A nurse is caring for a 6-year-old child who is receiving radiation therapy. The child is crying because their hair is falling out. Which of the following actions should the nurse take?

Rationale:

A. WBC count: The client’s WBC decreased from 33,000/mm³ on postpartum day 3 to 10,000/mm³ on day 5, indicating resolution of the infection and an appropriate response to antibiotic therapy. This reflects improvement in the client’s inflammatory and immune status.

B. Fundal height: The fundus has descended from 1 cm above the umbilicus to 4 cm below the umbilicus and remains firm and midline, demonstrating normal uterine involution and a return toward pre-pregnancy size, indicating recovery from postpartum changes.

C. Temperature: The client’s temperature decreased from 38.6° C on day 3 to 37.1° C on day 5, showing resolution of the febrile response associated with infection and stabilization of her overall condition.

D. Lochia: The lochia changed from moderate, dark brown, foul-smelling on day 3 to a small amount of brownish-red, odorless lochia on day 5, reflecting improvement in uterine healing and the absence of ongoing infection.

E. Hgb: The client’s hemoglobin decreased slightly from 11.1 g/dL to 10 g/dL. While slightly lower, it remains above critical levels and is not an indicator of improvement; in fact, it shows a mild drop, likely from blood loss during delivery, so it is not considered a sign of recovery.

F. Heart rate: The client’s heart rate decreased from 110/min on day 3 to 78/min on day 5, indicating resolution of tachycardia associated with infection, pain, or stress, and reflecting stabilization of cardiovascular status.

Rationale:

• Difficulty walking: Bone injury limits weight-bearing ability and causes alterations in gait. Localized pain and instability can make ambulation difficult. Clients often compensate with limping to avoid pressure on the injured limb. In DVT, A clot in the deep veins causes swelling and discomfort, making ambulation painful. The heaviness and fullness in the limb interfere with normal gait. Clients may develop a limp due to localized tenderness.

• Pain: A fracture typically produces sharp, localized pain that worsens with movement. Tissue disruption and swelling contribute to discomfort. The pain limits limb use and is often immediate after injury. DVT often causes aching or cramping pain in the affected limb, especially with walking. Venous congestion and inflammation contribute to tenderness. Pain increases when the calf is compressed or when standing.

• Limb heaviness: Venous obstruction causes blood pooling, producing a heavy and tight sensation. This finding reflects impaired venous return, especially when swelling is also present. It is common in unilateral DVT. A fracture typically causes sharp, localized pain rather than diffuse heaviness. Heaviness is more strongly associated with venous congestion.

• Fever: Low-grade fever may occur due to inflammatory response around the thrombus. Cytokine release produces systemic symptoms during clot formation. It can accompany swelling, warmth, and redness. A simple fracture does not generally cause systemic fever unless infection develops. Fever is more indicative of inflammatory or infectious conditions.

• Edema: Venous blockage leads to unilateral swelling due to trapped fluid and elevated venous pressure. The affected limb becomes warm, enlarged, and firm. This is a hallmark finding in deep vein thrombosis. While swelling may occur after a fracture, the client’s presentation shows significant unilateral edema matching venous obstruction.