A 2-year-old child is being transported to the trauma center from ...

[kshipps]

A 2-year-old child is being transported to the trauma center from a local community hospital for treatment of a burn injury that is estimated as covering over 40 of the body. The burns are both partial- and full-thickness burns.
 
  The nurse is asked to prepare for the arrival of the child and gathers supplies, anticipating that which of the following will be prescribed initially? 1. Insertion of a Foley catheter
  2. Insertion of a nasogastric tube
  3. Administration of an anesthetic agent for sedation
  4. Application of an antimicrobial agent to the burns

Question 2

The client is receiving oral anticoagulant therapy with warfarin (Coumadin). The result of a newly drawn prothrombin time (PT) is 40 seconds. The nurse anticipates carrying out a prescription to do which of the following?
 
  1. Hold the next dose of warfarin.
  2. Increase the next dose of warfarin.
  3. Administer the next dose of warfarin.
  4. Stop the warfarin, and administer heparin.

[lou]

Answer to Question 1

1

Rationale: A Foley catheter is inserted into the child's bladder so that urine output can be accu-rately measured on an hourly basis. Although pain medication may be required, the child would not receive an anesthetic agent and should not be sedated. The burn wounds would be cleansed after assessment, but this would not be the initial action. IV fluids are administered at a rate suf-ficient to keep the child's urine output at 1 to 2 mL/kg of body weight per hour for children weighing less than 30 kg, thus reflecting adequate tissue perfusion. A nasogastric tube may or may not be required but would not be the priority intervention.

Answer to Question 2

1

Rationale: The normal PT is 11.0 to 12.5 seconds for adults. Appropriate therapy for full anti-coagulation should prolong the PT by 1.5 to 2 times. Because the value stated is extremely high, the nurse should anticipate that the client would not receive further doses at this time. If the level were too high, then the antidote (vitamin K) could also be prescribed. It would be dangerous to add a different anticoagulant to the client's regimen at this time (stop the warfarin, and admin-ister heparin).

[kshipps]

Gracias!

[Viet Thy]

TYSM