Which child requires urgent care?

Choice A rationale

After a laparoscopically assisted endorectal pull-through procedure for Hirschsprung’s disease, it is important to monitor for the return of bowel sounds. This indicates that the gastrointestinal tract is starting to recover and function again after surgery. Until bowel

sounds return, indicating that peristalsis has resumed, the child should remain NPO (nothing by mouth) to prevent vomiting and aspiration.

Choice B rationale

Applying barrier cream to the diaper area is generally good practice for infants to prevent diaper rash, but it is not specifically related to the care of a child who has just undergone surgery for Hirschsprung’s disease.

Choice C rationale

While it is important to assess the surgical site regularly to check for signs of infection or complications, this does not need to be done every 2 hours. A more typical frequency might be every 4 to 8 hours, depending on the child’s condition and hospital policy.

Choice D rationale

Monitoring rectal temperature every 8 hours is not specifically related to the care of a child who has just undergone surgery for Hirschsprung’s disease. While it is important to monitor for fever as a sign of infection, temperature can usually be measured less invasively.

Choice A rationale

Distracting the patient and then taking the blanket for washing might seem like a practical solution, but it can lead to trust issues. The patient may feel betrayed or tricked, which can negatively affect the therapeutic relationship between the nurse and the patient.

Choice B rationale

Acknowledging that the blanket seems to be his favorite and allowing him to keep it with him is the best course of action. The blanket likely provides comfort and security to the patient.

Taking it away, even temporarily, can cause distress. The nurse should respect the patient’s attachment to the blanket and look for alternative solutions for maintaining hygiene, such as offering to clean the blanket when the patient is ready to part with it temporarily.

Choice C rationale

Telling the patient that you want to take the blanket home to wash and that you will bring it back might not be reassuring enough for the patient. The patient may worry about the blanket getting lost or not returned, which can cause unnecessary anxiety.

Choice D rationale

Suggesting getting him another blanket so that he will not mind giving up the current one might not work. The patient’s attachment is likely to the specific blanket, not to blankets in general. A new blanket will not have the same familiarity and comforting effect as the old one.