A nurse is assisting in the care of a 6 year old child who preoperative for repair of a fractured femur.

Exhibits

For each finding click to specify whether the finding indicates no change in the child's condition or is a sign of potential worsening condition.

A. "You should hide your grief as much as possible around your child." is incorrect. It is important for the guardian to express emotions openly and honestly in an age-appropriate way. Hiding grief can make the child feel isolated or that their own emotions are not valid.

B. "Your child likely views death as temporary." is incorrect. By age 10, most children have a mature understanding of death as final and irreversible. Younger children, such as preschoolers, may see death as temporary, but a school-age child is more likely to comprehend its permanence.

C. "You should be prepared to answer your child's questions about dying." is correct. Children facing terminal illness often have questions about death, and it is important for caregivers to provide honest, age-appropriate answers to help ease fears and concerns.

D. "You should limit visits between the siblings at this time." is incorrect. Encouraging family connections can provide emotional support for both the ill child and their siblings. Limiting visits may lead to increased anxiety or regret for the sibling later on.

A. Nasal discharge negative for glucose. Nasal discharge negative for glucose suggests that the child likely does not have cerebrospinal fluid (CSF) leaking from the nose, which would be concerning for a basilar skull fracture. This is a less urgent finding compared to asymmetric pupils.

B. Negative Babinski reflex. A negative Babinski reflex is a normal finding in children over the age of 2, and thus it is not an urgent concern in this case.

C. Asymmetric pupils. This is the priority. Asymmetric pupils could be a sign of increased intracranial pressure or brain injury, which requires immediate intervention. It may indicate a serious condition, such as a brain hemorrhage or concussion, that requires urgent medical attention.

D. 2 cm (0.8 in) scalp laceration. While a scalp laceration may require suturing, it is not as urgent as asymmetric pupils, which could indicate a life-threatening condition. The laceration can be addressed after ensuring that there is no neurological emergency.