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

Pink-tinged urine can be a symptom of various conditions, including kidney issues or urinary tract infections. While individuals with sickle cell crisis can experience kidney complications, pink-tinged urine is not a universal or primary manifestation of a vaso-occlusive crisis. The immediate priority is pain management and infection prevention.

Choice B rationale

Palpitations, an awareness of one's own heartbeat, can be a symptom of various cardiac issues or a physiological response to stress or pain. While the heart rate is elevated (140 bpm, normal for a toddler is 90-140 bpm), this is likely secondary to the severe pain the child is experiencing and not the primary problem to be addressed.

Choice C rationale

Acute pain is a hallmark and often excruciating symptom of a sickle cell crisis, resulting from vaso-occlusion and tissue ischemia. The toddler's crying, restlessness, and aversion to touch strongly indicate severe pain, making it an immediate priority for intervention to alleviate suffering and prevent further complications.

Choice D rationale

Risk for infection is a significant concern in sickle cell disease due to functional asplenia, which compromises the immune system's ability to fight encapsulated bacteria. Despite the normal oxygen saturation, the elevated temperature (102°F or 38.8°C) in a child with sickle cell disease warrants immediate attention due to the high risk of severe infection.