A nurse is caring for a child who has Legg-Calve-Perthes disease and is in Buck extension traction.

Which of the following actions should the nurse take?

a.Log rolling is an appropriate technique to reposition a postoperative scoliosis repair patient as it minimizes stress on the spine and helps maintain spinal alignment. Patients need frequent repositioning to prevent pressure ulcers and promote comfort, but every 4 hours may not be frequent enough; typically, every 2 hours is recommended.

b.Protective isolation is not typically required for patients undergoing scoliosis surgery unless they have specific risk factors for infection (e.g., immunocompromised status). Standard postoperative care focuses on monitoring for infection at the surgical site rather than isolation unless indicated by the patient's condition.

c.While it’s important to elevate the head of the bed to assist with breathing and comfort, after scoliosis surgery, the head of the bed is generally elevated to 30-45° to facilitate lung expansion and reduce the risk of aspiration. However, it should be ensured that this angle does not compromise spinal alignment, especially in the early postoperative period.

d.The use of a patient-controlled analgesia (PCA) pump is an appropriate intervention for pain management after scoliosis surgery. It allows the patient to self-administer pain medication within prescribed limits, leading to more effective pain management, improved patient satisfaction, and potentially reduced need for supplemental analgesics.

Choice A rationale: Yellow nasal discharge in a toddler with acute nephrotic syndrome signifies a potential upper respiratory tract infection, which is critically important. Children with nephrotic syndrome are highly susceptible to infections due to significant urinary loss of immunoglobulins, leading to an immunocompromised state. Furthermore, corticosteroid treatments, often prescribed for nephrotic syndrome, suppress the immune system. An infection can precipitate a relapse of the syndrome, lead to severe complications like peritonitis or sepsis, and requires prompt evaluation and potentially antibiotic therapy to prevent life-threatening outcomes.

Choice B rationale: Poor appetite is a non-specific symptom in toddlers with nephrotic syndrome and does not typically indicate an immediate, life-threatening complication. It can be attributed to generalized malaise, abdominal discomfort due to ascites, or even side effects of medications such as corticosteroids. While important to monitor for nutritional status and overall well-being, it does not carry the same urgency as signs of infection, which can rapidly lead to severe health deterioration in an immunocompromised child.

Choice C rationale: Facial edema is a cardinal clinical manifestation of acute nephrotic syndrome, resulting from profound hypoalbuminemia. Reduced plasma oncotic pressure causes fluid to shift from the intravascular space into the interstitial space, leading to generalized edema, often prominently in the face. This finding is expected and indicates the disease process itself, rather than an acute, unexpected complication requiring immediate reporting, unless there is a sudden, significant worsening or associated respiratory compromise.

Choice D rationale: Irritability in a toddler can be a manifestation of general discomfort, illness, or even a side effect of corticosteroid therapy, which can cause mood disturbances and behavioral changes. While it warrants assessment to identify the underlying cause, irritability is a non-specific symptom and does not directly indicate an urgent, life-threatening complication of nephrotic syndrome requiring immediate medical intervention, unlike the signs of an acute infection in an immunocompromised child.