A 14-year-old has come into the health clinic and she tells the nurse, “I think I might have caught gonorrhea from my boyfriend who has it. I need to get tested and treated but I don’t want my parents to know.

QUESTION

A 14-year-old has come into the health clinic and she tells the nurse, “I think I might have caught gonorrhea from my boyfriend who has it. I need to get tested and treated but I don’t want my parents to know. What should I do?”. How should the nurse respond?​

Provide three (3) examples of communicable diseases that need to be reported to the public health department.

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​​A client with streptococcal pharyngitis will need to be placed in droplet precaution. Provide three (3) characteristics of this form of precaution.

​A nurse is reinforcing teaching to a new mother about the colic hold. What would the nurse instruct the client to do?

​What is the sequence that should be followed when collecting data during an abdominal assessment? Why is it important to do the steps in order?

ANSWER

“Optimizing Abdominal Assessment: The Importance of a Systematic Approach for Nurses”

The nurse should respond to the 14-year-old by assuring her of confidentiality and explaining her rights to privacy. The nurse should inform the teenager that she can request confidential testing and treatment for sexually transmitted infections (STIs) without involving her parents. The nurse can explain that many health clinics offer confidential services specifically for adolescents, where they can seek medical care without parental involvement. The nurse should also emphasize the importance of getting tested and treated for gonorrhea to prevent complications and further transmission. The nurse can provide information on the potential consequences of untreated STIs and emphasize the importance of safe sex practices in the future. Additionally, the nurse can offer support and resources for the teenager, such as counseling or education on healthy relationships and sexual health.

Examples of communicable diseases that need to be reported to the public health department include:

Tuberculosis (TB)

TB is a bacterial infection that primarily affects the lungs but can also affect other parts of the body. It is highly contagious and can spread through the air when an infected person coughs or sneezes (Healthdirect Australia, 2023). Due to its potential for rapid transmission, TB cases are required to be reported to the public health department for appropriate monitoring, contact tracing, and treatment.

Measles

Measles is a highly contagious viral infection that spreads through respiratory droplets. It causes symptoms such as high fever, rash, cough, and runny nose. Given its ability to spread quickly in susceptible populations, measles cases need to be reported to the public health department to implement measures such as quarantine, immunization campaigns, and contact tracing.

Hepatitis B

 Hepatitis B is a viral infection that affects the liver and is transmitted through contact with infected blood or other body fluids. It can be transmitted through sexual contact, sharing needles, or from an infected mother to her newborn during childbirth. Cases of hepatitis B are required to be reported to the public health department to facilitate surveillance, prevention efforts, and identification of potential outbreaks.

Characteristics of droplet precautions, which should be implemented for a client with streptococcal pharyngitis, include:

Personal Protective Equipment (PPE

 Healthcare workers should wear a surgical mask when within close proximity to the client, as the infection can spread through respiratory droplets. The mask helps to prevent the inhalation of droplets containing the infectious agent.

Private Room or Cohorting

 The client should ideally be placed in a private room to minimize the risk of transmission to other individuals. If a private room is unavailable, the client can be placed in a room with individuals with the same infection to prevent the spread of droplets to susceptible individuals.

Hand Hygiene and Respiratory Etiquette

 Frequent hand hygiene, including handwashing with soap and water or using alcohol-based hand sanitizers, should be practiced by healthcare workers and the client (Healthdirect Australia, n.d.). The client should be educated on covering their mouth and nose with a tissue or their elbow when coughing or sneezing to reduce the release of infectious droplets into the air.

When instructing a client about the colic hold, a nurse would provide the following instructions:

Positioning

 Instruct the client to sit in a comfortable chair or on a couch with good back support. The client should keep their feet flat on the floor.

Hold the Baby

 Instruct the client to place the baby’s stomach against their chest, facing inward. The baby’s head should rest in the crook of the client’s arm, with the hand supporting the baby’s bottom.

Rocking and Soothing

 Encourage the client to gently rock the baby back and forth while maintaining a secure hold. The client can also use a rhythmic shushing sound or gentle patting on the baby’s back to provide additional comfort.

The sequence that should be followed when collecting data during an abdominal assessment is as follows:

Inspection

 The nurse begins by visually assessing the abdomen for any visible abnormalities, such as scars, rashes, or distension. They observe the shape, symmetry, and any visible pulsations or movement.

Auscultation

The nurse then uses a stethoscope to listen to the bowel sounds in all four quadrants of the abdomen. They listen for the presence, character, and frequency of bowel sounds, which can provide information about gastrointestinal motility.

Percussion

 Percussion involves tapping on the abdominal wall to assess the density of underlying organs and detect any abnormal fluid or air accumulation. It helps determine the size, location, and density of organs, as well as the presence of fluid or gas.

Palpation

Palpation involves using the hands to feel and assess the abdomen for any abnormalities, tenderness, masses, or organ enlargement (De Virgilio, 2015). The nurse starts with light palpation to assess for superficial tenderness or muscle guarding and then progresses to deep palpation to assess for organ enlargement or masses.

It is important to follow these steps in order during an abdominal assessment for several reasons. First, inspection provides valuable initial information about the overall appearance and any visible abnormalities, which can guide subsequent assessment techniques. Auscultation should be performed before palpation and percussion because the latter techniques can potentially alter bowel sounds. By listening to bowel sounds first, the nurse obtains a more accurate assessment of gastrointestinal activity. Percussion helps identify the density of underlying structures and detect any abnormal fluid or air accumulation, which can influence palpation findings. Palpation, performed last, allows for a thorough assessment of the abdomen’s organs, tenderness, and masses without interference from percussion or palpation itself. Following this sequence ensures a systematic and comprehensive assessment of the abdomen, aiding in accurate diagnosis and appropriate care planning.

References

De Virgilio, C. (2015). Question Sets and Answers. In Question Sets and Answers. https://doi.org/10.1007/978-1-4939-1726-6_59

Healthdirect Australia. (2023, March 22). Tuberculosis (TB). https://www.healthdirect.gov.au/tuberculosis 

Healthdirect Australia. (n.d.). Hand washing. Healthdirect. https://www.healthdirect.gov.au/hand-washing

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