The child is a 2-year-old who fell into a pool. He was retrieved from the pool by a family member but was not breathing. The family member started CPR, and the ambulance brought him to the hospital.

What factors are important in determining the level of hypoxemia that the child may have experienced during the submersion?

Select all that apply.

Choice A rationale:

The nurse should instruct the client to sleep with an extra pillow under their head. This position, known as the semi-Fowler's position, elevates the upper body and head, which can help reduce shortness of breath and difficulty breathing while lying down at night. Propranolol, a non-selective beta-blocker, can cause bronchoconstriction in some individuals, especially those with a history of respiratory issues. Elevating the head can assist in improving lung expansion and reducing the sensation of breathlessness.

Choice B rationale:

Sleeping on their left side would not be the best option in this case. While sleeping on the left side is often recommended for individuals with certain cardiac conditions to improve blood flow and reduce pressure on the heart, it may not be as effective for alleviating the respiratory symptoms caused by propranolol. Elevating the head is a more appropriate intervention in this scenario.

Choice C rationale:

Sleeping on their right side is not the ideal choice either. While it can have benefits for individuals with certain cardiac conditions, it does not address the specific respiratory symptoms reported by the client. Elevating the head is a more targeted intervention to alleviate breathlessness associated with propranolol.

Choice D rationale:

Sleeping on their back may worsen the client's symptoms. Lying flat on the back can lead to increased pressure on the diaphragm, making it more challenging to breathe for individuals experiencing shortness of breath. Therefore, it is not the recommended position for this client.

Serum creatinine is the most important laboratory value to review before administering an antibiotic that can cause nephrotoxicity. Nephrotoxicity is an alteration in the function of the kidney due to exposure to certain drugs or toxins.

It can be assessed by measuring the glomerular filtration rate (GFR), which is the rate of clearance of a substance from the blood by the kidneys. Serum creatinine is a waste product of muscle metabolism that is freely filtered by the glomeruli and not reabsorbed or secreted by the tubules.

Therefore, it is a reliable indicator of GFR and renal function. An increase in serum creatinine indicates a decrease in GFR and renal function, which may be caused by nephrotoxic drugs.

The other laboratory values are not directly related to nephrotoxicity or GFR:

• Serum calcium: This may be affected by renal function, but it is not a sensitive or specific marker of nephrotoxicity. It may be altered by other factors such as vitamin D, parathyroid hormone, and bone metabolism.
• Hemoglobin and hematocrit: These may be affected by renal function, but they are not sensitive or specific markers of nephrotoxicity. They may reflect the erythropoietin production by the kidneys, which stimulates red blood cell production in the bone marrow. However, they may also be influenced by other factors such as blood loss, hydration status, and iron deficiency.
• White blood cell count (WBC): This is not related to nephrotoxicity or GFR. It may reflect the presence of infection or inflammation, which may be a cause or a consequence of renal impairment, but it is not a direct measure of renal function.