The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?

Choice A reason:

Infants do not outgrow clubfoot when they learn to walk. Clubfoot is a congenital deformity that requires medical intervention to correct. Without treatment, the condition can lead to significant disability and difficulty in walking1. The goal of treatment is to correct the foot’s position and function, allowing the child to walk normally.

Choice B reason:

Surgical intervention is not the first line of treatment for clubfoot. While surgery may be necessary in severe cases or if other treatments fail, the initial approach typically involves non-surgical methods. The Ponseti method, which includes serial casting and gentle manipulation, is the preferred initial treatment. Surgery is considered only if these methods do not achieve the desired results.

Choice C reason:

Traction with foot manipulation is not a standard treatment for clubfoot. The primary non-surgical treatment involves the Ponseti method, which includes serial casting and gentle manipulation of the foot3. This method has been shown to be highly effective in correcting clubfoot without the need for traction.

Choice D reason:

Frequent serial casting is the first line of treatment for clubfoot. The Ponseti method, which involves weekly casting and gentle manipulation of the foot, is the most widely used and effective treatment for clubfoot. This method gradually corrects the foot’s position over several weeks, followed by bracing to maintain the correction4. Serial casting is preferred because it is non-invasive and has a high success rate.

Choice A reason:

Performing an ultrasound to determine if there is urinary retention is not the immediate priority action. While an ultrasound can help assess urinary retention, the presence of edema, redness, and the foreskin being behind the glans penis suggests a condition known as paraphimosis. Paraphimosis is a medical emergency that requires prompt attention to prevent complications such as tissue damage. Therefore, alerting the ER physician is the priority action.

Choice B reason:

Asking the parents specifically how long the infant has not voided is important for gathering information, but it is not the immediate priority action. The clinical signs of edema, redness, and the foreskin being behind the glans penis indicate a potential emergency that requires immediate medical intervention. While obtaining a detailed history is important, the nurse should first alert the ER physician to ensure timely management.

Choice C reason:

Alerting the ER physician to the patient’s condition is the correct priority action. The presence of edema, redness, and the foreskin being behind the glans penis suggests paraphimosis, which is a urological emergency. Prompt intervention is necessary to reduce the foreskin and restore normal blood flow to prevent tissue damage3. The ER physician can provide the necessary treatment and management for this condition.

Choice D reason:

Continuing to monitor the patient in the ER setting is not appropriate without first addressing the potential emergency. The signs of edema, redness, and the foreskin being behind the glans penis indicate a condition that requires immediate medical attention. Monitoring alone is insufficient; the nurse must alert the ER physician to ensure prompt intervention.