A 6 year old had a tonsillectomy today. When the nurse goes into ...

[Chelseaamend]

A 6 year old had a tonsillectomy today. When the nurse goes into the room to give him his antibiotics, she finds him irritable, coughing, nauseated, and swallowing repeatedly. What is the next action the nurse should take?
 
  1. Assess for signs of frank red blood in the mouth and nose and get a complete set of vital signs.
   2. Ask the child for a pain score and if he would like a popsicle with his pain medicine.
   3. Suction mouth vigorously to avoid aspiration of blood, and then hang antibiotic.
   4. Take a complete set of vital signs and divert the child's attention to the cartoon on TV.

Question 2

Adam has been brought to the pediatric outreach center for his kindergarten checkup. The nurse knows that she must assess which of the following areas to achieve a complete musculoskeletal assessment? Select all that apply.
 
  1. Physical head-to-toe exam
   2. History of birth and since for any major/minor injuries
   3. Height and weight
   4. Family expectations
   5. A Denver II study

[Ahnyah]

Answer to Question 1

1
Feedback
1. This intervention assesses for bleeding.
2. An assessment for blood needs to occur because the child continues to swallow.
3. Suctioning can cause clots to loosen and increases bleeding. It should be avoided.
4. Vital signs are needed and a focused assessment needs to be completed in order to identify complications.

Answer to Question 2

1, 2, 3, 4
Feedback
1. A head-to-toe assessment allows for all major body systems to be assessed in a systematic manner, not one that confuses or scares the child.
2. The history allows for information on anything that may influence findings.
3. Growth and nutrition can be assessed.
4. Family values and morals influence the child's cognitive, social, and physical well-being.
The Denver II is given in situations where there is concern for cognitive ability impairment This test takes substantial amount of time and is usually done with a doctor or therapist.

[Chelseaamend]

Gracias!

[aliotak]

Excellent