A seven-year-old with a head injury is hospitalized after losing ...

[Engineer]

A seven-year-old with a head injury is hospitalized after losing consciousness when he was hit in the head with a bat at baseball practice. The child was not wearing a helmet.
 
  The last set of vital signs showed heart rate 48, BP 148/74, respiratory rate 28 and irregular. The nurse suspects that these vital signs are: 1. A sign that this child has a spinal cord injury.
  2. A sign of increased intracranial pressure.
  3. Typical for a sleeping child at this age.
  4. A sign that the child's condition is improving.

Question 2

A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) along with bedrest have been ordered for this child.
 
  Place the following steps in order from first to last. 1. Administer the antibiotics.
   2. Administer IVFs as ordered.
   3. Obtain ordered cultures.
   4. Ensure the child has bedrest.

[tofugiraffe]

Answer to Question 1

2
Rationale 1: These vital signs are a sign of increased intracranial pressure. If it were a spinal cord injury, and neurogenic shock were suspected, the child would be hypotensive.
Rationale 2: These vital signs show increased BP, with a wide pulse pressure, slow heart rate, and respirations that are irregular, all indicating possible significant increased intracranial pressure.
Rationale 3: Normal sleeping pulse at this age is 60-90 bpm.
Rationale 4: Without previous vital signs, there is no way to determine the changes in the vital signs.
Global

Answer to Question 2

3,1,2,4

Explanation: Obtain the cultures first, because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Provide IVF after the higher-risk need of providing antibiotics had been met, unless the child is in shock, in which case IVF therapy would take precedence. Provide comfort followed by bedrest to allow the child to rest, once higher-priority
needs have been met.
Cognitive: Analysis
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome 29.3 Integrate information about oncologic emergencies into plans for monitoring all children with cancer.

[Engineer]

Thanks for the timely response, appreciate it

[cici]

Gracias!