The nurse is caring for a 37-weeks gestation infant born to a parent with hepatitis B. Which intervention will the nurse include in the plan of care?

Choice A reason: Squatting increases the return of venous blood back to the heart by compressing the large veins in the legs and abdomen. This position helps increase systemic vascular resistance, which in turn increases the blood flow to the lungs and improves oxygenation. Children with Tetralogy of Fallot often instinctively squat to relieve cyanotic spells, as it helps reduce the severity of symptoms by temporarily improving circulation.

Choice B reason: While a child might experience tachycardia during a cyanotic spell, squatting is not a position specifically associated with tachycardia. The primary purpose of squatting in children with Tetralogy of Fallot is to improve venous return and systemic vascular resistance, not to address tachycardia directly.

Choice C reason: Squatting does not decrease arterial blood flow away from the heart. Instead, it helps increase systemic vascular resistance, which improves pulmonary blood flow and oxygenation. This position assists in temporarily mitigating the effects of the heart defect by improving circulation.

Choice D reason: Squatting actually helps alleviate some of the workload on the heart by improving systemic vascular resistance and enhancing blood flow to the lungs. It is a compensatory mechanism that children with Tetralogy of Fallot use instinctively to manage cyanotic spells, and it does not increase the workload of the heart.

Choice A reason: While some parents may choose to home school their child, this is a personal decision and not a standard recommendation for all children with Trisomy 21. Educational needs should be tailored to the individual child's abilities and preferences, and many children with Trisomy 21 attend public or private schools with appropriate support.

Choice B reason: Teaching the parents about the need for a high-fibre diet is important for overall health but is not specific to Trisomy 21. While children with Trisomy 21 may benefit from a balanced diet, the need for monthly thyroid testing is more directly related to managing their condition.

Choice C reason: Instructing the parents on the need for yearly dental visits is essential for maintaining oral health, but it is not the most critical aspect specific to Trisomy 21. Regular dental check-ups are recommended for all children, regardless of whether they have Trisomy 21.

Choice D reason: Advising the parents that the child will need monthly thyroid testing is crucial because children with Trisomy 21 are at an increased risk for thyroid disorders. Regular monitoring of thyroid function is essential for early detection and management of hypothyroidism or hyperthyroidism, which can significantly impact growth and development.