A nurse in a long-term care facility is managing the care of an older adult client who has difficulty swallowing and occasional choking during meals. The nurse should initiate a referral to which of the following members of the interprofessional care team?

A. Vaccinate susceptible children and adults against smallpox: Vaccination is a public health intervention but is typically conducted under the direction of public health authorities and is not a routine nursing disaster preparation activity.

B. Assess types, levels, and scopes of disasters: While understanding disaster types is important, assessment of scope and level is generally part of emergency management planning at an organizational or governmental level, rather than a direct nursing responsibility.

C. Make quarantine preparations for those exposed to anthrax: Quarantine planning is a public health measure implemented by authorities during an actual event. Nurses may assist in care during quarantine, but preparing quarantines is not a primary preparation activity.

D. Participate in community drills and mock events: Engaging in drills and simulations allows nurses to practice roles, improve response times, and enhance preparedness for real disaster situations. Participation in these exercises is a key nursing activity in disaster planning.

Rationale for correct choices:

• Reye’s syndrome is a rare but serious condition that can develop after a viral illness when aspirin is given to children. The toddler’s symptoms—lethargy, persistent vomiting, and difficulty rousing—align with signs of increased intracranial pressure associated with Reye’s syndrome.

• Aspirin administration during a recent influenza A infection is a known trigger for Reye’s syndrome, as it can cause acute encephalopathy and liver dysfunction in pediatric patients.

Rationale for incorrect choices:

• Bronchitis would present with prominent lower respiratory symptoms such as productive cough, wheezing, and abnormal lung sounds, which are not noted here.

• Gastroenteritis is characterized by vomiting and diarrhea with signs of dehydration; this child has no diarrhea, and the neurological decline suggests CNS involvement rather than a purely GI process.

• Acetaminophen administration is not linked to Reye’s syndrome; toxicity causes liver injury but does not present with acute encephalopathy following viral illness in the same way.

• Cough finding is unrelated to the primary cause of the neurological changes and persistent vomiting; the cough has been present but is not the trigger for the current complication.