The nurse is caring for a 2-year-old patient. Which observation requires immediate action by the nurse?

The correct answer is choice A. Takes a bubble bath every day.

Choice A rationale:

Bubble baths can cause urinary tract infections (UTIs) in children. The soap and bubbles can irritate the child’s privates, leading to discomfort and potentially contributing to the development of a UTI. It’s particularly true for young girls, as exposure to soap and bubbles can hurt their privates, leaving them itchy and uncomfortable. While not the most common cause, bubble baths have been associated with UTIs due to the irritation they can cause.

Choice B rationale:

While handwashing is crucial for preventing the spread of germs, there is less direct evidence linking the lack of handwashing after toileting to UTIs. However, good hygiene practices, including handwashing, are generally recommended to reduce the risk of infections.

Choice C rationale:

Carbonated beverages have been associated with bladder irritation and UTIs in some cases. They can cause problems for individuals with interstitial cystitis, bladder stones, and UTIs due to the carbonic acid they contain. However, the link between carbonated beverages and UTIs is not as direct as that of bubble baths.

Choice D rationale:

Wiping the perineal area from front to back after toileting is actually a recommended practice to prevent UTIs. It helps to prevent bacteria from the stool from contaminating the urethra and bladder, which can lead to an infection. Therefore, this choice is unlikely to be related to the client’s UTI.

In conclusion, the most likely data related to the client’s urinary tract infection is the daily bubble baths, as they can directly irritate the urinary tract and create conditions conducive to a UTI.

Choice A rationale:

Ketonuria is the presence of ketones in urine and is not directly associated with vaso-occlusive crisis in sickle cell anemia. This crisis typically involves pain and ischemia in various body parts.

Choice B rationale:

Diplopia refers to double vision and is not a typical symptom of vaso-occlusive crisis. Pain, not vision changes, is the primary concern in this scenario.

Choice C rationale:

Severe abdominal pain can be a symptom of vaso-occlusive crisis in sickle cell anemia, but the patient's complaint of left elbow pain would not directly correlate with this choice.

Choice D rationale:

Hyperactive patellar reflex is the correct answer. During vaso-occlusive crisis, the body's response to pain can lead to increased muscle tone and reflexes, including hyperactive deep tendon reflexes like the patellar reflex. This is an indicator of neurologic involvement in the crisis. Remember that these rationales are intended to provide a concise understanding of the correct answers based on the information provided in the questions. Always refer to medical literature and consult with healthcare professionals for comprehensive and accurate information.