A 16-month-old patient being seen at the clinic has a fever and a diagnosis of bilateral otitis media. Which comment by the mother is most likely related to the patient's diagnosis?

Choice A rationale:

Monitoring the patient's breathing pattern at 15-minute intervals is crucial in an unconscious patient who may have ingested alcohol or drugs, as it helps assess their respiratory status. This intervention ensures early detection of any respiratory distress and guides necessary interventions.

Choice B rationale:

Inserting an indwelling Foley catheter for straight drainage is appropriate for unconscious patients to monitor their urinary output and renal function. This helps prevent urinary retention and complications related to inadequate urine elimination.

Choice C rationale:

Administering IV D5/45 NS at 100 mL/hr is a suitable intervention to maintain the patient's fluid and electrolyte balance. It prevents dehydration and supports hemodynamic stability.

Choice D rationale:

The nurse should question the prescription of syrup of ipecac. Ipecac is no longer recommended for use in cases of poisoning due to its potential to cause adverse effects like aspiration, electrolyte imbalances, and delayed treatment. Activated charcoal or gastric lavage may be more appropriate in this situation.

Answer is d. Monitor the capillary refill time in the toes on both feet. This is crucial for assessing circulation and ensuring that the cast is not impairing blood flow, which is a priority in cast care.

Choice A rationale:

Ensuring the appropriate care for a wet plaster cast is essential to prevent complications such as impaired circulation, discomfort, or skin breakdown. Keeping the cast covered with a lightweight blanket, as suggested in option A, may seem like a logical step to protect it from external elements and maintain warmth. However, covering a wet cast can actually retain moisture, which can slow the drying process. Moisture retention within the cast can lead to prolonged drying times, increasing the risk of complications such as skin maceration or discomfort for the patient. Therefore, while the intention behind covering the cast is to provide comfort, it may inadvertently prolong the drying process and contribute to potential complications.

Choice B rationale:

Maintaining increased humidity in the patient room, as mentioned in option B, might appear beneficial to aid in the drying process of the plaster cast. However, while humidity can influence the drying time of the cast, excessive humidity can have adverse effects on the integrity of the cast. High humidity levels can prolong the drying process by inhibiting the evaporation of moisture from the cast material. Additionally, increased humidity can compromise the structural integrity of the cast, potentially leading to weaknesses or deformities. Therefore, while it's important to consider environmental factors in cast care, maintaining excessively high humidity levels may not be advisable and could contribute to complications in the drying and integrity of the cast.

Choice C rationale:

Option C suggests using only the tips of the fingers when handling the wet cast. While it's crucial to handle a wet cast with care to avoid causing damage or deformities, limiting handling to just the fingertips may not provide adequate support or control. Plaster casts can be fragile when wet, and improper handling techniques may lead to misshaping or weakening of the cast structure. Additionally, relying solely on the fingertips for handling may increase the risk of inadvertently applying uneven pressure or causing accidental damage to the cast material. Therefore, while the intention behind this option is to promote gentle handling, it may not provide sufficient support or control to ensure the integrity of the wet cast.

Choice D rationale:

Monitoring the capillary refill time in the toes on both feet, as indicated in option D, is the most appropriate action for the nurse to take in this scenario. Capillary refill time is a valuable indicator of peripheral circulation and tissue perfusion. By assessing the capillary refill time in the toes, the nurse can evaluate the adequacy of blood flow to the extremities and detect any potential impairment caused by the plaster hip spica cast. Prolonged capillary refill time may suggest compromised circulation, which can lead to serious complications such as ischemia or tissue necrosis if left unaddressed. Therefore, regular monitoring of capillary refill time is essential for early detection of circulation problems and timely intervention to ensure patient safety and optimal outcomes.

In conclusion, while each option may seem plausible at first glance, careful consideration of the potential implications reveals that monitoring capillary refill time in the toes on both feet is the most appropriate action for the nurse to take when caring for a patient with a wet plaster hip spica cast. This proactive approach prioritizes patient safety by ensuring adequate circulation and minimizing the risk of complications associated with impaired blood flow. By adhering to evidence-based practice guidelines and maintaining vigilance in monitoring patient status, healthcare professionals can optimize outcomes and promote the effective healing and management of patients with plaster casts.