In the absence of suggestive clinical features, there is a documented risk of overdiagnosis of pneumonia A normal capillary carbon dioxide level despite persistent respiratory distress is a sign of impending respiratory failure. Medical management steps Treat hypoxemia,. Endotracheal intubation and ventilation for impending respiratory failure: Disposition Admission should be considered if any one of the following apply: An ongoing need for supplemental oxygen.
The patient requires continuous nebulized salbutamol and fails to improve on this therapy.
Call a tertiary care centre PICU specialist to discuss patient management and transport. ICS are currently approved for the following ages: Flovent 12 months and over, QVAR 5 years and over, Alvesco 6 years and over, Pulmicort nebules 3 months and over products insert. This information was originally published in Can Respir J 17 1: Reference 11 was used as a source, with permission, for this table.
Complete a 3- to 5-day course of oral steroids, depending on the severity of the illness at presentation.
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If severe or frequent exacerbations lead to further treatment in the ICU, referral to an asthma specialist, such as a paediatric allergist or respirologist, is strongly recommended. Garner R, Kohen D. Changes in the prevalence of asthma among Canadian children. Health outcomes in low-income children with current asthma in Canada. The exacerbation component of impairment and risk in pediatric asthma. Curr Opin Allergy Clin Immunol. Effectiveness of emergency department asthma management strategies on return visits in children: Asthma presentations by children to emergency departments in a Canadian province: Diagnosis and Management of Asthma, Ninth Edition.
American Heart Association; Achieving control of asthma in preschoolers. Carroll W, Lenney W. Drug therapy in the management of acute asthma. Evaluation of SaO2 as a predictor of outcome in children presenting with acute asthma. Risk factors for an intensive care unit admission in children with asthma.
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Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Development of a clinical asthma score for use in hospitalized children between 1 and 5 years of age. A responsive index of acute asthma severity.
Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness. Cheng A, Canadian Paediatric Society. Acute Care Committee Emergency treatment of anaphylaxis in infants and children. Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs.
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A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Anticholinergics in the treatment of children and adults with acute asthma: A systematic review with meta-analysis. Munro A, Maconochie I. Best evidence topic reports. Beta-agonists with or without anti-cholinergics in the treatment of acute childhood asthma? Corticosteroids for hospitalised children with acute asthma. Cochrane Database Syst Rev. Mohammed S, Goodacre S. Intravenous and nebulised magnesium sulphate for acute asthma: Systematic review and meta-analysis.
Roberts G, Newsom D, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: A randomised controlled trial. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. A randomized, controlled trial. The client will most likely be treated with:. Continue the infusion of magnesium sulfate while monitoring the client's blood pressure.
Which statement made by the nurse describes the inheritance pattern of autosomal recessive disorders? A pregnant client, age 32, asks the nurse why her doctor has recommended a serum alpha fetoprotein. The nurse should explain that the doctor has recommended the test:. A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse's response is based on the knowledge that:. There is no need to take thyroid medication because the fetus's thyroid produces a thyroid-stimulating hormone. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy.
It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism. The nurse is responsible for performing a neonatal assessment on a full-term infant. At 1 minute, the nurse could expect to find:. A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. The nurse should anticipate the client's need for:. A client with diabetes has an order for ultrasonography.
Preparation for an ultrasound includes:. An infant who weighs 8 pounds at birth would be expected to weigh how many pounds at 1 year? A pregnant client with a history of alcohol addiction is scheduled for a nonstress test. Vaginal exam reveals that the client's cervix is 8cm dilated, with complete effacement. The priority nursing diagnosis at this time is:. The client with varicella will most likely have an order for which category of medication? A client is admitted complaining of chest pain. Which of the following drug orders should the nurse question? Which of the following instructions should be included in the teaching for the client with rheumatoid arthritis?
A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse? The client is admitted to the chemical dependence unit with an order for continuous observation. The nurse is aware that the doctor has ordered continuous observation because:. A client with a history of abusing barbiturates abruptly stops taking the medication.
The nurse should give priority to assessing the client for:. During the assessment of a laboring client, the nurse notes that the FHT are loudest in the upper-right quadrant. The infant is most likely in which position? A client with mania is unable to finish her dinner. To help her maintain sufficient nourishment, the nurse should:.
Hips are slightly elevated above the bed and the legs are suspended at a right angle to the bed. Hips are elevated above the level of the body on a pillow and the legs are suspended parallel to the bed. The client has an order for a trough to be drawn on the client receiving Vancomycin.
Managing the paediatric patient with an acute asthma exacerbation
The nurse is aware that the nurse should contact the lab for them to collect the blood:. The nurse is providing postpartum teaching for a mother planning to breastfeed her infant. Which of the client's statements indicates the need for additional teaching? A client is receiving Pyridium phenazopyridine hydrochloride for a urinary tract infection. The client should be taught that the medication may:. Which of the following tests should be performed before beginning a prescription of Accutane?
Which nursing intervention is most critical during the administration of acyclovir? The nurse is caring for the client receiving Amphotericin B. Which of the following indicates that the client has experienced toxicity to this drug? A client with cystic fibrosis is taking pancreatic enzymes. The nurse should administer this medication:. Cataracts result in opacity of the crystalline lens.
Which of the following best explains the functions of the lens? A client who has glaucoma is to have miotic eyedrops instilled in both eyes. The nurse knows that the purpose of the medication is to:. A client with a severe corneal ulcer has an order for Gentamycin gtt. Which of the following schedules should be used when administering the drops?
The client with color blindness will most likely have problems distinguishing which of the following colors? The client with enuresis is being taught regarding bladder retraining. The nurse should advise the client to refrain from drinking after:. Which of the following diet instructions should be given to the client with recurring urinary tract infections? The physician has prescribed NPH insulin for a client with diabetes mellitus.
A client with pneumacystis carini pneumonia is receiving trimetrexate. The rationale for administering leucovorin calcium to a client receiving Methotrexate is to:. A client tells the nurse that she is allergic to eggs, dogs, rabbits, and chicken feathers. Which order should the nurse question? The physician has prescribed rantidine Zantac for a client with erosive gastritis. A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:.
While assessing the postpartal client, the nurse notes that the fundus is displaced to the right. Based on this finding, the nurse should:. The physician has ordered an MRI for a client with an orthopedic ailment. An MRI should not be done if the client has:. A 6-month-old client is placed on strict bed rest following a hernia repair. Which toy is best suited to the client? The nurse is preparing to discharge a client with a long history of polio.
The nurse should tell the client that:. A client on the postpartum unit has a proctoepisiotomy. The nurse should anticipate administering which medication? The doctor has ordered for sliding-scale insulin. The most likely explanation for this order is:. Total Parenteral Nutrition leads to negative nitrogen balance and elevated glucose levels. Total Parenteral Nutrition is a high-glucose solution that often elevates the blood glucose levels.
An adolescent primigravida who is 10 weeks pregnant attends the antepartal clinic for a first check-up. To develop a teaching plan, the nurse should initially assess:. An obstetric client is admitted with dehydration. Which IV fluid would be most appropriate for the client? The physician has ordered a thyroid scan to confirm the diagnosis. Before the procedure, the nurse should:. The physician has ordered an injection of RhoGam for a client with blood type A negative. The nurse understands that RhoGam is given to:.
The nurse is caring for a client admitted to the emergency room after a fall. X-rays reveal that the client has several fractured bones in the foot. Which treatment should the nurse anticipate for the fractured foot? A client with bladder cancer is being treated with iridium seed implants. The nurse's discharge teaching should include telling the client to:. Following a heart transplant, a client is started on medication to prevent organ rejection.
Which category of medication prevents the formation of antibodies against the new organ? The nurse is preparing a client for cataract surgery. The nurse is aware that the procedure will use:. A client with Alzheimer's disease is awaiting placement in a skilled nursing facility. Which long-term plans would be most therapeutic for the client? A client with an abdominal cholecystectomy returns from surgery with a Jackson-Pratt drain.
The chief purpose of the Jackson-Pratt drain is to:.
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The nurse is performing an initial assessment of a newborn Caucasian male delivered at 32 weeks gestation. The nurse can expect to find the presence of:. The nurse is caring for a client admitted with multiple trauma. Fractures include the pelvis, femur, and ulna. A client is brought to the emergency room by the police. He is combative and yells, "I have to get out of here.
They are trying to kill me. The nurse is preparing to suction the client with a tracheotomy. The nurse notes a previously used bottle of normal saline on the client's bedside table. There is no label to indicate the date or time of initial use. An infant's Apgar score is 9 at 5 minutes.
The nurse is aware that the most likely cause for the deduction of one point is:. The primary reason for rapid continuous rewarming of the area affected by frostbite is to:. A client recently started on hemodialysis wants to know how the dialysis will take the place of his kidneys. The nurse's response is based on the knowledge that hemodialysis works by:. During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action by the nurse is most appropriate?
A client hospitalized with MRSA methicillin-resistant staph aureus is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact? Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches.
Which response by the nurse indicates understanding of phantom limb pain? I will get you some pain medication. A client with cancer of the pancreas has undergone a Whipple procedure. The nurse is aware that during the Whipple procedure, the doctor will remove the:. The physician has ordered a minimal-bacteria diet for a client with neutropenia. The client should be taught to avoid eating:. A client is discharged home with a prescription for Coumadin sodium warfarin. The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to:.
A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for:. The nurse is providing discharge teaching for the client with leukemia. The client should be told to avoid:.
Quick Check Answer Key
The nurse is changing the ties of the client with a tracheotomy. The safest method of changing the tracheotomy ties is to:. The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was mL. The infant is admitted to the unit with tetrology of falot. The nurse would anticipate an order for which medication?
The nurse is educating the lady's club in self-breast exam. The nurse is aware that most malignant breast masses occur in the Tail of Spence. On the diagram, place an X on the Tail of Spence. The toddler is admitted with a cardiac anomaly. The nurse is aware that the infant with a ventricular septal defect will:. The nurse is monitoring a client with a history of stillborn infants. The nurse is aware that a nonstress test can be ordered for this client to:.
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The nurse is evaluating the client who was admitted 8 hours ago for induction of labor. The following graph is noted on the monitor. Which action should be taken first by the nurse? The nurse notes the following on the ECG monitor. The nurse would evaluate the cardiac arrhythmia as:. A client with clotting disorder has an order to continue Lovenox enoxaparin injections after discharge. The nurse should teach the client that Lovenox injections should:. The nurse has a preop order to administer Valium diazepam 10mg and Phenergan promethazine 25mg.
The correct method of administering these medications is to:. A client with frequent urinary tract infections asks the nurse how she can prevent the reoccurrence. The nurse should teach the client to:. The client has recently returned from having a thyroidectomy. The nurse should keep which of the following at the bedside?
The physician has ordered a histoplasmosis test for the elderly client. The nurse is aware that histoplasmosis is transmitted to humans by:. Examples include the following: The fees charged are based on the British Medical Association BMA suggested scales and our reception staff will be happy to advise you about them along with appointment availability. At Cestria we try to be as helpful, friendly and approachable as we can for young people. So, from roughly mid-teen years on ….
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Cervical Smears All women between the ages of 25 and 65 are recommended to have a cervical smear performed every 3 years until the age of 50, then every 5 years until the age of Physiotherapy A team of physiotherapists work within the Health Centre to treat back, joint and tendon problems. Counsellor various times A counsellor consults within the surgery to help with emotional and psychological problems.
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