A nurse is caring for a toddler who had a cleft lip and palate repair and is trying to touch the incision site. Which of the following provider prescriptions is recommended for the toddler?

A. Swaddle the toddler in a blanket. While swaddling may be comforting, it does not effectively prevent the toddler from reaching the incision site. Elbow restraints are a more appropriate choice for limiting arm movement and protecting the incision site.

B. Place the toddler in bilateral elbow restraints. Bilateral elbow restraints are commonly used after cleft lip and palate repair to prevent the toddler from touching or disrupting the incision site. These restraints help protect the surgical area while allowing the child to maintain some mobility.

C. Place the child in a mummy restraint. A mummy restraint (wrapping the child tightly) may be too restrictive and can cause distress, as it limits the child's ability to move freely. Elbow restraints are typically a better choice to prevent injury to the surgical site while still allowing some movement.

D. Obtain a prescription for lorazepam. Lorazepam is a sedative and would not be the first-line approach to managing the child's need to prevent touching the incision site. Using physical restraints is a safer and more effective option.

Condition Most Likely Experiencing: Crohn's disease

Actions to Take:

1. Record dietary intake
2. Provide a gluten-free diet.

Parameters to Monitor:

1. Albumin level.
2. Hemoglobin level.

Rationale:

Crohn’s Disease- Positive stool occult blood and positive leukocytes suggest intestinal inflammation and bleeding, which are characteristic of Crohn’s disease. Elevated C-reactive protein (CRP) (3.2 mg/dL) and WBC count (13,000/mm³) indicate inflammation and infection, common in Crohn’s disease flare-ups. Low albumin (3.4 g/dL) suggests malabsorption and protein loss, which occurs in Crohn’s disease due to chronic inflammation and poor nutrient absorption.

Appendicitis – Usually presents with localized right lower quadrant (RLQ) pain, fever, nausea, vomiting, and abdominal rigidity. The patient does not have classic signs of appendicitis.

Peptic Ulcer Disease (PUD) – Typically associated with H. pylori infection (negative in this case) and does not usually cause elevated CRP and WBC.

Celiac Disease – Would not cause elevated inflammatory markers (CRP, WBC) or stool occult blood.·

Record dietary intake.Nutritional deficiencies (e.g., low albumin) are common in Crohn’s disease. Keeping a food diary helps identify trigger foods that exacerbate symptoms.

Provide a gluten-free diet. While gluten-free diets are primarily for celiac disease, some Crohn’s disease patients may benefit from avoiding gluten and other inflammatory foods. Low-residue, high-protein diets are often recommended to reduce intestinal irritation and promote healing.

Administer an enema. Contraindicated in Crohn’s disease, as enemas can worsen inflammation and irritate the bowel.

Prepare for surgery. Surgery is not the first-line treatment for Crohn’s disease. It is only considered for severe complications (e.g., strictures, fistulas, or perforation).

Albumin level. Low albumin suggests malabsorption and protein loss, which should be monitored to assess nutritional status.

Hemoglobin level. Anemia (Hgb 11 g/dL, Hct 33%) suggests chronic blood loss from inflammation. Monitoring hemoglobin helps assess disease progression and response to treatment.

Abrupt decrease in pain level. This would be a concern for bowel perforation rather than an indicator of improvement in Crohn’s disease.

Abdominal rigidity. Not a typical assessment parameter for Crohn’s disease, but more relevant for appendicitis or peritonitis