The nurse is evaluating a preschool-aged child who is presenting with symptoms of flank pain, dysuria, and a low-grade fever. What additional information should the nurse obtain from the parent to determine if the child might have a urinary tract infection?

= Answer is... Choice A. Severe skin breakdown in the diaper area.

Choice A rationale:

In the case of the 3-month-old infant presenting with difficulty sleeping through the night, severe skin breakdown in the diaper area is the most significant finding requiring attention in care planning for this family. Diaper dermatitis, characterized by erythema, edema, and erosion of the skin in the diaper region, can cause considerable discomfort and distress to the infant. Moreover, severe skin breakdown increases the risk of secondary infections and exacerbates the infant's discomfort, potentially impacting sleep patterns and overall well-being.

Diaper dermatitis often results from prolonged exposure to urine and feces, friction, and the occlusive environment created by diapers. The acidic pH of urine and feces, coupled with the breakdown of urea into ammonia, contributes to skin irritation and inflammation. Additionally, the warm, moist environment beneath the diaper provides an ideal breeding ground for microbial overgrowth, further exacerbating skin damage.

Management of severe diaper dermatitis involves a multifaceted approach, including frequent diaper changes, gentle cleansing of the affected area, application of barrier creams or ointments, and promotion of air exposure to facilitate healing. In severe cases, topical corticosteroids or antifungal agents may be prescribed to reduce inflammation and prevent secondary infections.

Preventing and managing diaper dermatitis is essential not only for alleviating the infant's discomfort but also for promoting uninterrupted sleep patterns. Discomfort associated with diaper rash can lead to increased irritability and difficulty settling down for sleep, contributing to sleep disturbances for both the infant and the caregiver. By addressing the underlying cause of the skin breakdown and implementing appropriate interventions, healthcare providers can support the family in improving the infant's comfort and sleep quality.

Choice B rationale:

The mother stating that the baby is irritable during feedings is indeed noteworthy and may indicate various underlying issues, such as feeding difficulties, gastrointestinal discomfort, or inadequate milk supply. However, while irritability during feedings can contribute to disrupted sleep patterns, it is not as directly relevant to the immediate concern of severe skin breakdown in the diaper area. Nonetheless, addressing feeding concerns is essential for optimizing the infant's nutritional intake and overall well-being.

Choice C rationale:

The mother being a single parent and living with her parents provides contextual information about the family's social support structure but is not directly related to the infant's difficulty sleeping through the night or the significant finding of severe skin breakdown in the diaper area. While family dynamics and support systems play a crucial role in caregiving and may influence the implementation of care strategies, they do not directly address the infant's current health issue.

Choice D rationale:

The fact that the infant's formula has been changed twice may indicate attempts to address feeding-related concerns or suspected formula intolerance. While changes in formula may impact the infant's gastrointestinal comfort and feeding patterns, they do not directly address the primary concern of severe skin breakdown in the diaper area. Nonetheless, evaluating the appropriateness of the current formula and addressing any feeding-related issues remain important aspects of comprehensive care for the infant.

Choice A rationale
While it’s possible for an infant with projectile vomiting to have stool containing mucus and blood, this is not typically associated with the condition that most commonly causes projectile vomiting in infants, which is pyloric stenosis.
Choice B rationale
An olive-sized mass in the epigastric region is a classic symptom of pyloric stenosis. This condition occurs when the muscle between the stomach and the small intestine (the pylorus) thickens, preventing food from moving from the stomach to the intestine.
Choice C rationale
Frequent burping and poor feeding can be symptoms of many different conditions in infants, but they are not typically associated with pyloric stenosis.
Choice D rationale
Rebound tenderness in the left lower abdominal quadrant is a symptom of conditions like appendicitis, but it is not typically associated with pyloric stenosis.