A child presents with intense itching and small erythematous papules that appear as lines on the skin, after visiting a crowded daycare.
What is the likely diagnosis?

Choice A rationale

Initiating feeding too soon after pyloromyotomy, a surgical repair of the pyloric sphincter, can lead to vomiting and aspiration in the immediate postoperative period. The gastrointestinal system needs time to recover from anesthesia and the surgical manipulation to the pylorus, which controls the passage of food from the stomach to the small intestine. Introducing fluids prematurely can overwhelm the healing surgical site.

Choice B rationale

Encouraging parental bonding and cuddling is crucial for the psychosocial well-being of the infant and parents. However, in the immediate postoperative phase, physiological stability takes precedence. While emotional support is important, addressing potential complications and assessing the infant's physical status are the priority actions.

Choice C rationale

Documenting the surgical site appearance is an important nursing responsibility to monitor for signs of infection, bleeding, or dehiscence. However, assessing the infant's immediate postoperative condition, particularly pain, which can indicate complications or discomfort, is a more immediate concern. Pain management directly impacts the infant's physiological stability.

Choice D rationale

Identifying signs of pain using an appropriate pain scale is the priority intervention in a post-operative infant. Pain can lead to physiological instability, such as increased heart rate, blood pressure, and respiratory distress. Early identification and management of pain ensure the infant's comfort and facilitate recovery. Utilizing a validated pain scale for infants allows for objective assessment of pain levels and guides appropriate interventions.

Choice A rationale

Allergic reactions to food items typically manifest with systemic symptoms like hives, angioedema, vomiting, or diarrhea, in addition to skin manifestations. While a rash can occur, the localized nature of the dry, scaly patches on the hands, specifically after using a new hand soap, makes a food allergy less likely as the primary cause.

Choice B rationale

Irritant contact dermatitis is a localized inflammatory reaction of the skin caused by direct contact with an irritating substance. New scented hand soaps often contain chemicals and fragrances that can disrupt the skin barrier, leading to erythema, dryness, and scaling, particularly on areas frequently exposed like the hands. The absence of vesicles or oozing supports an irritant rather than an allergic reaction.

Choice C rationale

Fungal infections of the skin, such as tinea manuum, typically present with scaling, redness, and sometimes vesicles or pustules. While a pet can be a source of fungal infections, the recent introduction of a new hand soap makes an irritant reaction a more probable cause than a fungal infection, which usually develops more gradually.

Choice D rationale

Atopic dermatitis (eczema) is a chronic inflammatory skin condition characterized by itchy, red, and scaly patches. While it can affect the hands, it often has a history of exacerbations and remissions and may be associated with other atopic conditions like asthma or allergies. The sudden onset after using a new product points more towards contact dermatitis rather than an eczema flare-up in a child with no significant medical history.