Author Question: A nurse is caring for a child with nephritic syndrome who is severely edematous and has been placed ... (Read 76 times)

Metfan725 · **on:** Jul 22, 2018

A nurse is caring for a child with nephritic syndrome who is severely edematous and has been placed on complete bed rest. Which of the following is a priority intervention for this client?

1. Reposition the child every two hours
2. Monitor blood pressure every 30 minutes
3. Encourage fluids
4. Limit visitors

Question 2

While caring for a critically ill child, the child's mother becomes distraught and begins to cry loudly while stroking the child's face. The nurse's best response to this occurrence is to:

1. Tell the mother that she needs to control herself for the benefit of her child.
2. Distract the mother by having her straighten the linens on the bed.
3. Explain the procedure that will occur with the treatment.
4. Take the mother out of the room and comfort her.

cat123 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

1. Reposition the child every two hours

Rationale:
A child with severe edema, on bed rest, is at risk for altered skin integrity. To prevent skin breakdown, the child should be repositioned every two hours. Vital signs are taken every four hours. Fluids need to be monitored and should not be encouraged. The child needs social interaction, so visitors should not be limited.

Answer to Question 2

4. Take the mother out of the room and comfort her.

Rationale:
In this situation, the nurse must analyze which of the available options would be best for this mother and child. At this level of emotion, the nurse should remove the mother from the room and comfort her. While the mother's expression of anxiety is understandable, the child should be protected from this strongly upsetting situation. Just telling the mother to control herself discounts the seriousness of her anxiety and may serve to alienate the mother from the nurse. This mother is too upset to distract by smoothing linens. Explaining the procedure may help, but the mother should be removed at least temporarily and be comforted so that she will be able to receive the information.