While being comforted in the Emergency Department, the 7-year-old ...

[appyboo]

While being comforted in the Emergency Department, the 7-year-old sibling of a pediatric trauma victim blurts out to the nurse, It's all my fault When we were fighting yesterday, I told him I wished he was dead The nurse, realizing that the
 
  child is experiencing magical thinking, should respond by: 1. Asking the child if he would like to sit down and drink some water.
 
  2. Sitting the child down in an empty room with markers and paper so that he can draw a picture.
 
  3. Calmly discussing the catheters, tubes, and equipment that the patient requires, and explaining to the sibling why the patient needs them.
 
  4. Reassuring the child that it is normal to get angry and say things that we do not mean, but that we have no control over whether an accident happens.

Question 2

A two-month-old infant with a congenital heart defect has been admitted to the pediatric intensive care unit with congestive heart failure. Nursing care for this child should include which intervention?
 
  1. Monitor respirations during active periods.
  2. Give larger feedings less often to conserve energy.
  3. Organize activities to allow for uninterrupted sleep.
  4. Force fluids appropriate for age.

[diana chang]

Answer to Question 1

4

Rationale:

1. Ignoring the child's outburst will not help the child understand it really was not his fault.
2. Asking the child to draw a picture might be appropriate later, but the nurse first needs to make sure the child knows the trauma did not occur because of his statement.
3. Addressing the sibling's needs and equipment reinforces the child's magical thinking that the trauma was his fault.
4. Magical thinking is the belief that events occur because of one's thoughts or actions, and the most therapeutic way to respond to this is to correct any misconceptions that the child might have and reassure him that he is not to blame for any accident or illness.

Answer to Question 2

3
Rationale 1: Respirations are difficult to monitor during active periods, making this an unrealistic goal.
Rationale 2: Feedings should be small-volume, high-calorie.
Rationale 3: It is important to allow for uninterrupted sleep to decrease metabolic demands on the heart.
Rationale 4: Fluids should be restricted to high-calorie and low-volume in order to avoid overloading the lungs with fluid.
Global

[appyboo]

TYSM

[ryhom]

Excellent