A nurse is caring for an adolescent who is 1 hr postoperative following an appendectomy.
Which of the following findings should the nurse report to the provider?

The correct answer is d. Weight loss 7%.

Choice A reason: Respiratory rate 28/min. The normal respiratory rate for infants can vary depending on their age. For newborns, it’s typically between 30-60 breaths per minute1. As they grow older, the rate decreases. For example, infants aged 0-5 months have a normal respiratory rate of 25-40 breaths per minute. Therefore, a respiratory rate of 28/min falls within the normal range for an infant and does not specifically indicate moderate dehydration.

Choice B reason:. Bradycardia in infants is defined as a heart rate that is slower than normal for their age. For infants aged 0-3 years, a heart rate less than 100 beats per minute is considered bradycardia3. Bradycardia can be a sign of many conditions, including dehydration, but on its own, it is not a definitive indicator of moderate dehydration.

Choice C reason: Capillary refill time is the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. In infants, a normal capillary refill time is less than 2 seconds, and in newborns, it can be up to 3 seconds. A capillary refill time of 1 second is within the normal range and does not indicate moderate dehydration.

Choice D reason: Weight loss 7%. In infants, a weight loss of about 6-9% is generally considered a sign of moderate dehydration. This is because infants are particularly susceptible to fluid loss due to their small body size and higher body water content. A 7% weight loss in an infant who has rotavirus, which can cause significant fluid loss through diarrhea, is a strong indicator of moderate dehydration.

Choice A rationale:

Limiting fluids at bedtime is not a suitable instruction for a child with sickle cell disease. These patients are at risk of dehydration due to increased red blood cell destruction, and limiting fluids can exacerbate this condition, leading to vaso-occlusive crises and pain episodes.

Choice B rationale:

Applying cold compresses to painful areas might provide temporary relief for pain associated with sickle cell disease, but it does not address the overall management of the illness. Encouraging physical activity, on the other hand, is essential as it promotes overall health and can prevent complications like thrombosis.

Choice C rationale:

Encouraging physical activity as tolerated is the correct choice. Regular physical activity helps improve circulation and can reduce the risk of vaso-occlusive crises in patients with sickle cell disease. The nurse should advise the guardians to encourage the child to engage in activities that are appropriate for their age and physical condition, while also being mindful of any signs of fatigue or pain.

Choice D rationale:

Having the child wear a surgical mask to school is not relevant to the management of sickle cell disease. This measure is more appropriate for preventing the spread of contagious diseases and is not a specific intervention for sickle cell disease management.