You are preparing a child with sickle cell anemia for discharge after an acute crisis episode. Which of the following instructions is appropriate advice for the care of a child with sickle cell anemia?

Choice A reason:

In premature infants, it is common for the testes to not be palpable in the scrotum at birth. This condition, known as cryptorchidism, affects about 30% of preterm infants1. The testes usually descend into the scrotum by the time the infant reaches term or within the first few months of life. Therefore, the nurse should document this as an expected finding and continue to monitor the infant’s development.

Choice B reason:

Inserting a urinary catheter to collect a urine specimen is not necessary in this situation. The absence of palpable testes in a premature infant is a common finding and does not indicate a need for immediate urinary evaluation. Urinary catheterization should be reserved for specific medical indications, such as suspected urinary tract infection or urinary retention.

Choice C reason:

Initiating a social work consult is not relevant to the clinical finding of undescended testes in a premature infant. Social work consultations are typically initiated for psychosocial issues, family support, or discharge planning. The absence of palpable testes is a medical finding that should be documented and monitored by the healthcare team.

Choice D reason:

Calling the provider for this unexpected finding is not necessary because the absence of palpable testes in a premature infant is an expected finding. The nurse should document the finding and continue to monitor the infant’s development. If the testes do not descend by the time the infant reaches term or within the first few months of life, further evaluation and management may be needed.

Choice A reason:

Compartment syndrome is a condition where increased pressure within a muscle compartment leads to decreased blood flow, which can cause muscle and nerve damage. It is typically associated with severe trauma, fractures, or crush injuries. The symptoms include severe pain, swelling, and decreased sensation or movement in the affected limb. In this case, the child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are more indicative of an infection rather than compartment syndrome.

Choice B Reason:

Osteomyelitis is an infection of the bone, which can occur following an injury or infection elsewhere in the body. The symptoms include redness, swelling, tenderness, and pain in the affected area, along with fever and elevated WBC. Given the child’s history of a spider bite and the presence of redness, swelling, tenderness, and elevated WBC, osteomyelitis is the most likely diagnosis. The unremarkable X-ray does not rule out osteomyelitis, as early stages of the infection may not show changes on X-ray.

Choice C Reason:

Osteogenesis imperfecta, also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. It is not associated with infections or elevated WBC. The symptoms of osteogenesis imperfecta include frequent fractures, blue sclerae, and hearing loss. The child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are not consistent with osteogenesis imperfecta.

Choice D Reason:

Juvenile idiopathic arthritis (JIA) is a type of arthritis that occurs in children. It is characterized by persistent joint inflammation, pain, and swelling. While JIA can cause joint tenderness and swelling, it is not typically associated with a recent injury or infection, such as a spider bite. Additionally, JIA does not usually cause elevated WBC. The child’s symptoms are more indicative of an infection, making osteomyelitis the more likely diagnosis.