A school nurse is assessing a child and notes various bruises on the child's body that are unexplained. Which of the following actions should the school nurse take?

Rationale:

A. Administer a bronchodilator following meals: Bronchodilators should be administered before meals, not after, to help relieve shortness of breath and improve the client’s ability to eat without fatigue or dyspnea. Giving them afterward does not assist with eating difficulties.

B. Limit the client's food consumption between meals: Restricting food intake between meals would reduce overall caloric intake, which is counterproductive for a client who is underweight and experiencing nutritional deficits due to COPD. Frequent small meals are usually recommended.

C. Arrange for a low-protein diet: Clients with COPD who are underweight often need adequate protein to maintain muscle mass and respiratory function. A low-protein diet could worsen malnutrition and impair recovery.

D. Request non-gas-forming foods from the dietary department: Non-gas-forming foods reduce bloating and abdominal discomfort, which can make eating easier for clients with COPD who experience dyspnea. This intervention supports improved caloric intake and minimizes respiratory compromise during meals.

Rationale:

A. Hemoglobin and hematocrit: The client’s hemoglobin (9.1 g/dL) and hematocrit (27%) are significantly below normal, indicating anemia, likely from gastrointestinal bleeding. This finding requires immediate follow-up to prevent further hemodynamic compromise and assess for ongoing blood loss.

B. Stool results: The client reports dark, tarry stool, which is indicative of melena and gastrointestinal bleeding. Positive hemoccult (if confirmed) further supports active bleeding. Prompt evaluation is necessary to identify the source and prevent severe anemia or shock.

C. Temperature: The client’s temperature is 37.5°C (99.5°F), which is mildly elevated but not critically high. It does not indicate an immediate life-threatening condition, though it should be monitored as part of ongoing assessment for infection.

D. WBC count: The WBC is 6,700/mm³, which is within normal limits. There is no indication of acute infection requiring immediate intervention at this time.

E. Respiratory rate: The respiratory rate of 18/min is within normal limits and does not require immediate follow-up.

F. Heart rate: The client’s heart rate is 118/min, which is tachycardic and may indicate hypovolemia from blood loss. Immediate monitoring and intervention are warranted to prevent cardiovascular compromise.

G. Blood pressure: The client’s blood pressure is 90/50 mm Hg, which is hypotensive. This may result from fluid loss due to bleeding and requires urgent assessment and stabilization to prevent shock.

H. Current medications: The client is taking high-dose ibuprofen (800 mg three times daily), a nonsteroidal anti-inflammatory drug (NSAID), which increases the risk of gastrointestinal bleeding and ulcer formation. This directly relates to the client’s presenting symptoms and requires immediate review and discontinuation.