A nurse is preparing to perform a dressing change on a preschooler. Which of the following actions should the nurse take to prepare the child for the procedure?

Rationale for Correct Choices

• Administer oxygen at 2 L/min via nasal cannula: The client’s oxygen saturation of 92% indicates mild hypoxemia, which can worsen myocardial ischemia. Administering low-flow oxygen enhances myocardial oxygen delivery and helps reduce chest pain and tissue damage.

• Administer sublingual nitroglycerin: After oxygen therapy, sublingual nitroglycerin is the next appropriate step to relieve ischemic chest pain. It dilates coronary arteries, improves blood flow, and reduces myocardial oxygen demand. The nurse should monitor blood pressure and pain relief closely after administration.

Rationale for Incorrect Choices

• Request a prescription for an increase in statin medication: Although the client’s total cholesterol and LDL levels are elevated, statin adjustment is a long-term management measure. It does not address the acute chest pain or compromised oxygenation that the client is currently experiencing.

• Prepare the client for cardiac catheterization: While cardiac catheterization may be needed if myocardial infarction is confirmed, immediate stabilization of oxygen and pain takes priority. The nurse must first implement emergency interventions before preparing for invasive procedures.

• Request a prescription for a beta-blocker: Beta-blockers help lower heart rate and myocardial oxygen demand but are not administered during initial emergency management. They are prescribed only after the client is stabilized and contraindications have been ruled out.

• Checking a STAT cardiac troponin: Checking a STAT cardiac troponin is an important diagnostic action to rule in or out an acute myocardial infarction, however, clinical management of acute symptoms takes precedence over waiting for a laboratory result.

Rationale:
A. Encourage the client to eat a large meal in the evening: Clients with myasthenia gravis experience progressive muscle weakness, especially later in the day. Eating large evening meals increases the risk of fatigue and aspiration because muscle strength is reduced after activity.

B. Recommend the client eat within 45 min of taking cholinesterase-inhibitor medication: Cholinesterase inhibitors, such as pyridostigmine, enhance neuromuscular transmission and improve muscle strength. Eating within 45 minutes of taking the medication ensures optimal swallowing ability and reduces the risk of aspiration by aligning mealtime with peak effect.

C. Recommend the client extend their neck to facilitate swallowing: Extending the neck actually increases the risk of aspiration by opening the airway. Clients should be instructed to flex the neck slightly forward while swallowing to close the airway and promote safe swallowing mechanics.

D. Encourage the client to contact an occupational therapist to learn techniques of avoiding aspiration: While an occupational therapist can provide helpful adaptive techniques, primary aspiration prevention teaching should come directly from the nurse and speech-language pathologist.