A nurse is planning care for a school-age child who has acute glomerulonephritis. Which of the following interventions should the nurse include?

Developmental milestones are used to evaluate neurological, motor, and social progression during infancy. At 9 months of age, infants are expected to sit independently, begin pulling to stand, and demonstrate early language development such as babbling. Failure to achieve age-appropriate gross motor and language milestones may indicate developmental delay, neurological impairment, or underlying systemic conditions requiring further evaluation.

Rationale for correct choices:

• Sitting ability: By 9 months, infants are expected to sit independently without trunk support and begin transitioning toward crawling and pulling to stand. This infant is only able to sit with trunk support, which indicates delayed gross motor development. This suggests possible neuromuscular delay, hypotonia, or other developmental concerns affecting core muscle strength and postural control. Delayed sitting ability should be reported for further evaluation.

• Vocalization: By 6 to 9 months of age, infants should be babbling with consonant sounds such as “ba,” “da,” or “ma,” which reflects normal language and social development. The absence of vocalization or babbling at 9 months is a significant developmental delay in speech and language milestones. This may indicate hearing impairment, neurological delay, or global developmental delay. Lack of early communication skills requires further assessment.

Rationale for incorrect choices:

• Tooth eruption: The appearance of a single lower central incisor at 6 months falls within normal variation and does not require concern. Tooth eruption timing differs significantly between infants and is not used as a primary developmental milestone marker. Therefore, this finding is considered normal and does not need to be reported.

• Fine motor skills: No evidence in the assessment suggests abnormal fine motor development, such as inability to grasp objects or poor hand coordination. Without abnormal findings, fine motor skills cannot be identified as delayed.

Post–cardiac catheterization care in infants focuses on preventing complications related to vascular access and maintaining adequate circulation to the affected limb. Because the procedure commonly involves femoral vessel access, there is a risk of bleeding, thrombosis, and impaired distal perfusion. Nursing assessment must prioritize neurovascular status, including color, temperature, pulses, and capillary refill of the affected extremity. Early recognition of compromised circulation is essential to prevent tissue damage and serious complications.

Rationale:
A. Monitoring the color of the affected extremity is essential because changes such as pallor, cyanosis, or mottling may indicate decreased arterial blood flow after catheterization. Vascular spasm, clot formation, or bleeding at the insertion site can impair circulation to the limb. Frequent neurovascular checks help identify complications early and allow prompt intervention.

B. Maintaining NPO status for 8 hours is not routinely required after cardiac catheterization once the infant is stable and awake enough to safely tolerate feeding. Prolonged fasting may contribute to dehydration and irritability. Oral intake is usually resumed as soon as the provider determines it is safe, rather than using a fixed extended NPO period.

C. Assessing vital signs every 4 hours is too infrequent during the immediate post-procedure period. Infants require close monitoring for bleeding, hypotension, and hemodynamic instability, often with assessments every 15 to 30 minutes initially. Delayed monitoring may result in missed signs of serious complications.

D. Keeping the affected extremity fixed is not correct because the extremity should remain straight and immobilized, not flexed. Flexion can place pressure on the catheterization site and increase the risk of bleeding or hematoma formation. Maintaining extension helps protect the insertion site and supports proper healing.