NURS 217 Fall 25 at Baton Rouge Community College

The first step in providing adequate pain management for a child in sickle cell crisis is to assess the pain using an age-appropriate, standardized pain scale. Pain assessment establishes a baseline for evaluating severity, location, and effectiveness of interventions. Once the pain is assessed, the nurse can then appropriately administer analgesics—usually opioids or NSAIDs—as prescribed. Comprehensive assessment ensures individualized and effective pain control, which is crucial in sickle cell crises where pain can be severe and unrelenting.

The priority assessment in a child with acute rheumatic fever (ARF) is to evaluate for cardiac involvement, which can lead to rheumatic carditis—a potentially life-threatening complication. Rheumatic carditis causes inflammation of the heart valves, myocardium, and pericardium, which can result in new heart murmurs, tachycardia, pericardial friction rub, or signs of heart failure. Immediate cardiac assessment allows early detection and intervention to prevent permanent damage (rheumatic heart disease).

After a cardiac catheterization, the nurse’s priority is to assess circulation to the extremity used for catheter insertion. This is done by palpating the pulses distal to the insertion site (usually the dorsalis pedis and posterior tibial pulses if the femoral artery was used). Comparing these with the unaffected leg helps detect early signs of arterial obstruction or thrombus formation. The nurse should also monitor the insertion site for bleeding or hematoma formation and keep the affected extremity straight for 4–8 hours post-procedure to prevent complications.

Placental insufficiency occurs when the placenta fails to deliver adequate oxygen and nutrients to the fetus, leading to intrauterine growth restriction (IUGR). As a result, the newborn is often small for gestational age (SGA) with low birth weight. Chronic hypoxia and nutrient deprivation slow fetal growth and can also lead to complications such as hypoglycemia, meconium aspiration, and distress during labor.

The nurse should teach parents and young girls that wearing cotton underpants helps prevent urinary tract infections (UTIs) by allowing better air circulation and moisture absorption, keeping the perineal area dry and reducing bacterial growth. Synthetic fabrics trap heat and moisture, creating an ideal environment for bacteria such as E. coli to multiply. Encouraging proper hygiene and cotton underwear are key prevention strategies.

During a tet spell (hypercyanotic episode), the infant experiences severe hypoxia due to increased right-to-left shunting of blood through the ventricular septal defect. The knee-chest position increases systemic vascular resistance, which decreases the right-to-left shunt and improves pulmonary blood flow and oxygenation. This position also helps calm the infant and facilitates venous return to the heart, reducing cyanosis and dyspnea.

A. Firm nodules or persistent asymmetry should be evaluated
During pregnancy the breasts normally become fuller, heavier, and somewhat nodular because the milk-producing glands are enlarging. However, a distinct, firm, localized lump that persists or one breast looking very different from the other in a new way is not considered normal and should be assessed further. This teaching is important because pregnancy can sometimes delay evaluation of concerning breast changes.
B. Colostrum production may begin in the second trimester
Colostrum is the thick, yellowish, antibody-rich early milk that protects the newborn from infection. The breasts can begin making and sometimes leaking small amounts of colostrum as early as the second trimester. This is normal and does not mean the patient will go into labor early. Parents should be reassured that this is the body preparing for breastfeeding.
D. Montgomery tubercles (small bumps on areola) become more prominent
Montgomery glands are sebaceous glands in the areola. In pregnancy they enlarge and look like raised bumps. They secrete an oily, protective substance that helps moisturize and lubricate the nipple and areola, reducing friction and breakdown during breastfeeding. Seeing more obvious Montgomery tubercles is an expected change and not a sign of infection.
E. Nipples become more erect and areolas enlarge
Under hormonal influence (especially estrogen, progesterone, and prolactin), the nipples typically become larger, more pigmented, and more everted. The areola also darkens and increases in diameter. These changes help prepare for latching and also help the newborn visually locate the breast after birth. Many patients also report increased nipple sensitivity or tenderness during this time.

Rheumatic fever is a preventable complication of untreated or inadequately treated Group A beta-hemolytic streptococcal (GAS) pharyngitis. The most effective prevention strategy is early identification and treatment of strep throat with appropriate antibiotics (usually penicillin). By referring children with sore throats for throat cultures, the school nurse helps ensure early diagnosis and treatment, thereby preventing rheumatic fever, which can cause long-term cardiac damage (rheumatic heart disease).

A school-age child presenting with dysphagia (difficulty swallowing), drooling, and a hoarse voice is exhibiting classic signs of acute epiglottitis, a life-threatening airway emergency. The inflamed epiglottis can rapidly swell and obstruct the airway. This child must be prioritized immediately to maintain airway patency. The nurse should avoid examining the throat or using a tongue depressor and should notify the provider immediately while preparing for possible intubation or tracheostomy.