Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply.
Reduce exposure to environmental organisms.
Maintain the child in a semiprivate room.
Use strict aseptic technique for all procedures.
Ensure that anyone entering the child's room wears a mask
Apply firm pressure to a needlestick area for at least 10 minutes
Correct Answer : A,C,D
A.Reduce exposure to environmental organisms.
Explanation: Minimizing the child's exposure to environmental organisms helps reduce the risk of infections. This includes practices such as maintaining a clean environment and promoting good hygiene.
B. Maintain the child in a semiprivate room.
Explanation: The type of room (semiprivate or private) may not be directly related to infection control. However, maintaining a clean and controlled environment is important.
C.Use strict aseptic technique for all procedures.
Explanation: Strict aseptic technique is crucial to prevent the introduction of pathogens during procedures. This involves maintaining a sterile field and using appropriate infection control measures during medical interventions.
D.Ensure that anyone entering the child's room wears a mask.
Explanation: Wearing a mask helps prevent the spread of respiratory infections, which can be particularly risky for immunocompromised children. It is a measure to protect the child from potential airborne pathogens.
E. Apply firm pressure to a needlestick area for at least 10 minutes.
Explanation: Applying firm pressure to a needlestick area is relevant in the context of preventing bleeding or hematoma formation but is not directly related to infection control.
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Related Questions
Correct Answer is B
Explanation
A. Use a padded tongue blade:
Incorrect: Inserting anything into the child's mouth, including a padded tongue blade, is not recommended during a seizure. It can lead to oral and airway injuries. It's important to keep the airway clear, but this is achieved by positioning the child laterally.
B. Position the child laterally.
Correct Answer: This is the correct action. Placing the child on their side helps prevent aspiration of fluids and promotes a clear airway during the seizure. It also reduces the risk of injury.
C. Restrain the child's arms:
Incorrect: Restraining the child's arms can increase the risk of injury and is not recommended during a seizure. It's crucial to ensure a safe environment and prevent injury, but physically restraining the child is not the appropriate approach.
D. Attempt to stop the seizure:
Incorrect: It is not within the nurse's capacity to immediately stop a seizure. Seizures are neurological events, and they need to run their course. The focus should be on ensuring the safety of the child during the seizure.
Correct Answer is A
Explanation
A. Contact the assigned emergency room physician to evaluate the need for an advanced airway
Explanation:
Epiglottitis is a medical emergency that can rapidly progress to airway obstruction. The classic signs and symptoms include a high fever, difficulty swallowing, voice hoarseness, inspiratory stridor, and sternal retractions. Immediate intervention may be necessary to secure the airway. Therefore, contacting the emergency room physician to evaluate the need for an advanced airway (such as intubation) is a priority.
B. Administer intravenous corticosteroids
Explanation: While corticosteroids may be used in the management of epiglottitis to reduce airway inflammation, securing the airway is the priority in the acute phase. Corticosteroids would typically be administered after securing the airway.
C. Obtain a throat culture
Explanation: Obtaining a throat culture is not the immediate priority in the case of suspected epiglottitis. Prompt intervention to secure the airway takes precedence over diagnostic tests.
D. Inspect the throat to obtain further data to support the diagnosis
Explanation: Direct visualization of the throat (inspection) may exacerbate the airway obstruction and is not recommended in the acute management of suspected epiglottitis. The priority is to secure the airway while minimizing agitation and discomfort for the child. Diagnostic procedures, such as obtaining a throat culture, can be considered after the airway is stabilized.
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