Priorities...do you know them?
The ER RN has a 12-year old recently diagnosed with flu who has had fever for 2 days with a productive cough causing chest pain.
She also has a 10-year old who recently was diagnosed with pneumonia. This child also has fever for 2 days and a productive cough causing chest pain. Who does she triage to be seen first based off of this data alone?
What is the child with pneumonia?
There is a possibility this child is in need of antibiotics which you would not want to delay administering.
Kissing tonsils, management includes soft to liquid diet, some may find relief with tonsillectomy and/or adenoidectomy
What is tonsillitis?
Johnny was telling me about his day at school while eating his chip puffs. He went for water and then started coughing. What is the likely diagnosis?
What is aspiration pneumonia?
Jack, 10 months old, was sent home from daycare early for fever. Dad took him to the PCP where he was deemed to have the common cold. Dad reports congestion, fever, and lack of appetite. As the RN providing education before he speaks with the doc, what is on your list to review?
What is provide antipyretics, nasal saline rinses or suctioning, and pushing fluids?
You get all the points if you miss one of these earlier points but add hand washing for preventing further spread.
Tamiflu is prescribed for the management of this.
What is influenza?
A 3-month old with Pertussis or a 3-month old with TB. Who is to be seen first?
What is pertussis?
Young infants are with higher morbidity and mortality with pertussis.
Rapid Strep positive, patients may complain of sore throat, managed with penicillin or amoxicillin
What is acute infectious pharyngitis?
Susie is 4 years old and attended her first birthday party earlier today. She had so much fun when she called me, telling me about the cakes, and juices, and candies she was getting into. She also saw a dog for the first time and the mom sent me a picture of her hugging him. It was so cute. 30 minutes later, I received a call stating Susie was having trouble breathing and making whistling sounds when getting air. What is the likely diagnosis?
What is an asthma attack?
You are at Steak 48 celebrating your graduation from your nursing program when two tables across from you, there is a 14-month old child choking on a piece of steak. The choking is evidenced by coughing, gagging, and wheezing in the infant. You know that emergency treatment for a CHOKING child of this age includes what technique?
What is abdominal thrusts?
Current recommendations for the emergency treatment of a CHOKING child includes the use of abdominal thrusts for those older than 1, back blows and chest thrusts can be used for those younger than 1.
RSV causes most of these events.
What is bronchiolitis?
The RN learns of two visitors:
5-year old two months post bone marrow transplant who has an aunt coming in with a "common cold"
5-year old with cystic fibrosis who has a friend just like her from a support group site
Who serves as priority for the nurse to prevent visitation?
What is, the 5-year old with cystic fibrosis?
Those with cystic fibrosis should maintain a distance of 6-ft as they can harbor bacteria which is deadly for each other. While we want to minimize ill contacts with the fresh transplant child, they are 2-months post transplant and have begun to rebuild defenses to help fight infection as well as the families tend to be hypervigilant in ensuring mask wearing and good hand hygiene occur.
Principal cause is Epstein-Barr virus, it is transmitted in saliva or by direct intimate contact. Antibodies present IgM within 2 weeks of illness to 1 year.
What is infectious mononucleosis?
Bryan has snored like a grown man since 6 months old. We have taken him to ENT and they say his tonsils are not enlarged like his older sister's was. I just don't understand why else he would snore if he is not congested or with huge tonsils. What other test can be done to figure out what's going on AND what is the likely diagnosis?
What is a sleep study? AND What is obstructive sleep-disordered breathing (or sleep apnea)?
Tom, 12-years-old, was living on the streets and recently entered a boy's home. All members of the home were evaluated for TB and Tom was noted to be positive. He was sent to the hospital despite not displaying any symptoms. The hospital initiated a TB medication regimen and discharged him with instructions to continue outpatient. Will the RN return Tom to the boy's home understanding the management of TB?
What is yes?
Asymptomatic children with TB can attend school or daycare facilities if they are receiving pharmacotherapy. Keyword, asymptomatic.
After this injury, the child should be placed on 100% oxygen asap!
What is smoke inhalation injury?
12-year old with chronic asthma who is actively wheezing in the nurses office after PE
Or
12-year old with chronic asthma who is with peak flow readings of 40%
Who is being sent to the ER in the first ambulance?
What is peak flow reading of 40%?
A peak flow less than 50% indicates being in the red zone. Medications aren't working, they are with difficulty breathing and with multiple symptoms. We don't know if the one from PE has tried albuterol yet.
Childs classic presentation is in tripod position. This is a medical emergency with onset of symptoms being abrupt. Management includes humidified oxygen and nasotracheal intubation.
What is acute epiglottitis?
My baby was less than a year old and got this really bad cold that landed us in the hospital. She was irritable, with fever, and not really wanting to eat. This happened in the spring which was weird since I know most colds come in the winter. They said because she had this cold at less than 1 year, her risk for developing asthma in the next 12 years is significantly higher. They told me what virus it was but I forgot. I know it came up on a respiratory panel. What is the likely diagnosis?
What is respiratory syncytial virus?
Amanda presents with her 4-year-old who is currently in tripod position, drooling, and with froglike croaking projections. Doctors were able to get her settled from a respiratory standpoint. Understanding the course of illness, the RN suspects the doctors will order ____ to assist with reducing swelling.
What is antibiotic therapy (ceftriaxone or cephalosporin)?
Epiglottal swelling usually decreases after 24 hours of antibiotic therapy (ceftriaxone or alternate cephalosporin). And the epiglottis is near normal by the third day. Corticosteroids for reducing edema may be beneficial during the early treatment phase.
A new mother is in your clinic with tons of questions. She asks why is it that younger children are more likely to develop respiratory infections when compared to older children, even when she is providing magic milk (breast milk). You are able to answer this understanding this logic.
What is, immunity builds with age?
While breast milk has major benefits and can allow for a healthier child, nothing compares to actively building immunity through repeated exposure to illnesses and the increasing of lymphoid (protective) tissue in the body.
Two mothers report the following:
(1) If my baby has something stuck in her mouth, I will use my finger to sweep it out so she does not swallow it.
(2) My neonate will only fall asleep if she is sleeping face down.
Who does the RN need to work on educating first?
What is my baby only sleeps face down?
While parents should never finger sweep for fear of further lodging item, neonates sleep frequently and we worry about SIDS with this positioning. The danger for the neonate in this case is imminent and parents should be alerted immediately.
Associated with foul-smelling sputum, can cause chemical pneumonitis, and rarely leads to death but can cause infection.
What is aspiration pneumonia?
My 4-year old has heart failure and doctors told me he has increased pressures in the heart secondary to this. I was told this can move something into the alveoli making it harder for him to breathe. I know you're a nurse, do you know what this puts him at risk for?
What is (cardiogenic) pulmonary edema?
Peyton suffered a URI and then developed a barky, brassy cough. Doctors diagnosed her with acute laryngotracheobronchitis (croup). Mom was told plan of care by the docs but wants to know what to expect from you. You explain the plan as follows, knowing that these interventions assist with croup.
What is maintain the airway/ensure adequate respiratory exchange through dexamethasone, nebulized epinephrine (racemic epi), humidified air, and (its okay if you miss this) heliox (which is used during emergency transportation of a patient with severe croup, a mixture of helium and oxygen).
GABHS is the most common causative organism for this infection.
What is acute infectious pharyngitis?