A home care nurse is visiting a 5-day-old male infant for a ...

[bobbysung]

A home care nurse is visiting a 5-day-old male infant for a scheduled follow-up appointment to ensure that he is responding to home phototherapy for treatment of jaundice.
 
  After completing a thorough assessment and obtaining a history from the parents, the nurse recognizes that this infant is in the first phase of encephalopathy when he exhibits: 1. A high-pitched cry when touched.
   2. Severe muscle spasms.
   3. Fever and seizures.
   4. Hypotonia, lethargy, and a poor suck when feeding.

Question 2

Trevon, a 4-year-old has been admitted to the emergency room via ambulance after a motor vehicle accident. Trevon is unconscious and is being given life-sustaining treatment.
 
  When the family arrives, the charge nurse takes Trevon's parents to a family room. It is important that the nurse: 1. Provides clear information.
   2. Does not provide promises.
   3. Calls a member of the clergy and a social worker to be with the family.
   4. All of the above should be addressed for Trevon's family.
   5. None of the above should be addressed for Trevon's family.

[meganmoser117]

Answer to Question 1

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1. A high-pitched cry occurs in later phases of the encephalopathy.
2. Muscle spasms are not present with this diagnosis.
3. Fevers are rare in neonates with encephalopathy. The seizures can occur if the levels continue to climb.
4. Hypotonia, lethargy, and poor feedings are the first symptoms to occur in the first phase of encephalopathy caused by jaundice.

Answer to Question 2

4
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1. Needed for effective care for the family, along with other answers
2. Needed for effective care for the family, along with other answers
3. Needed for effective care for the family, along with other answers
4. All the answers provide effective communication for the situation.
5. One answer is correct.

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Gracias!

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TYSM