A nurse is planning care for a child who has epiglottitis. Which of the following actions should the nurse plan to take?
Obtain a throat culture.
Visualize the epiglottis using a tongue depressor.
Provide moist air to reduce the inflammation of the epiglottis
Initiate airborne precautions.
The Correct Answer is C
A. Obtain a throat culture.
This option is not appropriate as a primary nursing action in the acute management of epiglottitis. While obtaining a throat culture may be necessary for diagnostic purposes, it is not a priority in the immediate care of a child with suspected epiglottitis. The focus should be on ensuring airway patency and providing emergency treatment.
B. Visualize the epiglottis using a tongue depressor.
This option is contraindicated in the acute management of epiglottitis. Direct visualization of the epiglottis using a tongue depressor or other instruments can provoke spasm of the epiglottis and worsen airway obstruction. Attempting to visualize the epiglottis should be avoided until the child's airway has been secured in a controlled environment, such as in the operating room under anesthesia.
C. Provide moist air to reduce the inflammation of the epiglottis.
This option is appropriate. Providing moist air, such as humidified oxygen or a cool mist, can help soothe the inflamed tissues of the epiglottis and upper airway. Moist air may help alleviate discomfort and reduce inflammation, although it will not directly address the risk of airway obstruction. It is often used as supportive therapy in conjunction with other interventions.
D. Initiate airborne precautions.
This option is not necessary for the care of a child with epiglottitis. Epiglottitis is not typically transmitted through airborne droplets. The priority in the management of epiglottitis is ensuring a patent airway and providing appropriate treatment to reduce inflammation and prevent complications.
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Related Questions
Correct Answer is C
Explanation
A. A room with a toddler who has pneumonia.
This option is not ideal because both RSV and pneumonia are respiratory infections that can spread to other patients. Placing these two patients together could increase the risk of cross-infection.
B. A private room with reverse isolation.
Reverse isolation is typically used to protect immunocompromised patients from acquiring infections from others. However, in the case of RSV, reverse isolation is not necessary because RSV primarily affects infants and young children who are generally not immunocompromised. Therefore, this option is not appropriate for an infant with RSV.
C. A private room with contact/droplet precautions.
This option is the most appropriate. RSV is primarily spread through respiratory droplets and direct contact with respiratory secretions. Placing the infant in a private room with contact/droplet precautions helps to minimize the risk of transmission to other patients. Healthcare workers and visitors entering the room should adhere to appropriate precautions, including wearing personal protective equipment (PPE) such as masks, gloves, and gowns.
D. A room with an infant who has croup.
Placing an infant with RSV in the same room as an infant with croup is not ideal because both conditions involve respiratory symptoms and may increase the risk of cross-infection.
Correct Answer is C
Explanation
A. Overriding aorta: In Tetralogy of Fallot, the aorta is positioned over the ventricular septal defect (VSD), rather than solely over the left ventricle as it would be in a normal heart. This is called overriding aorta, which allows blood from both the right and left ventricles to enter the aorta.
B. Pulmonary stenosis: This is a critical component of Tetralogy of Fallot. Pulmonary stenosis refers to narrowing of the pulmonary valve or the area just below it, which restricts blood flow from the right ventricle to the pulmonary artery. This results in decreased blood flow to the lungs for oxygenation.
C. Left ventricular hypertrophy: This choice is not typically associated with Tetralogy of Fallot. Left ventricular hypertrophy refers to an enlargement or thickening of the muscular wall of the left ventricle of the heart. It is often seen in conditions where the left ventricle has to work harder to pump blood, such as in hypertension or aortic stenosis, but it is not a characteristic feature of Tetralogy of Fallot.
D. Ventricular septal defect: This defect is one of the four components of Tetralogy of Fallot. A ventricular septal defect (VSD) is a hole in the septum, the muscular wall that separates the left and right ventricles of the heart. In Tetralogy of Fallot, the VSD allows oxygen-poor blood from the right ventricle to flow directly into the left ventricle and out to the body.
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