A nurse is providing instructions about a 24-hour urine collection to an adolescent client. Which of the following should the nurse include in the teaching?

Choice A rationale: Using a mild detergent for the child’s laundry is important to avoid skin irritation. Harsh detergents can exacerbate skin conditions, especially in children with sensitive skin or a history of allergic reactions. Switching to a mild, hypoallergenic detergent can help reduce irritation and prevent further aggravation of the skin lesions.
Choice B rationale: Applying emollients to the child’s skin after bathing helps to lock in moisture and prevent dryness. Emollients create a protective barrier on the skin, which can soothe and hydrate dry, scaly patches. This is particularly important for children with conditions like eczema, where maintaining skin hydration is crucial to managing symptoms and preventing flare-ups.
Choice C rationale: Applying gloves to the child’s hands can help prevent scratching and further damage to the skin lesions. Scratching can lead to excoriation, bleeding, and an increased risk of infection. By using gloves, the child is less likely to cause harm to the affected areas, allowing the skin to heal more effectively.
Choice D rationale: Applying a thick layer of pimecrolimus cream to the child’s lesions is not recommended. Pimecrolimus should be applied as a thin layer to the affected areas as directed by the healthcare provider. Over-application can lead to potential side effects and may not provide additional therapeutic benefits.
Choice E rationale: Cutting and filing the child’s fingernails frequently is important to minimize the damage caused by scratching. Short, smooth nails are less likely to break the skin and cause excoriation or bleeding. This simple measure can help reduce the risk of infection and promote healing of the skin lesions.

Choice F rationale: The child’s condition is not contagious. Conditions like eczema or atopic dermatitis are not infectious and cannot be spread from person to person. It is important to reassure the guardian that the child’s skin condition does not pose a risk to others.
Choice G rationale: Informing the guardian that the child will experience occasional flare-ups of the condition is important for setting realistic expectations. Chronic skin conditions like eczema often have periods of exacerbation and remission. Understanding this pattern can help the guardian manage the child’s condition more effectively and seek appropriate treatment during flare-ups.

The correct answer is Choice B.

Choice A rationale

Serous chest tube drainage is a normal finding and does not typically indicate a complication. It is usually clear or pale yellow fluid that is expected after surgery.

Choice B rationale

Chest tube drainage of 200 mL in 1 hour is excessive and should be reported to the provider. This could indicate active bleeding or other complications that require immediate attention.

Choice C rationale

Fluctuation in the water-sealed chamber, also known as tidaling, is a normal finding and indicates that the chest tube is functioning properly. It reflects changes in pressure within the pleural space during respiration.

Choice D rationale

A respiratory rate of 22/min is within the normal range for a school-age child and does not typically indicate a complication.