A nurse is caring for an adolescent who has been admitted to the PICU with a diagnosis of septic shock. The nurse notes the following :

Exhibits

When planning care for this client, the nurse should anticipate a provider's prescription for which of the following?

Choice A reason: This test measures the level of antibodies that the body produces against the streptolysin O enzyme, which is produced by some strains of streptococcal bacteria. A high level of ASO titer indicates that the child had a recent streptococcal infection, which may trigger rheumatic fever in some cases.

Choice B reason: This test does not directly indicate if the child has rheumatic fever. Rheumatic fever is a complication of untreated or inadequately treated streptococcal infection, which causes inflammation of the heart, joints, skin, and brain. The diagnosis of rheumatic fever is based on clinical criteria, such as the presence of carditis, polyarthritis, chorea, erythema marginatum, or subcutaneous nodules.

Choice C reason: This test does not confirm if the child has immunity to streptococcal bacteria. Immunity is the ability of the body to resist or fight off an infection. A high level of ASO titer does not mean that the child is immune to streptococcal bacteria, but rather that the child was exposed to them recently.

Choice D reason: This test does not indicate if the child has a therapeutic blood level of an aminoglycoside. Aminoglycosides are a class of antibiotics that are used to treat serious bacterial infections, such as endocarditis or septicemia. The blood level of an aminoglycoside is measured by a different test, called a peak and trough level, which determines the effectiveness and safety of the drug.

Choice A reason: Encouraging the child to take a 45 min nap daily is not a helpful instruction, as it may interfere with the child's normal sleep pattern and school schedule. The child may benefit from regular rest periods throughout the day, but not necessarily a long nap. ⁵

Choice B reason: Administering prednisone on an alternate day schedule is a helpful instruction, as it is a common way of prescribing corticosteroids for children with juvenile idiopathic arthritis. Corticosteroids are used to reduce inflammation and control symptoms, but they have many side effects, such as growth suppression, weight gain, and osteoporosis. Giving the medication every other day may reduce some of these side effects and improve compliance. ⁶

Choice C reason: Applying cool compresses for 20 min every hour is not a helpful instruction, as it may cause skin damage and discomfort. Cool compresses may be useful for acute inflammation, but not for chronic arthritis. Warm compresses or baths may be more soothing and beneficial for the child's joints. ⁷

Choice D reason: Allowing the child to stay at home on days when her joints are painful is not a helpful instruction, as it may lead to social isolation, academic difficulties, and reduced physical activity. The child should be encouraged to attend school and participate in activities as much as possible, with appropriate accommodations and modifications if needed. The child may also benefit from physical therapy, occupational therapy, and pain management strategies. ⁸