A nurse is caring for a 4-month-old infant who is one day postoperative following surgical repair of a cleft lip. Which of the following actions should the nurse take? Select all that apply
Position the infant on their back and upright in Semi-Fowler's
Encourage the parents told the baby
Administer aspirin for pain
Apply elbow restraints as ordered
Maintain IV therapy for nutrition
Correct Answer : A,D,E
A. Positioning the infant on their back and upright in Semi-Fowler's helps prevent aspiration and supports respiratory function after surgery.
B. Encouraging parents to hold the baby is important for bonding, but caution should be taken to avoid placing pressure on the surgical site.
C. Aspirin should not be administered due to the risk of Reye's syndrome; acetaminophen is typically used for pain management in infants.
D. Applying elbow restraints as ordered is necessary to prevent the infant from pulling at the surgical site and to ensure proper healing.
E. Maintaining IV therapy is crucial for nutrition until the infant can take oral feeds safely.
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Related Questions
Correct Answer is D
Explanation
A. While monitoring temperature can be important, it is not the primary focus post-crisis unless there are specific concerns.
B. Cold compresses can constrict blood vessels and worsen sickling; heat is usually recommended for pain relief in sickle cell crisis.
C. Restricting outdoor play is not necessary; children with sickle cell anemia should be encouraged to engage in regular activities within their limits.
D. Offering fluids frequently helps prevent dehydration, which can trigger a sickle cell crisis, making it an essential part of discharge teaching.
Correct Answer is D
Explanation
A. Administering iron supplements at mealtimes can decrease absorption, making it less effective.
B. Giving ferrous sulfate with milk can inhibit the absorption of iron due to the calcium content.
C. Administering iron at bedtime is not recommended because it can cause gastrointestinal upset and may interfere with sleep.
D. Giving ferrous sulfate with orange juice enhances the absorption of iron due to the vitamin C content, which is beneficial for children with iron deficiency anemia.
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