A nurse is reinforcing teaching with the parents of a child who has hemophilia about the care of an injury that causes bleeding. Which of the following instructions should the nurse include in the teaching?

A. A 4-year-old preschooler who has a rivalry with their siblings is incorrect. Sibling rivalry is a normal part of child development and does not indicate abuse or neglect that would require reporting.

B. A 24-month-old toddler who experiences occasional incontinence is incorrect. Occasional incontinence is developmentally appropriate for a 2-year-old and is not a concern for mandatory reporting.

C. A 6-month-old infant who has a spiral fracture to a lower extremity is correct. Spiral fractures in non-ambulatory infants are highly suspicious for non-accidental trauma (child abusE. and should be reported to local authorities for further investigation. These fractures are often caused by twisting forces rather than accidental injuries.

D. A 9-month-old infant who has been exposed to bedbugs and has cellulitis is incorrect. While bedbug exposure and cellulitis require medical treatment and possibly social support, they do not necessarily indicate abuse or neglect that mandates reporting.

1. Steatorrhea
   Unrelated to diagnosis
   Steatorrhea, or fatty stools, is a symptom related to cystic fibrosis, specifically due to pancreatic insufficiency. It is not related to the acute issue of Streptococcus pneumonia infection but rather a chronic symptom of cystic fibrosis.
2. Barrel chest
   Unrelated to diagnosis
   A barrel chest is a long-term manifestation of cystic fibrosis caused by chronic lung damage. It is not a sign of worsening pneumonia but rather a physical characteristic of the patient's chronic condition.
3. Respiratory rate 32/min
   Indication of potential worsening of the condition
   An increased respiratory rate is an indication of respiratory distress or worsening of the pneumonia, particularly as the body attempts to compensate for inadequate oxygenation.
4. WBC count 17,000/mm3
   Indication of potential worsening of the condition
   An elevated white blood cell (WBC. count suggests ongoing infection or inflammation. Given the patient's history of pneumonia, this is likely an indication that the infection may not be fully controlled.
5. Hemoptysis 300 mL
   Indication of potential worsening of the condition
   Hemoptysis, or coughing up blood, especially in such a significant volume, is a serious sign of worsening lung conditions, possibly due to severe infection or complications like a pulmonary hemorrhage. This requires immediate attention.
6. Oxygen saturation 45% on 1 L oxygen via nasal cannula
   Indication of potential worsening of the condition
   A low oxygen saturation of 45% is critically low and indicates severe hypoxemia, suggesting that the patient’s respiratory function is deteriorating and more intensive intervention may be needed, such as mechanical ventilation.
   

   Findings 24 Hr Later	Unrelated to diagnosis	Indication of potential improvement	Indication of potential worsening of the condition
   Steatorrhea	✓
   Barrel chest	✓
   Respiratory rate 32/min			✓
   WBC count 17.000/mm3			✓
   Hemoptysis 300			✓
   Oxygen saturation 45% on 1 L oxygen via nasal cannula			✓