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: This statement does not indicate a need for further teaching, as it is correct that insulin can be injected anywhere there is adipose tissue. Adipose tissue is the layer of fat under the skin that can absorb insulin and prevent damage to muscles or organs. The common sites for insulin injection are the abdomen, thighs, buttocks, or upper arms.

Choice B: This statement does not indicate a need for further teaching, as it is correct that the child should rotate sites after 5 injections in one area. Rotating sites can prevent lipodystrophy, which is a condition that causes abnormal changes in fat tissue due to repeated injections. Lipodystrophy can affect the appearance and absorption of insulin in the affected area.

Choice C: This statement indicates a need for further teaching, as it is incorrect that the child should aspirate before injecting the insulin. Aspiration is the process of pulling back on the plunger of the syringe to check for blood before injecting the medication. Aspiration is not recommended for insulin injection, as it can cause pain, bruising, or leakage of insulin from the injection site.

Choice D: This statement does not indicate a need for further teaching, as it is correct that insulin should be injected at a 90-degree angle. Injecting insulin at a 90-degree angle can ensure that the medication reaches the adipose tissue and prevents skin irritation or muscle damage. The only exception is if the child has very thin skin or uses very short needles, in which case they may inject at a 45-degree angle.

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.