A practical nurse (PN) is caring for a child who demonstrates "squatting" during play and is admitted for corrective surgery of a congenital heart defect.
Upon rising in the morning, the child demonstrates tachypnea and tachycardia consistent with cyanotic (hypoxic) spells. Which procedure should the PN implement?

Choice A rationale

Assessing elimination hygiene habits is important for preventing recurrent UTIs, but it does not directly address the immediate goal of minimizing complications of vesicoureteral reflux (VUR) in an acute febrile UTI. While good hygiene reduces bacterial entry, VUR involves retrograde urine flow.

Choice B rationale

Completing post-void bladder scans helps assess bladder emptying and residual urine, which are risk factors for UTIs. However, in the context of VUR and a febrile UTI, it's a diagnostic tool rather than a primary intervention to actively minimize the reflux itself during the infection.

Choice C rationale

Implementing a frequent voiding schedule minimizes the volume of urine in the bladder and reduces the duration of bladder distention. This decreases the likelihood of vesicoureteral reflux and helps to flush out bacteria, thus minimizing the risk of renal parenchymal damage during a febrile UTI.

Choice D rationale

Encouraging adequate oral fluid intake helps flush bacteria from the urinary tract and prevents dehydration, which is beneficial for overall health and UTI management. However, while important, it does not directly impact the mechanics of vesicoureteral reflux as effectively as frequent bladder emptying.

Choice A rationale

Impulsive and hyperactive behaviors are typically associated with conditions such as attention-deficit/hyperactivity disorder (ADHD), which involves neurodevelopmental differences affecting executive function and impulse control. While these behaviors can sometimes lead to accidents, they are not a direct sign of secondary enuresis.

Choice B rationale

Involuntary passage of feces, known as encopresis, is a distinct elimination disorder characterized by the repeated passage of stool into inappropriate places, often due to chronic constipation and overflow incontinence. It is a separate condition from enuresis, which specifically refers to involuntary urination.

Choice C rationale

Increased thirst, or polydipsia, is a common symptom of conditions like diabetes mellitus or diabetes insipidus, where the body attempts to compensate for fluid imbalances or high glucose levels. While some medical conditions causing enuresis might also involve increased thirst, it is not a direct sign of enuresis itself.

Choice D rationale

Declining invitations for sleepovers is a behavioral manifestation often observed in children with enuresis. The fear of embarrassment and shame associated with involuntary urination during sleep can lead them to avoid situations where their condition might be exposed, such as overnight stays at friends' houses.