The school nurse suspects a first grade student has sinusitis. ...

[cookcarl]

The school nurse suspects a first grade student has sinusitis. Which symptoms might lead the nurse to this suspicion? (Select all that apply.)
 
  a. Child reports tooth pain.
  b. Severe wheezing is auscultated on inspiration.
  c. Child reports, I have had a cold for 2 weeks.
  d. Nurse observes periorbital swelling.
  e. Halitosis is present.

Question 2

The nurse is caring for a 4-year-old child diagnosed with H. influenzae type B. Which signs and symptoms exhibited by the child would alert the nurse to suspect epiglottitis? (Select all that apply.)
 
  a. Harsh cough
  b. Restlessness
  c. Edematous epiglottis
  d. Child insists on lying down
  e. Drooling

[gcook]

Answer to Question 1

ANS: A, C, D, E
The proximity of the sinus to the tooth roots often results in tooth pain when the sinus is infected. The maxillary and ethmoid sinuses are most often involved in childhood sinusitis. Therefore the signs and symptoms of sinusitis in children are different from those in adults, depending on the age of the child and which sinus is fully developed. An acute sinusitis is suspected when an upper respiratory infection lasts longer than 10 days, with a daytime cough. Halitosis is often present. Untreated sinusitis can lead to periorbital cellulitis. Severe wheezing is not indicative of sinusitis.

Answer to Question 2

ANS: B, C, E
H. influenzae type B and most often occurs in children 3 to 6 years of age. It can occur in any season. The course is rapid and progressive. The onset of epiglottitis is abrupt, and the child presents with classic symptoms. The child insists on sitting up, leans forward with the mouth open, and drools saliva because of the difficulty in swallowing. The child appears wide-eyed, anxious, and restless, and he or she may emit a froglike croaking sound on inspiration. Cough is absent. Inspection of the throat shows an enlarged, reddened edematous epiglottis much like a beefy-red thumb. However, the examining tongue blade may trigger a laryngospasm and result in sudden respiratory arrest.