15.16 Learning Activities

Infectious Mononucleosis Case Study^[1]

Use the following information to answer questions 1-6.

 Handoff Report:

1706: This is a 17-year-old male, David Garcia, in the emergency department for infectious mononucleosis.  He was initially diagnosed yesterday by his primary care provider.  He has no known allergies, weighs 75kg and has a BMI of 22.5.  He has significant fatigue, making it difficult for him to participate in ADLs.  He is also experiencing a severe sore throat that is impacting his ability to swallow. His lymph nodes remain palpable.  His spleen is enlarged and mildly tender upon palpation.  His most recent vital signs are: oral temperature 101.5°F, pulse 110 bpm, respirations 18 breaths/minute, blood pressure 120/80 mmHg and O2 saturation 99% on room air. He is ready to be transferred to the medical-surgical floor for continual monitoring of his temperature and intravenous fluids.  Surgery will also be consulted due to his spleen enlargement.

History & Physical:

History

• Client reports a several-day history of malaise, fatigue, and sore throat.
• Reports poor oral intake and decreased urine output
• Client denies cough or congestion.
• Client is a high school athlete, and his illness is impacting his ability to participate in sports.
• Client is concerned about falling behind in schoolwork due to his illness.

Physical Findings

• Posterior cervical and axillary lymphadenopathy
• Erythematous pharynx
• Splenomegaly on palpation
• Dry mucous membranes
• Urine is concentrated

Lab/Diagnostic Results:

Provider Orders:

Asthma Exacerbation Case Study^[2]

Use the following information to answer questions 1-6.

Handoff Report:

1900: This is Nurse Jones giving report on Sofia Gonzalez, a 7-year-old female admitted for an acute asthma exacerbation.  She has allergies to amoxicillin, peanuts, pollen, mold and pet dander.  She weighs 23 kg. She presented to the ED with her parents with complaints of worsening shortness of breath, wheezing, and cough.  She was noted to be using accessory muscles upon inspiration and her oxygen saturation was 88% on room air.  She received one dose of nebulized albuterol and was started on 2L of oxygen via nasal cannula in the ED, with improvement in her respiratory effort and oxygen saturations.  Her most recent vital signs are:  temperature 98.8 degrees F, heart rate 102 bpm, respiratory rate 27 breaths per minute, blood pressure 95/65 mmHg, and oxygen saturation 95% on 2L.  Please continue to monitor her respiratory status and oxygen saturation closely.

 History & Physical:

 History

• History of asthma since age 3
• Previous life-threatening asthma exacerbation requiring intubation at age 5
• Current exacerbation triggered by recent wildfires, according to parents
• Family history of asthma

Physical Findings

• Respiratory rate elevated
• Use of accessory muscles to breathe
• Audible wheezing upon auscultation of lungs
• Oxygen saturation levels below normal (initial assessment 88% on room air)

 Progress Notes:

• 1600: Client admitted to the pediatric unit from the ED.  Respiratory assessment completed – mild wheezing bilaterally.  Continues on 2L oxygen via nasal cannula.  Parents are at the bedside. -B. Jones, RN
• 1615: Oral prednisolone administered as ordered. -B. Jones, RN
• 1645: Client reports feeling less short of breath.  Wheezing is still present but improved from previous assessment. – B. Jones, RN
• 1730: Respiratory therapist provided education to client and parents about asthma triggers and management. – C. Smith, RRT

 Provider Orders:

1. Based on Sofia’s presentation and recent admission for an acute asthma exacerbation, which nursing diagnosis is the most appropriate?

a. Impaired Gas Exchange

b. Risk for Infection

c. Ineffective Airway Clearance

d. Anxiety

2. What is the priority nursing action for Sofia upon arrival to the pediatric unit?

a. Educate the client and her family about asthma triggers.

b. Administer oral prednisolone as prescribed.

c. Complete a focused respiratory assessment.

d. Orient Sofia and her parents to the unit.

3. The provider has entered orders for Sofia to have continuous pulse oximetry.  Which of the following actions is required when implementing this order?

a. Apply the sensor to Sofia’s finger and ensure the waveform correlates with her radial pulse.

b. Place the sensor on Sofia’s toe because it provides a more reliable reading.

c. Change the sensor location every 2 hours to prevent skin breakdown.

d. Set the pulse oximeter alarm limits to 85% and 100%.

4. One hour after administering the nebulized albuterol treatment, you evaluate Sofia’s response.  Which finding indicates that the albuterol has been effective?

a. Sofia’s respiratory rate is 18 breaths per minute.

b. Sofia states she feels tired and wants to sleep.

c. Wheezing is no longer audible upon auscultation of her lungs.

d. Sofia’s oxygen saturation remains at 96% on 2L of oxygen.

5. Sofia’s parents express concern that this is her second serious asthma exacerbation in two years and are worried about her long-term health.  How should the nurse best address their concerns?

a. Reassure Sofia’s parents that she is receiving the best possible care and should be fine.

b. Acknowledge their concerns, reinforce the importance of following the asthma action plan, and answer any questions they have.

c. Explain that Sofia is likely just prone to respiratory illnesses and there is not much they can do to prevent it.

d. Refer Sofia’s parents to the doctor to discuss their concerns further.

6. Considering Sofia’s asthma triggers, which of the following is the most comprehensive approach to preventing future asthma exacerbations?

a. Advise Sofia’s family to follow a daily asthma management plan that includes avoiding her known allergens and using prescribed medications as directed, with an emphasis on environmental control.

b. Recommend that Sofia avoid all outdoor activities, including walking or playing in the park, to eliminate exposure to environmental allergens.

c. Instruct Sofia’s family to administer a daily dose of oral corticosteroids to reduce inflammation, regardless of symptom presence.

d. Encourage Sofia’s parents to monitor her respiratory symptoms and only administer albuterol if she experiences symptoms of wheezing or shortness of breath.