A nurse collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at McBurney's point? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

• Temperature: The child has a fever of 38.9°C (102°F), which is above the normal range for toddlers (36.5°C to 37.5°C or 97.7°F to 99.5°F). A high fever can indicate an ongoing infection or inflammatory process and can lead to serious complications, especially in a toddler. Addressing the fever promptly is crucial to prevent potential febrile seizures, dehydration, and other heat-related complications. Fever management is essential to improving the child's comfort and preventing the worsening of symptoms.
• Pain: Although pain management is important for comfort and to improve quality of life, in this scenario, the child’s pain is rated as a 3 on the FLACC scale, which is moderate. Immediate pain does not seem to be the primary or most urgent concern compared to the high fever and potential underlying conditions.
• Bruising: The presence of bruising in various stages of healing and petechiae suggests a possible underlying hematologic issue or trauma. While concerning and needing further investigation, it does not require immediate intervention compared to the fever.
• Heart rate: The heart rate is elevated at 150 beats per minute, which could be a response to the fever, pain, or anxiety. Addressing the fever may help in normalizing the heart rate.

ii. Follow-up Priority: Laboratory Values

Rationale:

• Laboratory values: The child’s laboratory results show abnormalities that are significant. Hemoglobin is low at 7.6 g/dL (indicating anemia), hematocrit is also low at 21%, and platelets are decreased at 110,000/mm³, which could suggest a hematologic disorder such as leukemia or a severe infection. The elevated white blood cell count further supports the presence of an infection or an inflammatory response. These lab abnormalities are critical and need to be addressed to determine the underlying cause and to plan further treatment.
• Respiratory rate: The respiratory rate is elevated but not critically so (normal for a toddler is 20-30 breaths per minute). There is no increased work of breathing noted, so while monitoring is important, it is not the most immediate priority compared to the fever and lab abnormalities.
• Nasal stuffiness: While nasal congestion can be uncomfortable and contribute to respiratory distress, it is not an immediate threat to the child’s health and can be managed after addressing the fever and the concerning laboratory values.
• Petechiae: Petechiae are small red or purple spots that can indicate bleeding under the skin and may be associated with a bleeding disorder or infection. However, the underlying cause might be revealed through laboratory investigations, which are prioritized after managing the fever. Immediate intervention for petechiae alone is not usually required unless there is evidence of significant bleeding or other acute symptoms.

A. "I will keep my baby in an upright position after feeding." Keeping the infant upright after feedings helps reduce reflux by utilizing gravity to keep the stomach contents from coming back up into the esophagus.
B. "I will have to feed my baby formula, rather than breast milk." Breast milk is actually preferred for infants with reflux as it is digested more quickly than formula, which may reduce reflux episodes.
C. "My baby's formula can be thickened with oatmeal." While thickening feeds can help in some cases, it's generally done with rice cereal under the guidance of a healthcare provider. Oatmeal is not typically recommended for thickening formula for young infants.
D. "I should move my baby into a side-lying position during sleep." Side-lying position is not recommended for sleep due to the risk of sudden infant death syndrome (SIDS). The baby should be placed on their back to sleep.