A nurse is preparing to perform a dressing change on a 6-year-old client with mild cognitive impairment (CI) from a sport injury. Which strategy should the nurse use to prepare the child for the dressing change?

A. Although facial pain could be concerning, it is not the immediate priority when the child has a history of atlantoaxial instability and is presenting with signs that could indicate spinal cord compression. Facial pain does not suggest a direct threat to the spinal cord, which is a more critical concern in this case.
B. Continuous neck pain in a child with atlantoaxial instability is a significant priority and requires immediate intervention. This could be a sign of spinal cord compression or injury to the cervical spine, which can occur after trauma such as a fall. Since this child has a predisposition for atlantoaxial instability, there is a high risk for neck instability and spinal cord injury, making this a top priority.
C. While lower extremity pain may be concerning, it is not as high a priority as neck pain in this context. The primary concern here is potential spinal cord compression or neurological injury. If the child is able to move their extremities or does not have severe pain or weakness, this may not require as urgent intervention. However, it should still be monitored closely.
D. Loss of bladder control is a red flag in children with suspected spinal cord injury. It can indicate nerve involvement in the spinal cord or cauda equina, which can be caused by injury or compression, particularly in a child with atlantoaxial instability. This requires priority intervention to prevent further damage and to initiate appropriate care (e.g., neurological assessment, imaging, and potentially surgical intervention).
E. The loss of established motor skills is another concerning sign. In this child, it may indicate neurological impairment or spinal cord injury. Since the child has atlantoaxial instability, this is a critical symptom that suggests the possibility of spinal cord compression or injury, requiring immediate evaluation and intervention to prevent permanent neurological damage.

A. Assessing vital signs, including temperature and oxygen saturation, is appropriate for monitoring the child's condition and identifying any signs of respiratory distress or infection.
B. Gathering necessary supplies for possible intubation is a proactive measure in case the child experiences airway obstruction. Acute epiglottitis can lead to rapid deterioration in the child's airway.
C. Assessing the child's throat using a tongue blade can trigger airway obstruction in a child with acute epiglottitis, which is a medical emergency. The throat should not be examined visually due to the risk of causing a spasm or obstruction.
D. Reporting an elevated white blood count is a normal part of managing acute infections, such as epiglottitis, and should be done to inform the healthcare provider of the patient's condition.