Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most

Phimosis is a condition in which the foreskin of the penis is tight or difficult to retract over the glans (head of the penis). It is normal for infants and young boys to have a non-retractable foreskin, and it usually resolves naturally as they grow. Pulling back the foreskin forcefully or attempting to clean under it in an infant can cause injury, pain, and even infection.

The correct approach is to gently clean the external genitalia with mild soap and water, but the foreskin should not be forcibly retracted in an infant. The foreskin will gradually become more retractable on its own as the child grows.

The other statements are generally appropriate:

A. "This is a normal finding as my son is uncircumcised": Phimosis is more common in uncircumcised males, and it is often a normal developmental variation in infants.

B. "This means that there is a narrowing of his torch that could lead to an infection": This statement recognizes the possibility of complications related to phimosis, such as the risk of infection, which is accurate.

D. "If this continues to be an issue, we may have him circumcised": Circumcision may be considered in cases where phimosis persists and causes problems, but it is usually not recommended during infancy unless medically necessary. This statement acknowledges a potential treatment option.

Hypercyanotic spells, also known as "Tet spells," can occur in infants with congenital heart defects, particularly tetralogy of Fallot. During these spells, there is a sudden decrease in oxygen saturation, leading to cyanosis (blueness) of the infant's skin and lips, as well as respiratory distress and possible loss of consciousness.
The knee-chest position is a specific technique used to manage hypercyanotic spells. Placing the child in this position helps improve oxygenation by increasing systemic vascular resistance and reducing the degree of right-to-left shunting of blood in the heart. It also increases venous return to the heart, which can help improve cardiac output.

Now, let's discuss why the other options are incorrect:
A. Prepare family for imminent death: This is not the priority action. While hypercyanotic spells can be life-threatening, the immediate focus should be on managing the spell to improve oxygenation and prevent further deterioration. Preparing the family for death should only be considered if resuscitation measures fail, which is not the first-line intervention.
C. Assess for neurologic defects: Assessing for neurologic defects is important but not the immediate priority during a hypercyanotic spell. The primary concern at this moment is addressing cyanosis and respiratory distress to ensure the infant receives adequate oxygen.
D. Begin cardiopulmonary resuscitation: Initiating CPR is not the initial priority during a hypercyanotic spell. CPR would be indicated if the infant's condition deteriorates to the point of cardiac arrest, but it should not be the first step. Placing the child in the knee-chest position is a non-invasive intervention that should be attempted before considering CPR.