Alterations in the nurse's behavior:
Children with respiratory problems need skilled and competent nursing care. The symptoms of hypoxemia, a complication of respiratory problems, are often insidious. Frequently, there is peripheral vasoconstriction with accompanying skin color changes. Tachypnea, tachycardia, anxiety, and confusion may ensue. It is the nurse's responsibility to observe, evaluate, and document the patient's condition. In the emergency department, the nurse is the member of the health-care team who has the greatest contact with the patient. Any significant change in the patient's condition, based upon nursing observation, must be promptly communicated to the physician.
The nurse should have informed the physician promptly of the 11:08 p.m. observations. These indicated that the child's condition was not improving but was, in fact, deteriorating. Before processing the discharge order, the nurse should have communicated to the physician that the child had failed to improve with treatment and more aggressive therapy would have been followed, possibly including hospital admission.
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