Which interventions should be implemented for a pediatric client experiencing an asthma exacerbation? (SELECT ALL THAT APPLY)

A. Wheezing. Cystic fibrosis can cause airway obstruction due to thickened mucus, leading to wheezing and difficulty breathing, especially during respiratory infections or exacerbations.

B. A barrel-shaped chest is often seen in advanced stages of cystic fibrosis. It results from hyperinflation of the lungs due to air trapping, chronic lung disease, and repeated respiratory infections. The chest appears rounded and enlarged, similar to the shape of a barrel.

D. Clubbing of fingers and toes is a common finding in cystic fibrosis. It is caused by chronic hypoxia and inadequate oxygenation of tissues, leading to changes in the nail beds and fingertips. Clubbing typically develops over time in individuals with chronic respiratory conditions, including cystic fibrosis.

C. Thin, watery mucous is not expected in cystic fibrosis. Instead, cystic fibrosis is characterized by thick, sticky mucus due to dysfunction of the exocrine glands, leading to blockages in the airways, pancreas, and other organs.

E. Rapid growth spurts are not typically associated with cystic fibrosis. In fact, children with cystic fibrosis may experience growth failure or delayed growth due to malabsorption of nutrients, chronic illness, and increased energy expenditure.

C. Clubbing, characterized by bulbous enlargement of the fingertips and nail bed, is a result of chronic hypoxia in tetralogy of Fallot. In tetralogy of Fallot, there is a right-to-left shunting of blood due to the presence of a ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. This leads to reduced oxygenation of blood and chronic hypoxia, which can result in clubbing of the fingertips over time.

A This option is not the primary explanation for clubbing in tetralogy of Fallot. While decreased cardiac output may contribute to some manifestations of the condition, clubbing specifically results from chronic hypoxia rather than decreased cardiac output alone.

B Clubbing is not directly caused by a left-to-right shunting of blood. Instead, it is associated with chronic hypoxia, which can occur due to right-to-left shunting of blood in tetralogy of Fallot.

D Congestive heart failure may occur in individuals with tetralogy of Fallot but it is not the primary cause of clubbing. Clubbing in tetralogy of Fallot is primarily attributed to chronic hypoxia rather than heart failure alone.