The nurse is caring for a post-operative pyloromyotomy infant.
Which of the following interventions should be performed first?

Choice A rationale

For scabies treatment with topical permethrin in children, the medication should be applied from the neck down to the toes, ensuring all skin surfaces are covered because scabies mites can burrow anywhere on the body. The permethrin should be left on for the prescribed duration, typically 8-14 hours or overnight, to allow sufficient contact time to kill the mites and their eggs.

Choice B rationale

Applying permethrin only to affected areas may not be sufficient to eradicate scabies because mites can be present on areas of the skin that do not yet show visible signs of infestation or itching. Complete coverage is necessary to ensure treatment success.

Choice C rationale

Applying permethrin only to the scalp is inadequate for treating scabies, as the mites commonly infest other areas of the body. While scabies can affect the scalp, especially in infants and young children, treatment must extend to all skin surfaces from the neck down.

Choice D rationale

A hot bath should be avoided before applying permethrin. Hot water can irritate the skin and increase absorption of the medication, potentially leading to systemic toxicity or reduced effectiveness. Permethrin is typically applied to cool, dry skin.

Choice A rationale

Urinary tract infections can cause bladder irritation and dysfunction, leading to symptoms such as frequency, urgency, and nocturia, which can manifest as enuresis, especially secondary enuresis (bedwetting that starts after a period of dryness). Therefore, assessing for a UTI is a crucial first step to rule out a treatable medical cause. Normal urine specific gravity ranges from 1.005 to 1.030, and a urinalysis can detect the presence of bacteria, white blood cells, or nitrites indicative of infection.

Choice B rationale

Psychological stressors can contribute to enuresis, particularly secondary enuresis. Anxiety, family changes, or school-related stress can manifest physically. While important to explore, medical causes like UTIs should be ruled out first.

Choice C rationale

Sleep patterns are relevant in the context of enuresis, as bedwetting occurs during sleep. However, assessing for a medical cause like a UTI should precede a detailed evaluation of sleep habits.

Choice D rationale

A family history of enuresis can suggest a genetic predisposition. However, the immediate nursing priority is to assess for and rule out treatable underlying medical conditions, such as a urinary tract infection.