An 18-month-old infant hospitalized with a severe asthma attack is given prednisone, 15 mg po bid. The nurse… - JODHPUR AIIMS SNO-2018

JODHPUR AIIMS SNO-2018

Child Health Nursing (Pediatrics)

Medium

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

Prednisone is a powerful corticosteroid used to reduce inflammation in severe asthma attacks.
Its most significant and immediate side effect is immunosuppression, which severely weakens the body's ability to fight off pathogens.
Therefore, the highest priority for the nurse is to protect the child from any potential source of infection, as a new illness could be very dangerous for an immunocompromised infant.
This involves measures like strict hand hygiene, limiting visitors, and monitoring for subtle signs of infection.

Option A: Checking the eosinophil count is a diagnostic measure to assess the allergic component of asthma, not a primary nursing safety intervention for managing the side effects of prednisone.
Option B: While rest is beneficial for a child recovering from a severe asthma attack, it is a general supportive care measure and does not address the specific, life-threatening risk of immunosuppression caused by prednisone.
Option D: This action is contraindicated. Prednisone can cause significant gastrointestinal upset and increase the risk of peptic ulcers.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care and side effects of corticosteroid therapy in children to guide bedside assessment, documentation, and the next nursing action.
A primary nursing role is patient (and parent) education. The nurse must teach the parents about the importance of infection control at home, how to recognize early signs of illness, and the critical need to complete the prescribed course and taper the dose as directed.
Monitor for subtle signs of infection. Corticosteroids can mask classic signs like high fever and inflammation, so the nurse must be vigilant for less obvious cues like lethargy, irritability, or poor feeding in an infant.
What if the child develops a fever while on prednisone? This is a medical emergency. Unlike a typical childhood fever, a fever in an immunocompromised child must be investigated immediately to rule out a serious, potentially life-threatening infection. The nurse should notify the physician at once.

How to Approach the Question

First, identify the core elements of the question: an 18-month-old infant with severe asthma is receiving prednisone.
Recall the drug class and primary mechanism/side effects of prednisone. It is a corticosteroid, and its most potent side effect is immunosuppression.
Analyze the options based on the primary side effect. The question asks what the nurse should do, which implies a priority action.
Evaluate each option's relevance to immunosuppression. Preventing infection (Option C) directly addresses this major risk.
Eliminate other options. Checking labs (A) is diagnostic, not an action. Rest (B) is general care, not specific to the drug's risk. NPO (D) is contraindicated and harmful.
Conclude that preventing infection is the most critical, specific nursing action related to the administration of prednisone.

Concept Tested & Keywords

Concept Tested: Nursing care and side effects of corticosteroid therapy in children.
Stem keywords: 18-month-old infant, severe asthma attack, prednisone, nurse should
Lead-in keywords: The nurse should
Clinical cues: Patient is an 18-month-old infant, a vulnerable population.
Clinical cues: Medication is prednisone, a potent corticosteroid with significant side effects.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1418-1420