The practical nurse (PN) is caring for an infant with ambiguous genitalia and congenital adrenal hyperplasia.
Which intervention should the PN prioritize?

Choice A rationale

Assessing elimination hygiene habits is important for preventing recurrent UTIs, but it does not directly address the immediate goal of minimizing complications of vesicoureteral reflux (VUR) in an acute febrile UTI. While good hygiene reduces bacterial entry, VUR involves retrograde urine flow.

Choice B rationale

Completing post-void bladder scans helps assess bladder emptying and residual urine, which are risk factors for UTIs. However, in the context of VUR and a febrile UTI, it's a diagnostic tool rather than a primary intervention to actively minimize the reflux itself during the infection.

Choice C rationale

Implementing a frequent voiding schedule minimizes the volume of urine in the bladder and reduces the duration of bladder distention. This decreases the likelihood of vesicoureteral reflux and helps to flush out bacteria, thus minimizing the risk of renal parenchymal damage during a febrile UTI.

Choice D rationale

Encouraging adequate oral fluid intake helps flush bacteria from the urinary tract and prevents dehydration, which is beneficial for overall health and UTI management. However, while important, it does not directly impact the mechanics of vesicoureteral reflux as effectively as frequent bladder emptying.

Choice A rationale

Applying a cold pack to the perineum after a vaginal delivery effectively reduces localized edema and inflammation. Cold therapy causes vasoconstriction, which decreases blood flow to the area, thereby minimizing fluid extravasation into the interstitial spaces and reducing swelling of the episiotomy site.

Choice B rationale

While cold packs do provide a degree of comfort by numbing nerve endings and reducing pain signals, their primary physiological benefit in the postpartum period is the reduction of swelling and inflammation, which indirectly contributes to comfort. Comfort is a secondary effect.

Choice C rationale

The statement is incorrect. Cold therapy is a recognized and effective intervention postpartum. While it may help reduce bruising by limiting subcutaneous bleeding, its most significant and immediate benefit relates to the reduction of swelling and pain.

Choice D rationale

While cold can induce vasoconstriction and thus potentially reduce bleeding, it is not the primary or most effective method for controlling significant postpartum hemorrhage. Fundal massage and uterotonics are the primary interventions for controlling postpartum bleeding.