A nurse is collaborating with social services in the discharge planning for a young adult client who is below the poverty income level and will require home V therapy. Which of the following resources should the nurse recommend? (Select all that apply.)

Rationale:

• Drooling: Drooling is classic in epiglottitis due to severe throat pain and an inability to swallow. It is not commonly seen in RSV or streptococcal pharyngitis, where swallowing remains relatively intact.
• Hypoxia: Both epiglottitis and RSV can cause hypoxia. In epiglottitis, airway obstruction can quickly compromise oxygenation. In RSV, hypoxia results from inflammation and mucus plugging in the small airways.
• Fever: Fever is a nonspecific but common finding across all three conditions. It signals an inflammatory or infectious process, whether viral (RSV), bacterial (Streptococcus), or in epiglottitis (often Haemophilus influenzae type b if unimmunized).
• Tachypnea: Tachypnea may occur in both epiglottitis and RSV as the body compensates for airway compromise and impaired gas exchange. It is not a typical feature of uncomplicated streptococcal pharyngitis.
• Exudate on pharynx: Pharyngeal exudates are common in streptococcal pharyngitis and help differentiate it from viral causes. They are typically absent in RSV and epiglottitis, where the pathology lies elsewhere (lower airways or supraglottic structures).
• Wheezing upon auscultation: Wheezing is a hallmark of RSV due to bronchiolar inflammation and narrowing. It is not seen in epiglottitis or streptococcal pharyngitis, as those conditions do not primarily affect the bronchioles.

Rationale:

A. Nurses notes are used to create the critical pathway: Critical pathways are developed from evidence-based clinical guidelines and best practices, not directly from nurses’ notes. While documentation may help track progress, it is not the foundation for pathway creation.

B. Critical pathways should reduce health care costs: Critical pathways standardize care for specific diagnoses, promoting timely interventions and reducing unnecessary treatments or delays. This efficiency helps lower healthcare costs while improving patient outcomes.

C. Critical pathways have an unlimited timeframe for completion: Each critical pathway includes a defined timeline with expected outcomes for each phase of care. This structure ensures care is efficient and progress is monitored closely to prevent delays or complications.

D. Nurses should discontinue the critical pathway if variances occur: Variances are deviations from the expected outcomes and are used to evaluate and adjust care. They do not justify discontinuing the entire pathway but rather indicate a need for reassessment or individualized modifications.