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: A barking cough is not a finding that indicates that the treatment has been effective, but rather a symptom of acute laryngotracheobronchitis, which is also known as croup. Croup is a condition that causes inflammation and narrowing of the upper airway and produces a characteristic barking or seal-like cough. A barking cough may persist for several days after the onset of croup and does not reflect the severity of the airway obstruction.

Choice B: Decreased stridor is a finding that indicates that the treatment has been effective, as stridor is a sign of airway obstruction caused by acute laryngotracheobronchitis. Stridor is a high-pitched, noisy breathing sound that occurs when the air passes through the narrowed airway. Stridor may be inspiratory, expiratory, or biphasic,
depending on the level of obstruction. Decreased stridor means that the airway is less obstructed and the child can breathe more easily.

Choice C: Improved hydration is not a finding that indicates that the treatment has been effective, but rather a goal of treatment for acute laryngotracheobronchitis. Dehydration can worsen the symptoms and complications of croup by thickening the mucus and increasing the risk of infection. Improved hydration can help thin out the mucus and prevent dehydration. Hydration can be improved by encouraging oral fluids, administering intravenous fluids, or providing humidified air.

Choice D: Decreased temperature is not a finding that indicates that the treatment has been effective, but rather a possible outcome of treatment for acute laryngotracheobronchitis. Fever may or may not be present in croup, depending on the cause and severity of the condition. Fever can be caused by viral or bacterial infection, inflammation, or dehydration. Decreased temperature can indicate that the infection or inflammation is resolving or that the dehydration is corrected.

Choice A: This action is appropriate for a 10-year-old child who will be hospitalized for an extended period of time, as it meets their psychosocial needs according to Erikson's stage of industry versus inferiority. In this stage, which occurs from age 6 to 12 years, children develop a sense of competence and achievement by mastering skills and tasks that are valued by society. Encouraging the client to complete school work can help them maintain their academic progress and self-esteem.

Choice B: This action is not appropriate for a 10-year-old child who will be hospitalized for an extended period of time, as it does not meet their psychosocial needs according to Erikson's stage of industry versus inferiority. In this stage, which occurs from age 6 to 12 years, children need consistency and structure to develop a sense of competence and achievement. Varying the child's schedule each day can cause confusion and stress for them.

Choice C: This action is not appropriate for a 10-year-old child who will be hospitalized for an extended period of time, as it does not meet their psychosocial needs according to Erikson's stage of industry versus inferiority. In this stage, which occurs from age 6 to 12 years, children need opportunities to master skills and tasks that are valued by society. Providing a daily session with a play therapist can help them cope with their emotions and fears, but it does not help them develop their competence and achievement.

Choice D: This action is not appropriate for a 10-year-old child who will be hospitalized for an extended period of time, as it does not meet their psychosocial needs according to Erikson's stage of industry versus inferiority. In this stage, which occurs from age 6 to 12 years, children need social support and peer interaction to develop a sense of competence and achievement. Discouraging visits from the client's friends can cause isolation and depression for them.