Question

Susan is a 4-year-old girl who presents with a 7-day history of fever and lethargy. Susan’s physician has ordered laboratory work that includes a blood culture.

Subjective Data

Fever for 1 week

Mother has noticed decreased activity level

States she is “afraid” of needles

Objective Data

Weight 26.1 kg

Vital signs: T 39.3, P 110, R 40, BP 108/54, O2 sat 100%

No abnormal findings on physical examination

Questions:

1. When should Susan’s nurse explain the procedure to her?
2. To give Susan some control over this situation, what choices could be given to her?
3. What should the nurse do in this clinical situation? Prioritize actions.

Answer 1

Buid trust talking to the patient can be challenging if they find yu intimidating, Engage parents for shy or stoic children,communicate on their level and explain the procedure by allowing child to understand the purpose for the procedure.

Nursing diagnosis,

1. Hyper thermia related to infectious process as evidenced by temperature reading
2. Risk for infection related to lowerd immunity
3. Risk fo rinjury related to hyperthermia
4. Activity intolerance related to disease condition
5. Risk for hypothermia related to disease condition
6. Knowledge deficit of parents related to disease condition

Nursing interventionns,

• Adjust moniter enviornment factors kike room tempwrature and bed linen as indicated
• Eliminate excess clothing and cover
• Ready oxygen therapy for extreame cases
• Encourage ample fluid intake by mouth
• Provide cooling mattress cold pack applied to major blood vessels
• Evoporative cooling, cool with tapid bath do not use alcohole
• Invasive- Gastric lavage
• Rise the side rails all the time
• provide high caloric diet
• Educate famiy members about the signs and symptoms of hyper thermia and help in identifying factors related to occurance of fever.