If the child has bacterial pneumonia, a high fever is usually present. Increased temperature (usually more than 38 C or 100.4 F) or fever with tachycardia and/or chills and sweats is a major clinical finding. Physical findings also vary from patient to patient and mainly depend on the severity of lung consolidation, the type of organism, the extent of the infection, host factors, and existence or nonexistence of pleural effusion.

Option B: Bacterial pneumonia usually presents with a productive cough, not a nonproductive cough. The presence of a productive cough is the most common and significant presenting symptom. The lower respiratory tract is not sterile, and it always is exposed to environmental pathogens. Invasion and propagation of the above-mentioned bacteria into lung parenchyma at alveolar level causes bacterial pneumonia, and the body’s inflammatory response against it causes the clinical syndrome of pneumonia.
Option C: Rhinitis is often seen with viral pneumonia. Features in the history of bacterial pneumonia may vary from indolent to fulminant. Clinical manifestation includes both constitutional findings and findings due to damage to the lung and related tissue.
Option D: Vomiting and diarrhea are usually not seen with pneumonia. Atypical pneumonia presents with pulmonary and extrapulmonary manifestations, such as Legionella pneumonia, often presents with altered mentation and gastrointestinal symptoms.

For a child with epiglottitis and the possibility of complete obstruction of the airway, emergency tracheostomy equipment should always be kept at the bedside. Prepare for intubation or tracheostomy; Anticipate the need of an artificial airway. An artificial airway is required to promote oxygenation and ventilation and prevent aspiration.

Option A: Administer IV antibiotics as ordered. After obtaining blood and epiglottic cultures, second-or-third generation cephalosporins and beta-lactamase-resistant antibiotics should be started as soon as possible.
Option C: Discourage examining throat with a tongue blade or taking throat culture unless immediate emergency equipment and personnel at hand. Position the child in a sitting up and leaning forward position with mouth open and tongue out (“tripod” position). Allows maximum entry of air into the lungs for improved oxygenation.
Option D: Oxygen will not treat an obstruction. Endotracheal intubation must be readily available; assist with tracheostomy if needed or prepare for the procedure in surgery. Establishes airway if obstruction present and respiratory failure and asphyxia are imminent.

Exophthalmos (protrusion of eyeballs) often occurs with hyperthyroidism. Graves’ orbitopathy (ophthalmopathy) is caused by inflammation, cellular proliferation and increased growth of extraocular muscles and retro-orbital connective and adipose tissues due to the actions of thyroid stimulating antibodies and cytokines released by cytotoxic T lymphocytes (killer cells). These cytokines and thyroid stimulating antibodies activate periorbital fibroblasts and preadipocytes, causing synthesis of excess hydrophilic glycosaminoglycans (GAG) and retro-orbital fat growth.

Option A: Physical signs of hyperthyroidism include tachycardia, systolic hypertension with increased pulse pressure, signs of heart failure (like edema, rales, jugular venous distension, tachypnea), atrial fibrillation, fine tremors, hyperkinesia, hyperreflexia, warm and moist skin, palmar erythema and onycholysis, hair loss, diffuse palpable goiter with thyroid bruit and altered mental status.
Option B: Hyperthyroidism usually increases the appetite. If the client is taking in a lot more calories, they can gain weight even if their body is burning more energy. Make sure to eat healthy foods, get regular exercise, and work with a doctor on a nutrition plan. These steps can all help combat weight gain from an increased appetite.
Option D: In younger patients, common presentations include heat intolerance, sweating, fatigue, weight loss, palpitation, hyper defecation, and tremors. Other features include insomnia, anxiety, nervousness, hyperkinesia, dyspnea, muscle weakness, pruritus, polyuria, oligomenorrhea or amenorrhea in the female, loss of libido, and neck fullness.

The child with celiac disease should be on a gluten-free diet. When a child has celiac disease, gluten causes the immune system to damage or destroy villi. Villi are the tiny, fingerlike tubules that line the small intestine. The villi’s job is to get food nutrients to the blood through the walls of the small intestine. If villi are destroyed, the child may become malnourished, no matter how much he eats. This is because they aren’t able to absorb nutrients. Complications of the disorder include anemia, seizures, joint pain, thinning bones, and cancer.

Option A: Be careful of corn and rice products. These don’t contain gluten, but they can sometimes be contaminated with wheat gluten if they’re produced in factories that also manufacture wheat products. Look for such a warning on the package label.
Option B: Avoid all products with barley, rye, triticale (a cross between wheat and rye), farina, graham flour, semolina, and any other kind of flour, including self-rising and durum, not labeled gluten-free.
Option C: Substitute potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour for wheat flour. You can also use sorghum, chickpea or Bengal gram, arrowroot, and corn flour, as well as tapioca starch extract. These act as thickeners and leavening agents.

Remember the ABCs (airway, breathing, circulation) when answering this question. Administer oxygen first to increase the O2 saturation level. Provide humidified oxygen as ordered. Administering humidified oxygen prevents drying out the airways, decreases convective moisture losses, and improves compliance.

Option A: Monitor vital signs and cardiac rhythm. Tachycardia, dysrhythmias, and changes in BP can reflect the effect of systemic hypoxemia on cardiac function. Auscultate breath sounds, noting areas of decreased airflow and adventitious sounds. Breath sounds may be faint because of decreased airflow or areas of consolidation. Presence of wheezes may indicate bronchospasm or retained secretions. Scattered moist crackles may indicate interstitial fluid or cardiac decompensation.
Option B: The normal oxygen saturation for a child is 92%–100%. Monitor O2 saturation and titrate oxygen to maintain Sp02 between 88% to 92%. Pulse oximetry reading of 87% below may indicate the need for oxygen administration while a pulse oximetry reading of 92% or higher may require oxygen titration.
Option D: Before assessing the pulse, oxygen should be applied to increase the oxygen saturation. Monitor vital signs and cardiac rhythm. Tachycardia, dysrhythmias, and changes in BP can reflect the effect of systemic hypoxemia on cardiac function.