The emergency nurse is triaging four clients. Which client should the nurse assess first?

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11ecbb05_cadb_41c9_b433_c971417fbbe2_MD0009_00 Infant botulism is food poisoning that occurs after consuming Clostridium botulinum, a bacteria found in soil and animal products (eg, raw honey, milk). In infants, the bacteria often colonize the gastrointestinal tract and release an exotoxin that causes rapid, life-threatening paralysis. In addition to young age, absence of competitive bowel flora predisposes infants (age <1 year) to this infection. Therefore, infants should not be fed honey. Early clinical manifestations of infant botulism often include constipation, difficulty feeding, decreased head control, and diminished deep-tendon reflexes (Option A). It is essential to recognize symptoms early, because botulism progresses rapidly to respiratory failure and arrest. Management of infant botulism often includes administering intravenous botulism immune globulin (BIG-IV), which reduces severity and duration of symptoms by improving immune response. In addition, close monitoring and supportive care (eg, mechanical ventilation, enteral tube feedings) are provided. (Option B) Pain, swelling, and deformity of the elbow after falling may indicate a fracture. However, a fracture should not delay care of clients at risk for imminent respiratory failure. (Option C) Right-sided abdominal pain, fever, and inability to tolerate food may indicate acute appendicitis, which requires prompt care. However, clients with suspected botulism remain the priority. (Option D) Painful urination, back pain, and lethargy are clinical manifestations of urinary tract infection. Laboratory analysis and antibiotics may be required but should not delay care of suspected botulism. Educational objective: Infant botulism is food poisoning causing life-threatening paralysis, which occurs after consuming Clostridium botulinum. Infants (age <1 year) with signs of botulism (eg, constipation, difficulty feeding, decreased head control, diminished deep-tendon reflexes) require prompt intervention because respiratory failure may develop rapidly.

The Emergency Nurse Is Triaging Four Clients