A nurse is caring for an adolescent who was admitted to the emergency department with a minor head injury. Which of the following findings should the nurse expect?

Rationale for correct choices

• Crohn’s exacerbation: The adolescent presents with acute worsening of diarrhea, abdominal cramping, and decreased intake, consistent with a flare of Crohn’s disease. Laboratory findings show elevated WBC (15,000/mm³) and C-reactive protein (2.1 mg/dL), indicating an active inflammatory response. Positive stool occult blood further supports gastrointestinal mucosal involvement.

• Inflammation: Crohn’s disease flares are driven by intestinal inflammation, which damages the mucosa and leads to diarrhea, abdominal pain, and systemic responses like tachycardia and low-grade fever. Elevated inflammatory markers (CRP, WBC) provide objective evidence of active inflammation. Targeting the inflammatory process is central to management through medications and supportive care.

Rationale for incorrect choices

• Gastroenteritis: Although diarrhea and abdominal cramping can occur with viral gastroenteritis, the adolescent’s chronic history of Crohn’s disease, positive stool occult blood, and elevated inflammatory markers indicate a flare rather than an acute viral infection. Gastroenteritis usually presents with sudden onset, fever, vomiting, and is self-limiting in otherwise healthy children.

• Constipation: The adolescent is experiencing diarrhea, not constipation. Constipation presents with hard, infrequent stools, abdominal bloating, and discomfort, which are not consistent with the current presentation. Focusing on constipation would not address the inflammatory flare.

• Viral infection: No evidence of viral infection, such as high fever, vomiting, or systemic malaise, is present. Laboratory findings do not indicate viral etiology, making this an unlikely cause of symptoms. The diarrhea and abdominal pain are more consistent with Crohn’s disease exacerbation.

• Dietary triggers: Although diet can influence Crohn’s symptoms, there is no recent change in dietary intake reported. The primary driver of the flare appears to be inflammatory activity rather than a new dietary trigger. Management focuses on inflammation control rather than diet alone.

A. Secure the restraints with a quick-release knot: Using a quick-release knot ensures that restraints can be removed quickly in an emergency, such as if the child experiences respiratory distress or circulatory compromise. This practice promotes safety while maintaining control of aggressive behavior.

B. Assess the child every 4 hr while in restraints: Restraints require frequent monitoring, typically every 15–30 minutes for a child, to assess circulation, skin integrity, and psychological status. Assessing only every 4 hours would place the child at risk for injury or complications.

C. Tie the restraints to the side rails of the child's bed: Restraints should never be tied to side rails, as this can increase the risk of injury if the bed is adjusted or the child struggles. Restraints should be secured to a stable part of the bed frame that does not move.

D. Request that the provider renew the prescription for restraints every 48 hr: Pediatric restraint prescriptions are typically valid for a much shorter period, often 1–2 hours depending on hospital policy, and require frequent reassessment. A 48-hour renewal is unsafe and does not comply with standard guidelines.