A nurse in an urgent care clinic is caring for an infant who presents with vomiting, diarrhea, and decreased oral intake. Which of the following manifestations should the nurse expect?

Rationale:

• Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
• Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
• Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
• Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.
• Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.

Rationale:

A. Arrange for the nurses to have as few shifts together as possible: Avoiding the conflict by separating the nurses does not resolve the underlying issue. This strategy may worsen team dynamics and prevent meaningful resolution or improved communication.

B. Ask each nurse to take turns making the assignments: Allowing staff members to alternate assignment duties risks bias, inconsistency, and potential resentment. It also avoids addressing the source of the conflict and bypasses managerial responsibility.

C. Encourage collaboration between the two nurses when making the assignments:
Collaboration fosters open communication, mutual understanding, and shared responsibility. Involving both nurses promotes fairness and can help rebuild trust while ensuring transparency in assignments.

D. Tell the nurses that the assignments will be more equitable in the future: Reassuring staff without involving them in the solution may seem dismissive and fails to actively resolve the conflict. Transparency and participation are more effective than vague promises.