A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include?

Choice A: The OUCHER scale is not suitable for a 2-month-old infant, as it is designed for children aged 3 to 13 years who can point to pictures of faces that match their pain level. A 2-month-old infant cannot communicate verbally or point to pictures.

Choice B: The FACES scale is not suitable for a 2-month-old infant, as it is designed for children aged 3 years and older who can select a face that matches their pain level. A 2-month-old infant cannot communicate verbally or select a face.

Choice C: The PAINAD scale is not suitable for a 2-month-old infant, as it is designed for adults who have advanced dementia and cannot verbalize their pain. A 2-month-old infant does not have dementia and may have different behavioral indicators of pain.

Choice D: The FLACC scale is suitable for a 2-month-old infant, as it is designed for infants and children aged 2 months to 7 years who cannot verbalize their pain. The FLACC scale assesses five behavioral indicators of pain: face, legs, activity, cry, and consolability. Each indicator is scored from 0 to 2 based on the observation of the nurse. The total score ranges from 0 to 10, with higher scores indicating more pain.

Choice A: This prescription does not need clarification, as medicating the client for pain every 4 hours as needed is appropriate for a child who has suspected appendicitis. Appendicitis is a condition that causes inflammation and infection of the appendix, which is a small pouch attached to the large intestine. Appendicitis can cause severe abdominal pain, nausea, vomiting, fever, or loss of appetite. Pain medication can help relieve the discomfort and reduce inflammation.

Choice B: This prescription does not need clarification, as maintaining NPO status is appropriate for a child who has suspected appendicitis. NPO status means nothing by mouth, which means no food or fluids are given to the client. NPO status can prevent further irritation of the appendix and prepare the client for possible surgery.

Choice C: This prescription does not need clarification, as monitoring oral temperature every 4 hours is appropriate for a child who has suspected appendicitis. Oral temperature is a measure of body temperature taken by placing a thermometer under the tongue. Oral temperature can indicate infection or inflammation in the body. Monitoring oral temperature every 4 hours can help detect changes in the client's condition and guide treatment.

Choice D: This prescription needs clarification, as administering an enema is not appropriate for a child who has suspected appendicitis. An enema is a procedure that involves inserting a tube into the rectum and injecting fluid into the colon to stimulate bowel movement. An enema can cause perforation or rupture of the appendix, which can lead to peritonitis, which is inflammation of the peritoneum, which is the membrane that lines the abdominal cavity. An enema can also increase the risk of bleeding or infection.