A swollen joint.

The practical nurse (PN) is caring for a 20-month-old toddler who was admitted with a sickle cell crisis.

The mother rocks the toddler who continues to cry, is restless, and does not wish to be touched.

The electronic monitoring device indicates that the toddler's temperature is 102° F (38.8° C), heart rate is 140 beats/minute, blood pressure 122/70 mm Hg, and oxygen saturation 98%. Which problem(s) should the PN document as the priority in the client's plan of care (POC)? Select all that apply.

Choice A rationale

While preventing further disability is a component of care for some progressive conditions, it is not the primary overarching goal for all developmental disabilities. Many developmental disabilities are static and non-progressive, meaning their primary impact is on functional limitations rather than ongoing deterioration. The focus shifts to maximizing existing abilities and potential rather than preventing progression.

Choice B rationale

Meeting rehabilitation needs is a critical aspect of care for children with developmental disabilities, focusing on improving specific skills and functions. However, rehabilitation is a means to an end. The ultimate objective extends beyond just addressing deficits to encompassing the child's holistic development and empowering them to achieve their highest possible level of independence and functioning.

Choice C rationale

The primary goal for a child with a developmental disability is to help them achieve their maximum potential. This encompasses a holistic approach, focusing on enhancing their cognitive, physical, social, emotional, and adaptive skills. It aims to foster independence, improve quality of life, and integrate them into society as much as possible, recognizing their unique strengths and capabilities.

Choice D rationale

Promoting the child's social acceptability, while important for their well-being and integration, is a secondary outcome rather than the primary goal of treatment. The main focus is on the child's individual development and functional abilities. Enhanced social acceptability often naturally follows when a child achieves greater independence and participation in various life domains.

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.