Exhibits

Review H and P, and nurse's note.

Which action(s) is/are appropriate for the nurse caring for this child? Select all that apply.

A. Determine if the child can administer the insulin. While older children with type 1 diabetes can learn to self-administer insulin, a newly diagnosed 10-year-old may not yet have the skills or confidence to manage injections independently. The primary caregiver should first learn the procedure to ensure proper insulin administration.
B. Ask if the father can help with the injections. While involving another caregiver can be helpful, the mother, as a primary caregiver, needs to learn how to administer insulin. Avoiding the task entirely could compromise the child’s diabetes management, so supporting the mother in overcoming her fear is the priority.
C. Assess the mother's parenting skills. A fear of needles does not indicate poor parenting skills. Many people have needle-related anxiety, and the nurse should focus on providing support and education rather than questioning the mother’s ability to care for her child.
D. Encourage the mother to handle the needles. Helping the mother gradually become comfortable with insulin syringes through guided handling, demonstration, and practice can reduce her fear and build confidence. The nurse can use hands-on teaching techniques, such as allowing the mother to practice with an orange before injecting her child, to ease anxiety and ensure she can perform the procedure effectively.

A. Blood type: While important for transfusions, blood type is not relevant to assessing pain or determining appropriate pain management strategies. Pain assessment focuses on physiological and behavioral cues, not blood compatibility.
B. Parents’ religious affiliation: Religious beliefs may influence pain management preferences (e.g., preference for non-pharmacologic methods), but this is not a priority assessment before implementing pain management strategies. The immediate focus should be on assessing the infant’s pain level and physiological status.
C. Blood pressure: Pain can cause increased sympathetic nervous system activity, leading to elevated blood pressure. Monitoring blood pressure helps assess the severity of pain and guides appropriate pain management interventions.
D. Level of consciousness: Infants in significant pain may become restless, irritable, or inconsolable, while excessive sedation from pain medications can cause decreased responsiveness. Assessing level of consciousness helps ensure that pain relief measures do not cause over-sedation or respiratory depression.
E. Hearing acuity: Hearing assessment is not relevant for pain management in a 4-month-old infant. Pain assessment in infants focuses on physiological signs, crying, and behavioral responses, rather than auditory abilities.
F. Heart rate: Pain can lead to tachycardia due to sympathetic nervous system activation. Monitoring heart rate helps assess pain intensity and evaluate the effectiveness of pain relief interventions.
G. Deep tendon reflexes: Reflex testing is used for neurological assessment but is not relevant to pain management. Reflexes do not provide direct information about pain intensity or response to treatment.