The nurse is caring for a 10-month-old infant diagnosed with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care? (Select all that apply.).

The correct answer is choice A: Anaphylactic shock.

Choice A rationale:

Anaphylactic shock is the correct answer. Anaphylactic shock is a severe and potentially life-threatening allergic reaction that causes massive vasodilation, capillary leakage, and bronchoconstriction. It can occur rapidly after exposure to an allergen such as certain foods, insect stings, medications, or latex. The release of histamine and other inflammatory mediators leads to systemic vasodilation and increased permeability of blood vessels, resulting in a sudden drop in blood pressure and compromised organ perfusion.

Choice B rationale:

Cardiogenic shock is characterized by inadequate cardiac output due to severe heart dysfunction. It is typically caused by conditions like myocardial infarction, heart failure, or other cardiac issues. While allergic reactions can potentially affect the cardiovascular system, the symptoms described in the question are more indicative of anaphylactic shock.

Choice C rationale:

Neurogenic shock results from disruption of sympathetic nervous system control over blood vessel tone, often due to spinal cord injury or severe emotional distress. This leads to widespread vasodilation and a sudden drop in blood pressure. While it can cause hemodynamic instability, it doesn't specifically involve the hypersensitivity reaction and capillary leaks associated with anaphylactic shock.

Choice D rationale:

Hypovolemic shock is caused by a significant loss of blood volume or bodily fluids, leading to decreased intravascular volume and subsequent inadequate tissue perfusion. This shock type is not directly related to a hypersensitivity reaction or capillary leakage caused by allergic responses. 2 / 2

The correct answer is choice C. The child needs opportunities to play with peers.

Choice A rationale:

While it's important for children with congenital heart disease to understand their limitations, it's not the primary concern in this scenario. Allowing the child to interact and play with peers is essential for their social, emotional, and psychological development.

Choice B rationale:

While parents play a crucial role in a child's care, completely isolating the child from peers is not ideal. Overprotectiveness can lead to social isolation and hinder the child's ability to develop important social skills.

Choice C rationale:

Children with congenital heart disease should be encouraged to engage in age-appropriate physical activities and play with peers. Of course, the level of activity should be discussed with the child's healthcare provider, but limiting the child's interactions could have negative consequences on their overall development and emotional well-being.

Choice D rationale:

While supervision is important for any child's safety, constant parental supervision to avoid overexertion might not be necessary or feasible. Educating the child about their limitations and providing opportunities for play while monitoring their comfort level is a more balanced approach.