nurse is planning care for a child who has suspected epiglottitis. Which of the following actions should the nurse take?
Visualize the epiglottis with a tongue depressor.
Transport the child to radiology for a throat x-ray.
Obtain a throat culture.
Place the child in an upright position.
The Correct Answer is D
A. Visualizing the epiglottis with a tongue depressor is contraindicated in suspected epiglottitis due to the risk of triggering airway obstruction.
B. Transporting the child to radiology for a throat x-ray is not a priority and can delay necessary interventions.
C. Obtaining a throat culture is not appropriate in this situation, as airway compromise can occur quickly, and immediate management is crucial.
D. Placing the child in an upright position helps ease breathing and can alleviate distress, which is vital for a child with suspected epiglottitis.
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Correct Answer is C
Explanation
A. Using a tongue depressor can provoke spasm of the epiglottis and lead to airway obstruction; therefore, this action is contraindicated in a child with epiglottitis.
B. Airborne precautions are not necessary for epiglottitis; droplet precautions are more appropriate due to the risk of transmission.
C. Monitoring oxygen saturation is critical in this situation to assess the child's respiratory status and ensure adequate oxygenation, making it the most appropriate action.
D. Obtaining a throat culture may not be safe or practical in this scenario, as it can provoke further distress and complications; immediate assessment and stabilization are prioritized.
Correct Answer is D
Explanation
A. Encouraging excessive rest and avoidance of physical activities can lead to feelings of inferiority by limiting opportunities for achievement and social interactions.
B. Limiting social interactions is counterproductive, as friendships and peer relationships are critical for social development during this stage.
C. While supervision is important, overly controlling the child’s activities can inhibit their ability to explore and learn, negatively impacting their sense of industry.
D. Involving the child in decision-making and providing opportunities for independent tasks fosters a sense of competence and accomplishment, essential for developing a sense of industry, according to Erikson’s theory.