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The elevated WBC count, fever, rising airway pressures, and increased secretions are consistent with adeveloping ventilator-associated pneumonia (VAP). Asputum cultureis needed to identify the infectious agent and guide antibiotic therapy.

“Signs of VAP include increased airway secretions, elevated temperature, and rising ventilator pressures. Diagnostic workup includes obtaining sputum culture to guide treatment.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Ventilator Complications and Infection)

Small pneumothoraces (<10%) are oftenmanaged conservativelyin hemodynamically stable pediatric patients. The body's natural reabsorption of intrapleural air typically resolves the conditionwithout invasive intervention, provided that the patient is monitored closely.

“Observation is appropriate for small pneumothoraces (less than 10%) in stable pediatric patients. Serial chest radiographs and clinical assessments are used to monitor for progression. Chest tube insertion is generally reserved for larger or symptomatic pneumothoraces.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary Trauma and Chest Injury)

In a trauma situation, theprimary and secondary surveys take precedenceto assess life-threatening injuries and prioritize interventions. While a certified interpreter should be used for communicationas soon as possible, thenurse should not delay the physical assessmentduring a critical time.

“The priority in trauma is completion of the primary and secondary assessments. While interpreter use is standard, care must not be delayed in critical evaluations.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Cultural Competence and Emergency Protocols)

It is a best practice—and often required by hospital policy—fortrained personnel such as an organ donation liaison or organ procurement organization (OPO)representative to approach families about organ donation. This ensures that the conversation is handled sensitively, accurately, and in accordance with regulatory requirements.

“The nurse should notify the designated organ donation liaison or team when a patient meets criteria for brain death. These individuals are trained to communicate effectively and ethically with families.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Ethics, End-of-Life Care, and Organ Donation)

In end-of-life situations, especially involving pediatric patients, psychosocial support must extend to the entire family. When a parent expresses uncertainty or ambivalence, the nurse's role is to facilitate open communication and exploreparental concerns without imposing judgment or directives.

“Effective psychosocial care requires assessment of family readiness and emotional state. Nurses should encourage family expression of feelings and help clarify concerns before offering direction or education.”

(Referenced from CCRN Pediatric – Direct Care: Psychosocial Support and Palliative Care)

By asking about the parent's concerns, the nurse promotes a therapeutic relationship and gains insight into the family's emotional and cultural dynamics, allowing further support or child life referrals as needed.

Immediate access to the deceased patient supportsgrief processingandfamily-centered care. Presence at the bedside allows the family to begin saying goodbye and mayreduce psychological traumaassociated with sudden loss.

“Grief support includes prompt access to the deceased loved one. Delaying this can intensify distress and negatively affect family outcomes.”

(Referenced from CCRN Pediatric – Direct Care: Psychosocial, End-of-Life and Bereavement Support)

While patients with hypoplastic left heart syndrome (HLHS) typically have lower baseline oxygen saturations due to mixing of systemic and pulmonary blood flow,feverin this population is especially concerning due to theirimmunocompromised and pre-transplant status. Fever may signalinfection or sepsis, both of which can jeopardize transplant eligibility and lead to rapid decompensation.

“In patients awaiting heart transplantation, fever is a red flag for infection or systemic inflammatory response, both of which significantly increase mortality risk and complicate transplant candidacy. Prompt evaluation is required.”

(Referenced from CCRN Pediatric – Direct Care: Cardiovascular, Pre-Transplant Management)

Peritoneal dialysis usesdialysate fluid that contains glucoseto create an osmotic gradient for fluid removal. This glucose can beabsorbed into the bloodstream, especially with prolonged dwell times, resulting inhyperglycemia, particularly in pediatric patients with small body mass.

“Glucose in peritoneal dialysis solutions may be systemically absorbed, causing elevated serum glucose levels, particularly in pediatric and insulin-sensitive patients.”

(Referenced from CCRN Pediatric – Direct Care: Endocrine/Renal, Dialysis Complications)

These findings are consistent withpyelonephritisor another upper urinary tract infection. Arenal ultrasoundis a non-invasive test used to evaluate forstructural abnormalities, abscess, or obstruction, especially in a febrile child with a urinary tract infection.

“Renal ultrasound is indicated after diagnosis of febrile UTI to evaluate renal anatomy and rule out complications like abscess.”

(Referenced from CCRN Pediatric – Direct Care: Renal, Urinary Tract Infections and Imaging)

Encephalopathy refers to aglobal brain dysfunctioncaused by various factors such asmetabolic imbalances, toxins, hypoxia, or infections. In many cases,no definitive causative agent is identified, and treatment focuses onsupportive care and managing underlying triggers.

“Pediatric encephalopathy is often multifactorial, and in many cases no specific causative agent is isolated. Families should be counseled accordingly.”

(Referenced from CCRN Pediatric – Direct Care: Neurological, Encephalopathy and Parental Education)