Exhibits

For each potential assessment finding, click to specify if the finding is consistent with Crohn’s disease, appendicitis or intussusception. Each finding may support more than 1 disease process.

Rationale:

A. "Avoid high-fiber foods while taking this medication." High-fiber foods are encouraged when taking opioids like fentanyl due to the common side effect of constipation. Dietary fiber supports bowel function and should not be avoided.

B. "Apply the patch to your forearm." The patch should be applied to a flat, non-irritated area with minimal hair, such as the chest, back, or upper arm. The forearm is not the preferred site due to its mobility and smaller surface area.

C. "Avoid hot tubs while wearing the patch." Heat increases the absorption rate of transdermal fentanyl, potentially leading to overdose. Clients should avoid hot tubs, heating pads, or prolonged exposure to direct sunlight while wearing the patch.

D. "Remove the patch for 8 hours every day to reduce the risk of tolerance." Fentanyl patches are designed to provide continuous pain control and should not be removed intermittently. Removing the patch disrupts pain management and does not prevent tolerance, which is managed by medical adjustment if necessary.

Rationale for correct choices:

• Pneumonia: The child is at risk for pneumonia, a common postoperative complication in pediatric clients, particularly after abdominal surgery. The presence of shallow breathing, refusal to use the incentive spirometer, and slight decrease in breath sounds at the bases suggest poor lung expansion and secretion stasis, increasing the risk of atelectasis and secondary infection.
• Shallow breathing: Shallow breathing is likely due to pain and limited movement of the diaphragm after abdominal surgery. It reduces alveolar ventilation, promoting hypoventilation and mucus retention, which predisposes the lungs to infection and the development of postoperative pneumonia.
• Lack of incentive spirometer use: Incentive spirometry is essential for preventing postoperative pulmonary complications by encouraging deep breathing and lung expansion. The child’s ongoing refusal to use the spirometer further increases the risk of pneumonia by allowing mucus to accumulate in the lungs, especially when combined with shallow breathing.

Rationale for incorrect choices:

• Peritonitis: Peritonitis would likely present with a rigid abdomen, high fever, worsening or spreading pain, and systemic signs of infection. While the child has abdominal tenderness, the dressing remains dry and intact, bowel sounds are absent but stable, and there is no significant fever or signs of sepsis, making peritonitis less likely.
• Wound infection: Wound infection would manifest as redness, swelling, purulent drainage, or increased warmth at the surgical site. The child’s dressing is consistently dry and intact throughout the day, with no signs of wound disruption or local infection noted in the nurse’s documentation.
• Bowel sounds: Absent bowel sounds are expected after abdominal surgery and may persist for 24–72 hours. While this finding warrants monitoring, it is not directly linked to pneumonia and is better associated with risks like postoperative ileus or delayed gastrointestinal recovery.
• Temperature: The child’s temperature remains below the threshold of 38.5°C and has only minimally increased from 37.0°C to 37.7°C throughout the day. This mild elevation is not specific to indicate infection and does not confirm a risk of pneumonia or other systemic complications.
• Surgical dressing: The surgical dressing remains dry and intact with no signs of leakage or infection. This finding suggests appropriate healing at the incision site and does not indicate any direct complication such as pneumonia or wound infection.
• Abdominal tenderness: Although abdominal tenderness has increased slightly, it is still expected in the postoperative period. Without signs of peritoneal inflammation or wound infection, this symptom alone does not confirm a complication and is more reflective of localized surgical pain.