Risks and treatment options for respiratory illnesses.
Scenario:
You are one of the LPNs on duty at the clinic today. It has been very busy; it is cold and flu season. There have been so many kids in with respiratory illnesses that there is a designated LPN in charge of getting them all checked in. That is your role today: you will be taking vital signs, obtaining weights, and alerting the RN to any child with abnormal vital signs.
Your call the next child back to the treatment room for vital signs and a weight. This little one is three years old. He was brought in by his mom who says he has had a cough and sniffles for two days. Mom is also carrying a baby who she says is four-months-old. Mom says the baby has sniffles too, but she does not think the doctor needs to see the baby. The baby is sleeping when you call back the other child.
This is the data you collected from the three-year-old child:
Temperature- 102.2 F orally (above normal range)
Heart rate- 110 (above normal range)
Blood pressure- 100/60 (within normal range)
Respiratory rate- 28 (above normal range)
Oxygen saturation- 90% (below normal range)
Weight- 28 pounds (within normal range)
Instructions:
Using the above scenario, answer the following questions:
There are four measurements above that are abnormal and will be reported to the RN. Which measurement has the highest priority and should be reported immediately? Explain your response.
What additional information will be helpful to report to the RN regarding this priority concern? Explain your response and include what your findings might be.
There are four vital sign readings that are abnormal. What is the normal range for each finding? What treatments would be anticipated for the oxygen saturation and the temperature? Which treatment will be given first? Explain your response.
Additionally, since Mom reported that the four-month-old baby has sniffles. Should we be more or less concerned about this based on the child’s age? Explain your response.
Sample Solution
The highest priority and the one that should be reported immediately is the oxygen saturation as it is below normal range. The normal oxygen saturation for this age range would typically be around
95-98%, so at 90% this indicates a potential problem with their breathing or underlying respiratory illness that needs further investigation. It is important to report any other abnormal findings, such as temperature, heart rate, and respiratory rate which are also above normal ranges.
When reporting this finding to the RN, it will be helpful to provide additional information such as the child's symptoms (cough + sniffles) and any observations made during vital signs (e.g., wheezing, discoloration of skin/lips). This will help inform next steps in treatment for the patient.
The normal ranges for each of these vital sign readings are: Temperature - 97-100F; Heart Rate - 80-120 beats per minute; Blood Pressure - 90/60-130/80 mmHg; Respiratory Rate - 16-20 breaths per minute; Oxygen Saturation – 95%-98%.
Treatments anticipated for an oxygen saturation reading below normal range would include providing supplemental oxygen or nebulizer treatments while monitoring closely if they need more interventions like IV fluids or antibiotics depending on their clinical course. Treatments anticipated for a temperature above normal range would include fever reducing medications and close monitoring if there are underlying infections present that require antibiotics. Generally speaking, oxygen supplementation should be given first since hypoxia can have more serious implications than fever alone.
Since Mom reported that the four month old baby has sniffles we should definitely be more concerned about this due to their young age because babies under six months old may have difficulty regulating their body temperatures leading to rapid progression from mild colds into severe illnesses such as bronchiolitis or pneumonia without proper medical intervention. We recommend bringing them back in for evaluation by a provider even if mom does not think it necessary in order to ensure safety of both babies involved.