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You are working in a large urban pediatric clinic after-hours.
A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.
- The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
- Born at 36 weeks gestation.
- Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
- T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
- A swab for respiratory syncytial virus (RSV) is positive.
Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.
After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.
Client is discharged with these orders:
- methylprednisolone 0.4 mg/kg oral BID for 3
- Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
- Call if needed prior to the Q4 dose.
- Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
- Return for re-evaluation in 3 days
- 1.What short and long-term possible complications should the nurse anticipate?
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- You are working in a large urban pediatric clinic after-hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions. The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA). Born at 36 weeks gestation. Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare. T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96% A swab for respiratory syncytial virus (RSV) is positive. Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated. After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home…You are working in a large urban pediatric clinic after-hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions. The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA). Born at 36 weeks gestation. Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare. T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96% A swab for respiratory syncytial virus (RSV) is positive. Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated. After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home…You are working in a large urban pediatric clinic after-hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions. The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA). Born at 36 weeks gestation. Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare. T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96% A swab for respiratory syncytial virus (RSV) is positive. Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated. After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home…
- You are working in a large urban pediatric clinic after-hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions. The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA). Born at 36 weeks gestation. Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare. T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96% A swab for respiratory syncytial virus (RSV) is positive. Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated. After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home…You are working in a large urban pediatric clinic after-hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions. The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA). Born at 36 weeks gestation. Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare. T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96% A swab for respiratory syncytial virus (RSV) is positive. Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated. After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home…This 58-year-old nuclear power plant worker saw his family physician because of increasing fatigue and weakness. He also reported pain in his lower back and arms when he walks. Physical examination revealed that the man had pale mucous membranes and hepatosplenomegaly. The physician orders a complete blood count (CBC) and urinalysis (UA). A follow-up appointment is scheduled for the following week. Laboratory Data The CBC revealed that the patient had anemia. His leukocyte count and differential count were normal, except for a rouleaux (rolled coin) appearance of the RBCs. The UA was normal. The patient was called and requested to return to the laboratory for additional tests. The physician ordered an ESR, kidney screening profile, liver blood profile, and radiographic skeletal survey, with the following results: ESR—50 mm/hr Kidney profile—normal Liver profile—normal, except for increased globular protein Skeletal survey—bone lesions in various sites What follow-up laboratory tests…
- Mr. Cardia has been admitted to your ward and care is assigned to you. Information from the history you have taken includes reporting 4 days of anorexia, nausea, vomiting, and occasional diarrhoea before he sought medical attention. His wife says he'd started falling asleep frequently, looked pale, and mentioned seeing yellow spots. Current medications: 0.25 mg of digoxin once a day and 20 mg of frusemide twice a day for heart failure. Vital signs: BP 110/60 P 46 RR 26 T 36.5 What may the signs and symptoms indicate? (two words)The Admitting Diagnosis was Pre-eclampsia with superimposed chronic hypertension, and the final diagnosis was Pre-eclampsia with severe features. Monitoring of V/S and FHT q 4hrs was ordered and done. At 9:45 pm, delivered to a baby boy with AS of 8, 9. Several hours after delivery, the mother was ordered to undergo laboratory tests. The findings are normal results in CBC with typing, platelet count, and creatinine. Non-reactive HBsAg and high levels of BUN and oliguria in urinalysis. Upon checking the mother, she exhibited edema around her hands, has severe dehydration, decreased urine output, and her uterus is still boggy. The V/S of the mother is BP: 140/90 mmHg, T: 37.0ºC, RR: 15 breaths/min, PR: 65 beats/min, and the mother verbalize pain and discomfort. Monitor V/S every 2 hours and record. what are the possible nursing diagnosis based on this situation?A lethargic 22-month old black female was presented by her mother to the emergency room at 2:15am on a Sunday. The child had a history of a runny nose, hoarse cough and low-grade fever (-99F) for the past 48 hours. The mother was concerned about the forced and noisy breathing of the child. The pediatrician examined the child and found cloudy eyes and mild inflammation of the ears, but no overt signs of bacterial infection (no significant changes in the eardrums). The throat of the child was red and coated with mucus. The larynx was swollen and raw. The physician performed a rapid Strep test and found it was negative. Throat swabs were taken for culture. The physician placed the child in a room with a warm vaporizer for about 30 minutes. This dramatically improved the breathing of the child. 1. What is the infectious agent that caused this case? 2. Do you believe that this is a bacterial or viral disease? Why? 3. What further treatment is indicated for this case?
- The healthcare provider orders erythromycin 20 mg/kg/day every 8 hours in equally divided dose.The child weighs 44 pounds. How many rilligrams per dose should the nurse administer?Mr. Reddy is a 62 yo presenting to ED at 1500hrs. He was preparing the gas cylinder for a Sunday BBQ when it suddenly exploded while he was trying to connect the hose. Family standing by tried to extinguish the fire with their hands and tried to remove his clothing. Burns 30% TBSA – Face, hands, bilateral lower limbs. Complaints of severe pain and burning 10/10. Past Medical History: Hypertension, Type II DM Regular medications – Candesartan 8mg, Glimepiride 4mg, Metformin 500mg and Pravastatin 20mg. Fully vaccinated against COVID. Airway. - Patent, superficial burns to right side of face Breathing. - Spontaneous, RR-22mt, SPO2-92% RA, air-entry equal Circulation- Lower limb odema, cap refill 3 seconds, bilateral dorsal pedis pulses weak. BP- 88/50 mmHg, HR- 127/mt, sinus tachycardia, Disability - GCS-15 E4V5M6, PEARL- 3mm, Exposure - Temperature 35.9 deg Celsius. Full thickness burns to right lower limb and right arm, partial thickness burns to left lower limb, bilateral hands.…Bradley Buchanan presents to the neighborhood nurse-run clinic with shortness of breath, a persistent cough with blood-tinged sputum, recent weight loss, and night sweats. On initial assessment, the client has a fever of 101.4°F and pain in his chest. His other vital signs are as follows: pulse 98 beats per minute; respirations 26 per minute; blood pressure 110/76 mm Hg; height 68 inches; and weight 140 pounds. Mr. Buchanan is 45 years old. He is employed as a dishwasher at a local restaurant and lives at the local shelter with his wife, who is 8 months pregnant, and his 13-year-old son. Mr. Buchanan is concerned that if he cannot go to work, he will lose the family’s only income. At this point, although Mr. Buchanan’s signs and symptoms and his purified protein derivative test results seem to indicate that he may have tuberculosis, the nurse must pursue further confirmation of the diagnosis. Questions for students: What would be the nurse’s next action? Should the nurse do any…