What nursing consideration is important when suctioning a young ...

[Alainaaa8]

What nursing consideration is important when suctioning a young child who has had heart surgery?
 
  a. Perform suctioning at least every hour.
  b. Suction for no longer than 30 seconds at a time.
  c. Expect symptoms of respiratory distress when suctioning.
  d. Administer supplemental oxygen before and after suctioning.

Question 2

Seventy-two hours after cardiac surgery, a young child has a temperature of 38.4 C (101.1 F). What action should the nurse perform?
 
  a. Report findings to the practitioner.
  b. Apply a hypothermia blanket.
  c. Keep the child warm with blankets.
  d. Record the temperature on the assessment flow sheet.

[deja]

Answer to Question 1

ANS: D
When suctioning is indicated, supplemental oxygen is administered with a manual resuscitation bag before and after the procedure to prevent hypoxia. Suctioning should be done only as indicated and very carefully to avoid vagal stimulation. The child should be suctioned for no more than 5 seconds at a time. Symptoms of respiratory distress are avoided by using appropriate technique.

Answer to Question 2

ANS: A
In the first 24 to 48 hours after surgery, the body temperature may increase to 37.8 C (100 F) as part of the inflammatory response to tissue trauma. If the temperature is higher or fever continues after this period, it is most likely a sign of an infection, and immediate investigation is indicated. A hypothermia blanket is not indicated for this level of temperature. Blankets should be removed from the child to keep the temperature from increasing. The temperature should be recorded, but the practitioner must be notified for evaluation.