A nurse is planning to change the dressings on a school-age child who has sustained multiple burns. Which of the following actions should the nurse plan to take?

Miosis : Pinpoint pupils are a hallmark of opioid overdose due to stimulation of the parasympathetic nervous system. This finding helps distinguish opioid toxicity from other types of substance use, which often cause pupil dilation instead.

Respiratory depression : Opioids depress the medullary respiratory centers in the brainstem, leading to slowed breathing. A respiratory rate of 10/min is significantly reduced and signals impaired ventilation, making it a critical diagnostic clue.

Opioid overdose: The clinical signs—needle marks, sedation, pinpoint pupils, bradypnea, and a positive response to naloxone—all strongly point to an opioid overdose. A similar prior episode adds to the likelihood of chronic opioid misuse.

Alcohol intoxication: While alcohol can depress the central nervous system, it does not typically cause miosis or respond to naloxone. Also, the pattern of rapid reversal with naloxone suggests opioid involvement rather than alcohol alone.

Benzodiazepine overdose: Though it shares features like sedation and respiratory depression with opioid overdose, benzodiazepine toxicity does not cause miosis, and naloxone has limited or no effectiveness as a reversal agent.

Cocaine intoxication : Typically causes stimulant effects including mydriasis (dilated pupils), increased heart rate, hypertension, and agitation. These are not consistent with the symptoms in this case, which reflect CNS depression.

A. Place the booster seat where there is an air bag in the vehicle. Booster seats should never be placed in front of an active air bag, especially in the front seat. Air bags can cause serious injury or death to young children in the event of deployment.
B. Avoid using the lap shoulder belt when the child is in a booster seat. A lap-shoulder belt is required for proper use of a booster seat. The shoulder belt helps distribute force across the child’s chest and shoulders in a crash. Using only a lap belt increases the risk of serious abdominal and spinal injuries.
C. Use a no-back booster seat if the vehicle seat has a headrest. This is correct and safe. A no-back booster is appropriate as long as the vehicle seat has a high back or headrest that provides support for the child’s neck and head, ensuring proper positioning of the seat belt.
D. Keep the booster seat rear-facing until the child weighs at least 16 kg (35.3 lb). Booster seats are designed for forward-facing children who have outgrown a forward-facing harness seat, typically around 4 years of age and 40 pounds. Rear-facing seats are used prior to booster seats, for infants and toddlers, not for booster seat-age children.