A mother visits her critically ill infant daily. Which comment most strongly suggests this mother is successfully progressing in attachment to her infant?

The correct answer is choice A. Takes a bubble bath every day.

Choice A rationale:

Bubble baths can cause urinary tract infections (UTIs) in children. The soap and bubbles can irritate the child’s privates, leading to discomfort and potentially contributing to the development of a UTI. It’s particularly true for young girls, as exposure to soap and bubbles can hurt their privates, leaving them itchy and uncomfortable. While not the most common cause, bubble baths have been associated with UTIs due to the irritation they can cause.

Choice B rationale:

While handwashing is crucial for preventing the spread of germs, there is less direct evidence linking the lack of handwashing after toileting to UTIs. However, good hygiene practices, including handwashing, are generally recommended to reduce the risk of infections.

Choice C rationale:

Carbonated beverages have been associated with bladder irritation and UTIs in some cases. They can cause problems for individuals with interstitial cystitis, bladder stones, and UTIs due to the carbonic acid they contain. However, the link between carbonated beverages and UTIs is not as direct as that of bubble baths.

Choice D rationale:

Wiping the perineal area from front to back after toileting is actually a recommended practice to prevent UTIs. It helps to prevent bacteria from the stool from contaminating the urethra and bladder, which can lead to an infection. Therefore, this choice is unlikely to be related to the client’s UTI.

In conclusion, the most likely data related to the client’s urinary tract infection is the daily bubble baths, as they can directly irritate the urinary tract and create conditions conducive to a UTI.

Answer is d. Monitor the capillary refill time in the toes on both feet. This is crucial for assessing circulation and ensuring that the cast is not impairing blood flow, which is a priority in cast care.

Choice A rationale:

Ensuring the appropriate care for a wet plaster cast is essential to prevent complications such as impaired circulation, discomfort, or skin breakdown. Keeping the cast covered with a lightweight blanket, as suggested in option A, may seem like a logical step to protect it from external elements and maintain warmth. However, covering a wet cast can actually retain moisture, which can slow the drying process. Moisture retention within the cast can lead to prolonged drying times, increasing the risk of complications such as skin maceration or discomfort for the patient. Therefore, while the intention behind covering the cast is to provide comfort, it may inadvertently prolong the drying process and contribute to potential complications.

Choice B rationale:

Maintaining increased humidity in the patient room, as mentioned in option B, might appear beneficial to aid in the drying process of the plaster cast. However, while humidity can influence the drying time of the cast, excessive humidity can have adverse effects on the integrity of the cast. High humidity levels can prolong the drying process by inhibiting the evaporation of moisture from the cast material. Additionally, increased humidity can compromise the structural integrity of the cast, potentially leading to weaknesses or deformities. Therefore, while it's important to consider environmental factors in cast care, maintaining excessively high humidity levels may not be advisable and could contribute to complications in the drying and integrity of the cast.

Choice C rationale:

Option C suggests using only the tips of the fingers when handling the wet cast. While it's crucial to handle a wet cast with care to avoid causing damage or deformities, limiting handling to just the fingertips may not provide adequate support or control. Plaster casts can be fragile when wet, and improper handling techniques may lead to misshaping or weakening of the cast structure. Additionally, relying solely on the fingertips for handling may increase the risk of inadvertently applying uneven pressure or causing accidental damage to the cast material. Therefore, while the intention behind this option is to promote gentle handling, it may not provide sufficient support or control to ensure the integrity of the wet cast.

Choice D rationale:

Monitoring the capillary refill time in the toes on both feet, as indicated in option D, is the most appropriate action for the nurse to take in this scenario. Capillary refill time is a valuable indicator of peripheral circulation and tissue perfusion. By assessing the capillary refill time in the toes, the nurse can evaluate the adequacy of blood flow to the extremities and detect any potential impairment caused by the plaster hip spica cast. Prolonged capillary refill time may suggest compromised circulation, which can lead to serious complications such as ischemia or tissue necrosis if left unaddressed. Therefore, regular monitoring of capillary refill time is essential for early detection of circulation problems and timely intervention to ensure patient safety and optimal outcomes.

In conclusion, while each option may seem plausible at first glance, careful consideration of the potential implications reveals that monitoring capillary refill time in the toes on both feet is the most appropriate action for the nurse to take when caring for a patient with a wet plaster hip spica cast. This proactive approach prioritizes patient safety by ensuring adequate circulation and minimizing the risk of complications associated with impaired blood flow. By adhering to evidence-based practice guidelines and maintaining vigilance in monitoring patient status, healthcare professionals can optimize outcomes and promote the effective healing and management of patients with plaster casts.