A nurse is assisting with the development of an education program about child maltreatment. Which of the following findings should the nurse include in the program as a possible indication of sexual abuse?

A. "Your baby has an increased risk for a heart defect.": Infants with Down syndrome have a significantly higher risk for congenital heart defects, such as atrioventricular septal defects (AVSD) and ventricular septal defects (VSD). It is important for the parents to be aware of this risk and have the infant screened by a cardiologist.
B. "Expect your baby to need factor replacement therapy every month.": Factor replacement therapy is typically associated with hemophilia, not Down syndrome. Down syndrome is a genetic condition that affects development, but it is not clotting disorders.
C. "Expect your baby to grow in height more rapidly than weight.": Infants with Down syndrome often experience growth delays, but there is no specific expectation that height will outpace weight.
D. "Your baby should have no issues with eyesight.": Children with Down syndrome are at higher risk for vision problems, including strabismus, refractive errors, and cataracts. Regular eye exams are important for early detection and management of these issues.

Rationale for Correct Choices:

• Ceftriaxone: The infant has a documented allergy to amoxicillin, and ceftriaxone is a cephalosporin antibiotic that has potential cross-reactivity with amoxicillin. Therefore, the nurse should clarify the prescription for ceftriaxone to ensure it’s safe for the infant.
• Allergy: The infant’s known allergy to amoxicillin suggests a potential allergy to ceftriaxone as well. Given the risk of anaphylaxis or other allergic reactions, the nurse must clarify the use of ceftriaxone with the healthcare provider.

Rationale for Incorrect Choices:

• Furosemide: Furosemide is a diuretic used to manage fluid retention, especially in conditions like heart failure or VSD. There are no contraindications based on the infant's current findings, such as the heart rate, medical history, or electrolyte values.
• Digoxin: Digoxin is used to help regulate heart function in infants with conditions like VSD. The infant's heart rate of 84/min is within an acceptable range for digoxin administration.
• Acetaminophen: Acetaminophen is used to manage the infant’s fever (39.2°C). Given that the infant’s temperature is elevated, acetaminophen is appropriate for fever reduction and does not require clarification.
• Ibuprofen: Ibuprofen could also be used for fever management, no immediate concerns require clarification for ibuprofen. The nurse should monitor the infant closely for any side effects, but it doesn't necessitate clarification.

• Diet: The infant's diet is not directly related to the concern about ceftriaxone administration. The infant is being fed via gastrostomy tube, and while this is a consideration for medication administration, it does not specifically affect the need to clarify ceftriaxone due to an allergy.
• Temperature: The infant’s temperature of 39.2°C indicates fever, but it is not directly related to the need to clarify the ceftriaxone prescription.
• Heart rate: The infant’s heart rate is within an acceptable range for digoxin administration (84/min), and there’s no concern regarding bradycardia or tachycardia that would require clarifying the prescription for digoxin.
• Medical history: While the infant has Down syndrome and a ventricular septal defect (VSD), which require ongoing care, the focus here is on the allergy to amoxicillin, which is directly relevant to the ceftriaxone prescription.