A 10-year-old with sickle cell disease reports frequent joint pain. Which nursing intervention is most appropriate?

A. Use the inhaler as needed during an asthma attack, but avoid overuse is correct. Albuterol is a short-acting beta-agonist (SABA) used as a rescue inhaler to relieve acute bronchospasm. It should be used during episodes of wheezing, coughing, or shortness of breath, but parents should be instructed not to overuse it, as excessive use can cause tachycardia, tremors, and decreased effectiveness. Monitoring frequency helps identify poorly controlled asthma that may require a review of the maintenance regimen.

B. Use the inhaler only when the child has difficulty breathing during physical activity is partially correct, but limiting it to activity-induced symptoms alone ignores other potential triggers, such as allergens or infections, which can also precipitate asthma attacks. Rescue inhalers are intended for all acute exacerbations, not just activity-induced ones.

C. Use the inhaler every 4 hours as a preventative measure is incorrect. Albuterol is not a maintenance or preventive medication; daily scheduled use is not recommended unless prescribed for specific short-term prophylaxis (e.g., before exercise). Long-term control requires inhaled corticosteroids or other controller medications, not a SABA.

D. Limit the use of the inhaler to prevent dependency on the medication is incorrect. Albuterol does not cause drug dependency, but overuse can indicate poor asthma control. The focus should be on appropriate use for symptom relief rather than fear of dependency.

A. The lochia is small with scant clots is incorrect because scant lochia is a normal finding in the immediate postpartum period. Scant lochia reflects the normal shedding of the uterine lining and is not affected by bladder distention. While abnormal lochia patterns can indicate complications such as retained placental fragments or infection, small, scant lochia alone does not suggest a distended bladder.

B. The fundus is at the umbilicus and midline is incorrect because a firm, midline fundus at the umbilicus is considered a normal finding 2 hours postpartum. This indicates that the uterus is contracting appropriately and that there is no interference from bladder distention. A normal fundal position rules out bladder distention as a cause for uterine displacement.

C. The lochia is moderate with no clots is incorrect because moderate lochia is also within the expected range for 2 hours postpartum and represents normal uterine bleeding as the uterus continues involution. This finding does not indicate bladder distention, although excessive bleeding or clots could signal uterine atony or retained tissue.

D. The fundus is deviated to the right at U+2 is correct because a lateral displacement of the fundus, most commonly to the right, is a hallmark sign of bladder distention. The full bladder physically pushes the uterus out of midline, preventing adequate contraction. If left unrelieved, this can increase the risk of uterine atony and postpartum hemorrhage. The nurse should assist the patient to void or catheterize if necessary, then reassess the fundal position to ensure the uterus is firm and midline.