A nurse on a pediatric unit is caring for four children. The nurse should use droplet precautions for which of the following children?

Condition Most Likely Experiencing

• Pyloric stenosis causes projectile vomiting, dehydration, and hunger.
• Cystic fibrosis causes chronic respiratory infections, steatorrhea, and failure to thrive.
• The condition that the infant is most likely experiencing is congestive heart failure, which can cause poor weight gain, tachypnea, decreased appetite, and periorbital edema.
• Respiratory syncytial virus bronchiolitis causes wheezing, coughing, and respiratory distress.

Actions to Take

• Digoxin is a medication commonly prescribed to manage congestive heart failure in infants by improving cardiac contractility and reducing heart rate.
• Elevating the head of the bed helps reduce venous return to the heart, thereby decreasing preload and relieving symptoms of congestion in congestive heart failure.
• Contact precautions are not indicated for congestive heart failure, but for infections that are transmitted by direct or indirect contact.
• Chest physiotherapy and postural drainage are not indicated for congestive heart failure, but for conditions that cause excessive mucus production and retention.

Parameters to Monitor

• Number of steatorrhea stools is not relevant for congestive heart failure, but for cystic fibrosis or other malabsorption disorders.
• Monitoring intake and output is crucial in assessing fluid balance, especially in congestive heart failure where fluid retention can lead to volume overload.
• Monitoring respiratory status is essential in congestive heart failure to assess for signs of pulmonary congestion and respiratory distress, such as tachypnea, retractions, and crackles.
• Presence of periorbital edema is not a parameter to monitor, but a sign of fluid overload.

A. Cutting and filing the child's fingernails frequently can help prevent excessive scratching and further damage to the skin.
B. Using a mild detergent reduces the risk of skin irritation and exacerbation of atopic dermatitis.
C. Pimecrolimus cream should be applied thinly, not in a thick layer, to the affected areas to avoid potential side effects.
D. Atopic dermatitis tends to have periodic flare-ups, so it's important to inform the guardian about this aspect of the condition.
E. Atopic dermatitis itself is not contagious, although the child may be prone to skin infections if lesions are present.
F. Applying gloves to the child's hands can prevent scratching and further skin damage.

G. Emollients help to moisturize the skin and improve its barrier function, which is important in managing atopic dermatitis.