A child with severe pertussis has been prescribed erythromycin (Erythrocin) and prednisone (Deltasone). Four days later, the parent informs the clinic nurse the child is sleeping more than usual and is not eating well
Which response by the nurse is the most appropriate?
A.
"Go to the emergency department for an infection workup."
B.
"Let her sleep; she is just exhausted from having pertussis."
C.
"Stop the prednisone for now and see how she does tomorrow."
D.
"Take her temperature; if it's normal bring her in tomorrow."
ANS: A
Children with severe pertussis are occasionally prescribed steroids to reduce the severity of the symptoms. Steroids, including prednisone, can mask signs of infection (including temperature). A child who is lethargic and not feeding well should be seen immediately for a sepsis workup. The child is acutely ill and needs evaluation, not sleep or waiting until tomorrow to be seen. The child's temperature may be normal or subnormal due to the immune-suppressive effects of the steroids and is not a reliable indicator of infection.
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