A nurse is providing discharge instructions to a parent and their school-age child who has juvenile idiopathic arthritis.

Which of the following instructions should the nurse include?

The correct answer is d. Modify the environment.

Rationale for each choice:

Choice a. Improve the client's communication skills.

• Statement:While communication is important,it is not the priority for a child with hemiplegic cerebral palsy.
• Rationale:Hemiplegic cerebral palsy primarily affects motor skills,not communication abilities.While some children with hemiplegic cerebral palsy may have speech difficulties,it is not the most pressing concern in this case.Addressing environmental barriers to promote mobility and independence takes precedence.

Choice b. Provide respite services for the parents.

• Statement:Respite services can provide valuable support for parents,but they are not the priority in this case.
• Rationale:The focus of the care plan should be on the child's immediate needs and safety.Modifying the environment to enhance the child's functional abilities is crucial for their development and well-being.

Choice c. Foster self-care activities.

• Statement:Encouraging self-care is essential,but it requires a supportive environment.
• Rationale:Before promoting self-care activities,the nurse must ensure the child has the necessary accommodations and modifications in place to facilitate independence.

Choice d. Modify the environment.

• Statement:This is the priority goal for a child with hemiplegic cerebral palsy.
• Rationale:Modifying the home environment can significantly improve the child's mobility,safety,and ability to participate in daily activities.Examples of modifications include:
  • Installing grab bars in the bathroom
  • Widening doorways
  • Removing tripping hazards
  • Providing adaptive equipment such as special chairs or utensils
  • Ensuring adequatelighting

Chronic glomerulonephritis is a condition that causes inflammation of the glomeruli, which are tiny filtering units in the kidneys.
This can lead to poor kidney function and an increase in waste products in the bloodstream.
Blood urea nitrogen (BUN) is a waste product that is normally filtered by the kidneys and excreted in urine.
A BUN level of 50 mg/dL is higher than the normal range, indicating poor kidney function.
Choice B is incorrect because a serum phosphorus level of 4.0 mg/dL is within
the normal range for adults.
Choice C is incorrect because a serum potassium level of.8 mEq/L is within the normal range for adults.
Choice D is incorrect because proteinuria (the presence of protein in urine) is a
common finding in glomerulonephritis.