A nurse is giving a report to their supervisor. Which of the following indicates a need for client care to be transferred to a registered nurse?

Rationale:

A. A child who was conceived by in vitro fertilization: Children conceived through IVF are typically highly desired and planned for, and families may invest significant emotional and financial resources into their care. This background generally reduces rather than increases the risk of maltreatment.

B. A toddler who has atopic dermatitis: Although chronic conditions can be stressful for caregivers, atopic dermatitis is relatively common and manageable. It does not significantly increase the risk of child abuse or neglect compared to more severe or demanding conditions.

C. An only child: Being an only child does not inherently increase the risk for maltreatment. Risk factors for abuse are more closely associated with caregiver stress, socioeconomic status, substance use, and the presence of physical or cognitive impairments in the child.

D. A school-age child who has cerebral palsy: Children with disabilities like cerebral palsy are at higher risk for maltreatment due to the physical, emotional, and financial stress their care may place on caregivers. These children often require more supervision and support, which can lead to frustration or neglect in high-risk environments.

Rationale:

A. "I will irrigate the colostomy every day.": Colostomy irrigation is used for descending or sigmoid colostomies to regulate bowel movements. It is not recommended for ascending colostomies because the stool is too liquid and unpredictable for effective irrigation.

B. "I will notify my doctor if the stoma starts to look purple.": A healthy stoma should be pink or red and moist. A purple or dusky appearance suggests compromised blood flow or ischemia and should be reported to the provider immediately as it may indicate a serious complication.

C. "I should expect my stool to be formed.": Stool from an ascending colostomy is generally liquid to semi-liquid due to the location in the digestive tract. Formed stool is more typical of descending or sigmoid colostomies, not ascending ones.

D. "I will no longer be able to eat nuts.": While some clients may choose to avoid certain foods based on personal tolerance, there is no absolute dietary restriction against nuts for colostomy clients unless otherwise advised.