A child with SAM having hypothermia should be?

P.CHO-2019

Child Health Nursing (Pediatrics)

Medium

Appeared in: P.CHO-2019

Explanation

In children with Severe Acute Malnutrition (SAM), hypothermia, hypoglycemia, and infection are known as the 'lethal triad' because they frequently occur together and worsen each other.
Effective management requires a simultaneous, multi-pronged approach that addresses all three components of this triad.
The child must be actively rewarmed (e.g., under a warmer) to correct the hypothermia.
Immediate feeding is essential to provide glucose, which combats hypoglycemia and supplies the energy needed for metabolic heat production.
Screening for infection and starting antibiotics is mandatory because hypothermia is a classic sign of sepsis in this vulnerable population, where typical signs like fever may be absent.

Option A: This is an incomplete intervention. While rewarming is essential, doing it in isolation without addressing the underlying lack of energy (hypoglycemia) and the high probability of infection is insufficient and will lead to a poor outcome.
Option B: This is an incomplete intervention. Immediate feeding is critical to combat hypoglycemia, but it must be combined with active rewarming and infection management to ensure survival.
Option C: This is an incomplete intervention. Screening for and treating infection is vital as it is often the root cause, but it does not address the immediate, life-threatening problems of low body temperature and lack of energy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of hypothermia in Severe Acute Malnutrition (SAM) as background academic context rather than a clinical decision trigger.
Hypothermia in a malnourished child is a medical emergency, defined as a rectal temperature below 35.5°C (95.9°F) or an axillary temperature below 35.0°C (95°F).
Nurses must initiate slow rewarming. Skin-to-skin contact (Kangaroo Mother Care) is an effective and recommended method. Rapid rewarming should be avoided as it can cause physiological instability.
A nurse's role includes frequent monitoring of temperature and blood glucose, ensuring 2-hourly feeds (even at night), and administering antibiotics as prescribed.

How to Approach the Question

First, identify the key elements in the question: the patient is a 'child with SAM' and the presenting problem is 'hypothermia'.
Recall the common, life-threatening complications associated with SAM. This should trigger the memory of the 'lethal triad': hypothermia, hypoglycemia, and infection.
Understand that these three conditions are interlinked and must be managed together, not as separate problems.
Evaluate each option. Option A (warmer), Option B (feeds), and Option C (screening) each address one part of the triad.
Recognize that treating only one component is insufficient. A comprehensive approach is required for survival.
Therefore, the option that includes all necessary interventions, 'All of the above', is the most complete and correct answer.

Concept Tested & Keywords

Concept Tested: Management of hypothermia in Severe Acute Malnutrition (SAM)
Stem keywords: child, SAM, hypothermia
Lead-in keywords: should be
Clinical cues: Hypothermia in a child with SAM is a critical sign indicating a high risk of concurrent hypoglycemia and sepsis.