A teenager has Crohn's disease and presents to the emergency department with a 3-day history of decreased appetite, lethargy, and fatigue. Today the parent reports the child is confused and "looks blue." The nurse finds the child hypotensive
Which assessment question is most helpful?
A.
"Could your child be using illicit recreational drugs?"
B.
"Has your child been taking steroids for Crohn's disease?"
C.
"Have you taken her temperature today or yesterday?"
D.
"Is anyone else in your family sick now or recently?"
ANS: B
Steroids are often used to treat Crohn's disease and other autoimmune disorders. Because the child is manifesting signs of Addisonian crisis, the nurse should inquire about the use of steroids. Also, because the patient is a teenager, noncompliance is always a possibility. Abrupt discontinuation of steroids can precipitate an Addisonian crisis. The other assessment questions may yield valuable information but are not directly related to this child's history and presentation.
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