A nurse receives a telephone call from a parent reporting that their school-age child has a nosebleed and that they cannot stop the bleeding. Which of the following instructions should the nurse provide to the parent?

Rationale:

A. "Can you talk about what was happening with your partner at home?": This open-ended question encourages the partner to express emotions and provide context, which helps build trust and gather relevant information. It’s a therapeutic response that validates the partner’s experience without judgment or assumptions.

B. "Why do you think your partner's symptoms are progressing so quickly?” This question may come off as accusatory or put the partner on the defensive. "Why" questions can create a sense of blame or pressure, which is not conducive to a supportive therapeutic environment.

C. "You should make sure your partner takes the prescribed medication”: This directive may be perceived as dismissive and does not acknowledge the partner’s emotional distress. While medication adherence is important, this is not the most therapeutic or empathetic initial response.

D. "You did the right thing by bringing your partner in for treatment”: While affirming the decision is supportive, this response closes the conversation and doesn’t invite the partner to explore their concerns or emotions further, limiting therapeutic dialogue.

Rationale:

• Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
• Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
• Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
• Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.
• Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.