Frequently Asked Questions
As a nurse working in the emergency department of the local hospital, you see a
variety of pediatric conditions. What conditions should you consider when you see a
child demonstrating clinical manifestations of respiratory acidosis (i.e., dyspnea,
lethargy, somnolence, confusion, tachycardia, and possibly cyanosis)?
Respiratory acidosis (decrease in pH and increase in pCO2) is caused by conditions that
decrease the child’s respiratory effort and causes the formation of carbonic acid. A
variety of clinical conditions can be associated with respiratory acidosis. Some of the
common health problems associated with respiratory acidosis include head trauma, drug
overdose, brain tumors, asthma, pneumothorax, and atelectasis. Remember, it is essential
to support your thinking with physical assessment findings and history data.
What skills or knowledge will you need to best provide care for the infant or child
who is experiencing fluid, electrolyte, or acid-base balance issues?
It is very important that the nurse working with children who are experiencing any
condition, but particularly conditions involving altered fluid, electrolyte, or acid-base
balance, develop excellent observation and assessment skills, as well as understand
developmental perspectives. In preparing to collect history data and to perform the
assessment, think about collecting the following information: history of recent illnesses,
signs and symptoms that the parents felt brought them to the emergency department, a
history of recent intake and output, and recent lost or gained weight.
As the night nurse for a local pediatric clinic, you receive a call from Mrs. Young.
She is concerned because Jesse, her 3-month-old, has been having diarrhea for the
last 3 days and it seems to be getting worse. Mrs. Young states that she continues to
change wet diapers, but that it is beginning to be difficult to know how much is
urine and how much is “poop.” Jesse is becoming more irritable and fussy. Jesse’s
bottom is becoming very red and irritated, and she cries tears when her diaper area
is cleaned. Jesse seems to want to eat, but then becomes disinterested quickly. Mrs.
Young wants a prescription or a recommendation for an over-the-counter
antidiarrheal medication. What should be your response?
Jesse is most likely experiencing gastroenteritis, inflammation of the mucous membranes
of the stomach and intestines, most often caused by a virus. It is usually a self-limiting
problem that is manifested by sudden onset and progression of diarrhea without
accompanying nausea, fever, or abdominal pain. Vomiting is not uncommon, but is
unrelated to nausea. Mrs. Young should receive education about the importance of not
using antidiarrheal medications, whether over-the-counter or by prescription. Diarrhea is
the body’s method of removing the infective organism. To prevent dehydration from
occurring, Mrs. Young needs to administer increased volumes of appropriate fluids (i.e.,
containing electrolytes) as well as maintaining adequate calories. It will be important to
teach Mrs. Young the indicators of dehydration to enable her to know when to seek
medical assistance before dehydration becomes an issue. Also remind Mrs. Young to use
good handwashing after diapering Jesse, before feeding or eating, and after using the
toilet. You might also recommend that Mrs. Young change diapers frequently, wash the
perineal area after each diarrheal stool with mild soap and water, and dry thoroughly. She
can also apply a protective ointment, available at the local drugstore.
You are working in a small community rural hospital. You are assigned to care for a
new client 4 hours into your evening shift. Jimmy is a 10-year-old who was playing
with matches in the garage. His clothing caught fire, and he has major burns. What
are your biggest concerns and responsibilities?
You should immediately complete a nursing assessment, evaluating Jimmy’s respiratory,
cardiac, and renal status. Your interventions should focus on monitoring his airway,
breathing, circulation, vital signs, urine output, and fluid status, including administering
intravenous (IV) fluid. Adequate pain management should also be a top concern. In
addition, you should note any additional injuries that might have occurred. During the
shift, you should continue to monitor Jimmy for changes in fluid volume status (e.g.,
hypotension; tachycardia; pale, cool skin; decreased urinary output; and changes in level
of consciousness). Sample nursing diagnoses include risk of deficit fluid volume,
ineffective tissue perfusion, impaired gas exchange or ineffective airway, and pain.
Working as a school nurse, you have heard about Jimmy’s accident and burn
injury. How can you use this knowledge in promoting the health of the
schoolchildren?
As a school nurse, you are aware that burns are preventable when safety rules and
guidelines are in place. You can help by providing education on fire safety. Your
presentation might discuss the importance of smoke detectors placed throughout the
house, a prearranged escape route for each person in the house, keeping pots and pan
handles turned inward, placing scalding hot bowls and cups out of reach, using the
microwave oven appropriately, and keeping electrical sockets covered. For additional
ideas, you might involve members of the local fire department.
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