A primigravida with a history of no prenatal care delivers a normal neonate by sterile vaginal delivery with no complications. The practical nurse (PN) enters the room with an injection of Rho immune globulin and explains the rationale for the injection.
Which situation warrants this injection?

Choice A rationale

A resting respiratory rate of 35 breaths/minute for a 4-month-old infant is within the normal range (typically 30-60 breaths/minute). Therefore, this finding alone does not indicate acute respiratory distress.

Choice B rationale

Bilateral bronchial breath sounds are normal findings when auscultated over the trachea. However, their presence over the peripheral lung fields can indicate consolidation, such as in pneumonia. While abnormal in the periphery, it is not an isolated sign of acute respiratory distress.

Choice C rationale

Diaphragmatic respirations, also known as abdominal breathing, are the predominant and normal breathing pattern in infants and young children due to the preferential use of the diaphragm for respiration. This is not a sign of respiratory distress.

Choice D rationale

Flaring of the nares is a significant clinical sign of increased work of breathing and respiratory distress in infants. It indicates that the infant is attempting to decrease airway resistance and maximize oxygen intake by dilating the nasal passages. This is a compensatory mechanism indicating respiratory compromise.

Choice A rationale

Promoting range-of-motion is typically achieved through exercises and movement. Dynamic splinting aims to maintain a specific joint position rather than actively increasing range of motion, which might be counterproductive to hip stability in developmental dysplasia.

Choice B rationale

Increasing extension would involve straightening the hip joint. In developmental dysplasia of the hip, the goal of treatment is to maintain the femoral head within the acetabulum, which often requires a flexed and abducted position, not extension.

Choice C rationale

Maintaining abduction is the primary purpose of dynamic splinting in developmental dysplasia of the hip. Abduction helps to seat the femoral head deeply into the acetabulum, promoting proper hip development and stability by stimulating acetabular ossification.

Choice D rationale

Providing immobilization implies completely restricting movement. Dynamic splinting, like the Pavlik harness, allows some movement while maintaining the abduction, flexion, and external rotation necessary for proper hip development. Full immobilization is typically not the goal for developmental dysplasia.