Question

A nurse is creating a plan of care for a newly admitted child. Which of the following actions should the nurse include in the plan?

Exhibit 1: H&P
8-year-old male admitted with cystic fibrosis
Reports shortness of breath
Wheezing throughout lung fields
Productive cough with thick sputum
Exhibit 2: Graphic Record
Heart rate 108/min
Respiratory rate 26/min
Temperature 37.2°C (98.9°F)
Blood pressure 100/62 mm Hg
Oxygen saturation 92%
Exhibit 3: Diagnostic Results
Sputum culture: Burkholderia cepacia
a) Initiate airway clearance techniques
b) Administer bronchodilators
c) Increase oxygen supplementation
d) Encourage deep breathing exercises

Answer 1

In the plan of care for a child with cystic fibrosis, initiating airway clearance techniques should be included to help improve lung function and reduce the risk of complications.

Step-by-step explanation:

In the plan of care for the newly admitted child with cystic fibrosis, the nurse should include initiating airway clearance techniques. This is important because cystic fibrosis can cause the accumulation of thick and sticky mucus in the airways, leading to breathing difficulties and increased risk of infections. Airway clearance techniques, such as chest physiotherapy and breathing exercises, can help loosen and remove the mucus, improving lung function and reducing the risk of complications.