During a routine clinic visit, a nurse finds that a 5-year-old girl’s systolic blood pressure is above the 90th percentile. What should be the nurse’s subsequent action?

= Answer is... Choice A. Severe skin breakdown in the diaper area.

Choice A rationale:

In the case of the 3-month-old infant presenting with difficulty sleeping through the night, severe skin breakdown in the diaper area is the most significant finding requiring attention in care planning for this family. Diaper dermatitis, characterized by erythema, edema, and erosion of the skin in the diaper region, can cause considerable discomfort and distress to the infant. Moreover, severe skin breakdown increases the risk of secondary infections and exacerbates the infant's discomfort, potentially impacting sleep patterns and overall well-being.

Diaper dermatitis often results from prolonged exposure to urine and feces, friction, and the occlusive environment created by diapers. The acidic pH of urine and feces, coupled with the breakdown of urea into ammonia, contributes to skin irritation and inflammation. Additionally, the warm, moist environment beneath the diaper provides an ideal breeding ground for microbial overgrowth, further exacerbating skin damage.

Management of severe diaper dermatitis involves a multifaceted approach, including frequent diaper changes, gentle cleansing of the affected area, application of barrier creams or ointments, and promotion of air exposure to facilitate healing. In severe cases, topical corticosteroids or antifungal agents may be prescribed to reduce inflammation and prevent secondary infections.

Preventing and managing diaper dermatitis is essential not only for alleviating the infant's discomfort but also for promoting uninterrupted sleep patterns. Discomfort associated with diaper rash can lead to increased irritability and difficulty settling down for sleep, contributing to sleep disturbances for both the infant and the caregiver. By addressing the underlying cause of the skin breakdown and implementing appropriate interventions, healthcare providers can support the family in improving the infant's comfort and sleep quality.

Choice B rationale:

The mother stating that the baby is irritable during feedings is indeed noteworthy and may indicate various underlying issues, such as feeding difficulties, gastrointestinal discomfort, or inadequate milk supply. However, while irritability during feedings can contribute to disrupted sleep patterns, it is not as directly relevant to the immediate concern of severe skin breakdown in the diaper area. Nonetheless, addressing feeding concerns is essential for optimizing the infant's nutritional intake and overall well-being.

Choice C rationale:

The mother being a single parent and living with her parents provides contextual information about the family's social support structure but is not directly related to the infant's difficulty sleeping through the night or the significant finding of severe skin breakdown in the diaper area. While family dynamics and support systems play a crucial role in caregiving and may influence the implementation of care strategies, they do not directly address the infant's current health issue.

Choice D rationale:

The fact that the infant's formula has been changed twice may indicate attempts to address feeding-related concerns or suspected formula intolerance. While changes in formula may impact the infant's gastrointestinal comfort and feeding patterns, they do not directly address the primary concern of severe skin breakdown in the diaper area. Nonetheless, evaluating the appropriateness of the current formula and addressing any feeding-related issues remain important aspects of comprehensive care for the infant.

Step 1: First, convert the child’s weight from pounds to kilograms. Since 1 pound is approximately 0.45 kilograms, an 18-pound child weighs about 8.16 kilograms (18 pounds × 0.45 kg/pound).

Step 2: Next, calculate the total daily dosage of amoxicillin. The prescribed dosage is 25 mg/kg/day. Therefore, the total daily dosage is 204 mg/day (8.16 kg × 25 mg/kg).

Step 3: Since the medication is to be administered in two divided doses every 12 hours, each dose should be half of the total daily dosage. Therefore, each dose is 102 mg (204 mg/day ÷ 2).

Step 4: Finally, calculate the volume of the suspension to be administered for each dose. The label on the bottle reads, “Amoxicillin for Oral Suspension, USP 400 mg per 5 mL.”. Therefore, each milliliter of the suspension contains 80 mg of amoxicillin (400 mg/5 mL). To administer a dose of 102 mg, the nurse should administer approximately 1.275 mL (102 mg ÷ 80 mg/mL). If rounding is required, round to the nearest tenth.

Therefore, the nurse should administer 1.3 mL for each dose.