A nurse is caring for a 4-year-old child who has dehydration. Which of the following findings should the nurse identify as the priority?

A. Place a warm, moist heat pack on the cast: Incorrect. Moisture can damage the integrity of a plaster cast, and heat can increase swelling.

B. Position the casted arm in a dependent position: Incorrect. Keeping the arm elevated helps reduce swelling and pain.

C. Move the casted arm with a firm grasp: Incorrect. A firm grasp can cause further injury or discomfort. It’s important to handle the casted limb gently.

D. Administer diphenhydramine to relieve itching: Correct. Itching is common under a new cast, and diphenhydramine can help manage this symptom without risking damage to the cast.

A. A 4-year-old preschooler who has status asthmaticus and a pulse oximetry of 95%. While status asthmaticus is a serious condition, a pulse oximetry reading of 95% indicates adequate oxygenation, so this child is not in immediate distress.

B. A 1-year-old infant who has roseola and a temperature of 39°C (102.2°F). While the fever requires monitoring and treatment, roseola is typically a self-limiting illness, and this temperature, while high, is not immediately life-threatening.

C. A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.002. A urine specific gravity of 1.002 indicates very dilute urine, which is concerning for diabetes insipidus and potential dehydration. This condition requires immediate attention to prevent severe dehydration and electrolyte imbalance.

D. A 10-year-old child who has sickle cell anemia and a pain rating of 6 on a 0 to 10 scale. While managing pain in sickle cell anemia is important, the child’s condition is stable, and pain relief can be addressed after assessing the more urgent case of potential dehydration in the child with diabetes insipidus.