Which of these orders would you expect to see in her postoperative orders?
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Topic: Nursing care of children
Details: Otitis Media
Three-year-old C.E. is admitted to the emergency department (ED) fast track clinic. Her mother tells the nurse that C.E. has had a low-grade fever for 2 days and is complaining of ear pain and a sore throat. C.E.’s mother states that C.E.’s appetite has been “off,” but she has been drinking and using the bathroom as usual. As you get C.E. settled in the exam room, you suspect C.E may have otitis media (OM).
1. What routine information regarding risk factors for OM would you want to obtain from C.’s mother?
2. C.’s mother asks, “Why does C. keep getting ear infections? Is there something I should do?” Explain the etiology of ear infections
3. You continue to obtain a history from C.’s mother and learn C.E. has had “ear problems” and throat infections since she was a baby. She is in day care each weekday, the father smokes outside of the house, and there is a family history of seasonal allergies. Describe what you will include in your physical examination with rationales
Tonsilitis
C.’s mother takes C.E. to an ENT specialist. It is determined that her enlarged tonsils might be contributing to the frequent throat and ear infections, and a tonsillectomy and adenoidectomy (T&A) is scheduled. She is admitted postoperatively for 24-hour observation. After the surgery, the postoperative nurse receives C.E. in the short-stay unit from the postanesthesia care unit (PACU). C.E. is awake and alert, bilateral breath sounds are clear, and her oxygen saturation is 98% on room air. She has tolerated sips of clear fluids, and her parents are with her.
1. Which of these orders would you expect to see in her postoperative orders? Select all that apply, and discuss the rationales for each of your choices.
a. Vital signs q4h
b. Clear liquids; advance to regular toddler diet
c. Methylprednisolone (Solu-Medrol) 2.3 mg IV q8h × 3 doses
d. Acetaminophen (Tylenol) 210 mg (15 mg/kg) PO q4h prn for pain
e. Home prescription for amoxicillin (Amoxil) 120 mg PO q8h
f. Maintain peripheral IV with D51⁄2NS at 50 mL/hr; saline lock when taking PO well
g. Aggressively gargle and swish with water after eating or drinking
2. State at least two nursing interventions for each of these commonly encountered nursing problems during the postoperative phase of care.
a. Airway
b. Pain
c. Fluid and electrolyte balance
d. Bleeding risk
3. C. is able to verbalize discomfort to you and her mother. Which pain rating scales would be most appropriate?
Pediculoitis Capitis
A.P. is an 8-year-old who is sent to the nurse’s office because she has had a 2-day history of scratching her head so badly that she complains that her“head hurts.”You complete a general examination of A.P.’s head and notice that she has red, irritated areas with several scratch marks; a few open sores; and sesame seed– sized, silvery white and yellow nodules (bugs) that are adhered to many of her hair shafts. You determine that A.P. has pediculosis capitis.
1. What will be your next steps in A.P.’s care?
2. What should be included in the educational plans for A.P. and her parents?
3. What possible complications can occur as a result of failing to treat head lice?
Burns
You are working in the emergency department (ED) of a community hospital when the ambulance arrives with A.N., a 18-year-old woman who was involved in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at 15L/min per non-rebreather mask and started a 16-gauge IV with lactated Ringer’s solution. On arrival in the ED, her vital signs are 100/66, 125, 34, Spo2 93%. She appears anxious and in pain.
1. Describe the interventions needed to care for A.N. on her arrival in the ED
2. You suspect that A.N. has sustained deep partial-thickness burns. Which best describes this type of burn?
3. Because you are concerned about possible smoke inhalation, what will you monitor for in A.N.?
4. Interpret A.N.’s laboratory results
Laboratory Test Values Hgb 20 g/dL, Hct 51%, K 4.9 mEq/dL, Na 133 mEq/dL, Cl 100 mEq/dL, Glu 159 mg/dL, BUN 28 mg/dL, Cre 1.0 mg/dL
5. Because of her significant burn injury, A.N. is at high risk for infection. What measures will you institute to prevent this?
Measles
1. “I am not used to working with children,” says Nurse Singh. “I need a quick reminder of the characteristics of the rash in chickenpox and in measles.”
2. Mrs. Dreyer’s son Donny, age 6, had a high fever, enlarged cervical lymph nodes, runny nose, and a “barking” cough. She took him to a pediatric nurse practitioner, who told her that Donny probably had measles and would break out in a rash in a day or two. The rash came the very next day. “Donny has measles, just as the nurse practitioner said. All she did was take Donny’s temperature, feel his neck, and look carefully in his mouth,” says Mrs. Dreyer. “How did she know he had measles?
Variella
Kyle, age 5 years, is in kindergarten. Kyle’s mother calls the school nurse to report that he “broke out” with chickenpox last night. Kyle was in school yesterday.
1. Kyle’s mother says, “I’m glad he broke out at night so he can’t give it to the other children.” The nurse’s response should be based on knowledge that chickenpox
A. is not very contagious.
B. is only spread by direct contact with lesions.
C. probably can be transmitted to others 1 day before eruption of lesions.
D. probably can be transmitted to others 5 or 6 days before eruption of lesions.
2. Kyle’s mother asks what she can do to minimize itching. The most appropriate recommended plan of care and nursing consideration for this patient
3. Kyle’s mother asks the nurse, “Is it OK for him to scratch the rash?” When teaching Kyle’s mother about home care, the nurse tells her to prevent scratching because scratching:
A. increases the risk of contagion and communicability.
B. causes increased spread of chickenpox lesions.
C. prolongs varicella symptoms such as fever.
D. increases prevent secondary infection and scarring.
Impetigo
Joey is a 7-year-old boy who comes to the school nurse’s office with the complaint of an itchy rash on his face. You, the school nurse, assess the rash and find reddened papules and pustules with a yellowish crust occurring around his mouth and nose.
1. As the school nurse, what is your first priority?
2. What is the plan of care and nursing consideration for Joey
3. Which medication would you expect Joey’s health care provider to order?
1. Oral acyclovir
2. Griseofulvin
3. IV Vancomycin
4. Oral antibiotics and warm compresses
Acne
A 13-year-old girl complains about “zits” on her face and shoulders. She has tried over-the-counter benzoyl peroxide for 2 months to no avail, and has stopped eating chocolate and French fries on her mother’s advice. She has been invited to an upcoming school dance and wants to look her best. She complains about blackheads, but also lesions that are deep and painful.
1. What is the plan of care and nursing considerations for the patient
2. Discuss the potential side effects of isotretinoin
Conjunctivitis
The mother of a 2-year-old girl calls the after-hours pediatric call center and reports that her daughter awoke with her eyelashes matted, her eyes swollen, and copious thick, greenish yellow discharge in both eyes. The mother thinks that chlorine from the public wading pool in which the daughter played the day before irritated her eyes. The mother asks which over-the-counter (OTC) eye drops would be best to use on her daughter’s eyes for irritation.
1. What are the signs and symptoms of conjunctivitis in the child? What is the treatment and nursing consideration?
Cleft Lip Repair
S.G. is a 6-month-old girl who is scheduled for sequential repair of her cleft lip (cheiloplasty) and palate (palatoplasty). She has recently been adopted from China and her past medical history is unknown. S.G. is scheduled for her cleft lip repair, and Mrs. G. brings her to the same-day surgery unit the week before for her preoperative workup. As you do her workup, you recognize that care of the child with clefting uses a multidisciplinary approach.
S.G. returns to your unit 6 months later for her cleft palate repair (palatoplasty).
1. Which of these nursing interventions are appropriate as you plan her care? Select all that apply, and explain why or why not.
a. Position patient side-lying or on abdomen postoperatively.
b. Use elbow restraints as needed.
c. Clear fluids; advance as tolerated. Patient may use a straw.
d. Administer pain medications as ordered.
e. Oral suction with a Yankauer catheter as needed.
f. Maintain strict intake and output.
2. S.G. has a normal recovery and is being discharged. When giving her parents discharge instructions, what will you advise them concerning diet and signs and symptoms to report?
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