomy Antipyretic and analgesic Tonsillectomy Antipyretic, analgesic, and antibiotic

Antipyretic, analgesic, and antibiotic These symptoms are consistent with bacterial tonsillitis. Therapy for bacterial tonsillitis includes an antipyretic for fever, an analgesic for pain, and a full 7- to 10-day course of an antibiotic such as penicillin or amoxicillin. If the cause is viral, no therapy other than comfort or fever reduction strategies is necessary. Tonsillectomy is removal of the palatine tonsils. Adenoidectomy is removal of the pharyngeal tonsils. In the past, tonsillectomy was recommended for children after an episode of tonsillitis. This is no longer recommended as tonsillar tissue is an important component of the immune system.

In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? To stabilize the cell membranes Management of chronic pain Prevention of mild symptoms Relief of acute symptoms

Relief of acute symptoms Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Bronchodilators are not effective for pain.

The nurse is assessing the site of a client's Mantoux skin test. The client is HIV positive. The nurse notes the induration to be 10 mm. Which action will the nurse take next? Document the finding in the client's medical record Determine if the client has been exposed to tuberculosis. Place the client on droplet precaution. Schedule the client for a chest x-ray.

Schedule the client for a chest x-ray. Diagnosis of tuberculosis (TB) is confirmed with a positive Mantoux test. An induration of 5 mm is considered positive for clients with HIV. If a client's Mantoux test is positive, the client is next scheduled for a chest x-ray to look for lung changes related to TB, or for a sputum smear test. These tests are done to determine if a client has latent or active TB, which will then determine the course of action for the client. The nurse will document the results; however, documentation is not priority. There is no need to ask about exposure since the test results indicate exposure. The client with active TB will be placed on airborne precautions.

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first? "Have him use his low-dose steroid inhaler now and again in 15 minutes." "Continue to watch his PEFR readings and call back if they go below 40%." "You need to take him to the emergency department right away." "Have him use his short-acting bronchodilator right away."

"Have him use his short-acting bronchodilator right away." The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply. "The dose is adequate when your child is only having 1 to 2 stools per day." "You will need to give your child less enzyme pills when high-fat foods are eaten." "The dose prescribed is based on your child's pancreatic laboratory values so it should be correct." "When your child starts to eat more quantities of food you will need to adjust the amount of enzyme pills." "The dose is adequate when your child's weight is improving."

"The dose is adequate when your child is only having 1 to 2 stools per day." "The dose is adequate when your child's weight is improving." "The dose is adequate when your child's weight is improving." Pancreatic enzymes are required for the child with cystic fibrosis (CF) to help absorb nutrients from the diet and to aid in digestion. They are given with each meal and snack the child eats. The number of capsules required at each dose depends upon the diagnosis of how the pancreas is functioning and the amount of food needed to be digested. The pancreatic laboratory values may determine a baseline for the number of pills to start with, but the dosage is adjusted regularly. The dosage of pancreatic enzymes is adjusted until an adequate growth pattern is established and the child is having no more than 1 to 2 stools per day. The child should be given an increased number of enzyme pills when a meal with high-fat content is consumed, not fewer.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which statement best indicates an understanding of the management and treatment for this diagnosis? "Even the babysitter helps us keep up the diary with her symptoms." "He knows how and even when he needs to use his peak flow meter." "We have taken the carpet out of our house and let my mom take our dog." "The medications she takes are all in one place, ready for her to take at any time."

"We have taken the carpet out of our house and let my mom take our dog." Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.

The nurse is teaching home care to the parents of a 4-year-old client diagnosed with asthma. The nurse knows additional teaching is needed if the parents make which statement? "We will not enroll our child in preschool this year." "We feel confident we can administer medication with a nebulizer." "Emergency instructions and phone numbers are posted in our home." "It is important for us to know what triggers an attack."

"We will not enroll our child in preschool this year." Enrolling in preschool is fine for children with asthma. There is the risk for increased exposure to illness; however, asthma should not limit the child from living a normal, active life. Should the child enroll, the nurse can assist in meeting the asthma education needs of the preschool staff through counseling the parents and providing access to accurate asthma education materials. The parents should know what triggers an asthma attack in their child, have emergency information and numbers posted in the home for emergency situations, and should know how to use a nebulizer as needed.

The nurse has assessed four clients. Which assessment finding warrants immediate action? 10-year-old child with extreme sinus pressure and headache 4-year-old child with enlarged tonsillar and adenoidal tissue 1-week old newborn with nasal congestion 6-year-old child who is consistently mouth breathing

1-week old newborn with nasal congestion Until 4 weeks of age, newborns are obligatory nose breathers and breathe only through their mouths when they are crying. The newborn cannot automatically open the mouth to breathe if the nose is obstructed; therefore, a newborn with nasal congestion needs immediate action. Also, the newborn and young infant have very small nasal passages, so when excess mucus is present, airway obstruction is more likely. Mouth breathing may occur when a large amount of nasal congestion is present. Although this finding is abnormal and warrants follow up, in a 6-year-old child this finding does not warrant immediate action. Through early school-age, children tend to have enlarged tonsillar and adenoidal tissue even in the absence of illness; therefore, this finding is normal in a 4-year-old child and does not warrant immediate follow up. The frontal sinuses and the sphenoid sinuses develop by age 6 to 8 years; therefore a 10-year-old child may develop a sinus infection. Although these symptoms warrant follow up, immediate action is not necessary.

A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of the parents? Encourage the parents to return home and get some rest. Tell the parents that their child is receiving the best care possible. Avoid telling the parents unnecessary facts regarding the child's prognosis. Allow the parents to remain with the child as much as possible.

Allow the parents to remain with the child as much as possible. Pneumonia may be caused by many reasons: bacteria, viruses, fungus, and aspiration. If the child has mild symptoms (no respiratory distress) he or she may be treated at home. Hospitalization is required if the child has oxygen requirements, shows signs of respiratory distress, has poor oral intake, and has lethargy. Oxygen supplementation, IV fluids, and antibiotics will be necessary. It is very frightening for the parents to see their child so ill, and it is very frightening for the child to be so sick and be in a strange environment. The parents should be allowed to remain with their child at all times and their concerns should be addressed. The nurse should explain that not eating is part of the illness, but the child is being hydrated with IV fluids and will start eating as the illness improves. Telling the parents the child is receiving the best care possible does not address their concern of not eating. Parents should be educated on all aspects of the child's condition and prognosis.

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? Assisting with racemic epinephrine nebulizer therapy Urging the child to continue to take oral fluids Administering an oral analgesic Teaching the child to take long, slow breaths

Assisting with racemic epinephrine nebulizer therapy Croup is a viral infection that causes inflammation and edema of the larynx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is an alpha adrenergic agent. It works on the mucosal vasoconstriction to reduce the edema. This increases the lumen of airways, allowing for better intake of air. A child in respiratory distress is unable to take slow, deep breaths. The child should not be offered fluids because this is an aspiration risk and analgesics will not reduce swelling.

What measure at home could help a child with an upper respiratory infection breathe more easily? Enforcing strict bed rest Playing "rapid breathing" games Increasing room humidity Limiting fluid intake

Increasing room humidity A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise.

During a class for caregivers of children with asthma, a caregiver asks the nurse the following question when medications are being discussed. "They told me about a plastic device my child can hold in his a hand which will give him a premeasured and exact amount of his corticosteroid." The nurse recognizes that the caregiver is most likely referring to which device? Nebulizer Medication cup Metered-dose inhaler Needleless syringe

Metered-dose inhaler In the treatment of asthma, corticosteroids are most often delivered by metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). The medication cup and needleless syringe may deliver PO medications, but most often corticosteroids are not given PO in the treatment of asthma, and those would not be premeasured and an exact dosage like a metered-dose inhaler would be. Corticosteroids are not administered by nebulizer.

What statement is the most accurate regarding the structure and function of the newborn's respiratory system? Most infants are nasal breathers rather than mouth breathers. Infants and young children have smaller tongues in proportion to their mouths. The diameter of the child's trachea is the same as that of adults. The respiratory tract in the child is fully developed by age 2.

Most infants are nasal breathers rather than mouth breathers. Newborns are obligatory nose breathers until at least 4 weeks of age. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. During the first 5 years of life, infants and young children have larger tongues in proportion to their mouths.

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? Iodized salt Saturated fat Pancreatic enzymes Calories from protein

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.

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child? Pulmonary functions test Blood culture and sensitivity Sweat sodium chloride test Purified protein derivative test

Sweat sodium chloride test Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider? The child received the pneumococcal vaccine series within his or her first year. The child has two cousins who have many allergies. The child was eating peanuts yesterday. The parent has supervised the child in the same room for the past 24 hours.

The child was eating peanuts yesterday. Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. Allergic situations cause early symptoms such as rash development and are generally not genetic or inherited in nature. The US Centers for Disease Control and Prevention recommends children receive pneumococcal vaccine series before 2 years of age, usually at 2, 4, and 6 months.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method? Through a gastrostomy tube Sprinkled onto the food Using a nebulizer Directly into the vein

Using a nebulizer Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.

The caregiver of a 6-month-old boy calls the nurse concerned about her child. The child has been irritable, fussy, and is sneezing. The child's temperature is 100oF (37.8oC). The nurse suspects that the cause of the symptoms is: cystic fibrosis. pneumonia. a common cold. a pollen-based allergy.

a common cold. The child with a common cold sneezes and becomes irritable, fussy and restless. The congested nasal passages can interfere with nursing, increasing the infant's irritability. Because an older child can mouth breathe, nasal congestion is not as great a concern as it is in the infant. The infant usually develops fever early in the course of the infection, often as high as 102°F to 104°F (38.9°C to 40°C), The child with an allergy would have more symptoms and will not likely have an elevated temperature The infant with pneumonia will most likely have a rapid and abrupt temperature increase, possibly to 103°F to 105°F (39.4°C to 40.6°C) and marked respiratory distress with obvious air hunger, flaring of the nostrils, circumoral (around the mouth) cyanosis, and chest retractions. The child with cystic fibrosis will have a hard, nonproductive chronic cough, a barrel chest, and clubbing of fingers. The abdomen becomes distended, and body muscles become flabby.

How is wheezing in children best heard? with the child supine without a stethoscope as the child exhales as the child cries

as the child exhales Wheezing occurs from obstruction in the lower trachea and bronchioles. It is an expiratory sound from difficulty pushing air through a narrowed airway. When there is obstruction of the bronchioles—as with such disease processes as asthma and cystic fibrosis—wheezing will not clear with coughing. A stethoscope is necessary to auscultate lung sounds and hear wheezing. If a child is wheezing it can be heard with the child in any position. Crying makes the lung sounds harder to hear.