A six-year-old girl is being admited to the hospital for repair of an umbilical hernia. Which information, collected by the admitting nurse, is particularly helpful in planning care for this child?

Flaring of the nares is a sign of increased respiratory effort, which is a manifestation of acute respiratory distress. This finding occurs when the child is attempting to draw in more air to meet the increased demand for oxygen.

Bilateral bronchial breath sounds can indicate consolidation or a bronchial obstruction, but they are not specific to acute respiratory distress.

Diaphragmatic respirations are a normal finding and may occur in response to respiratory distress, but they do not necessarily indicate acute respiratory distress.

A resting respiratory rate of 35 breaths/min is within the normal range for a 1-year-old child and does not necessarily indicate acute respiratory distress.

Answer: A

Rationale:

(A) Repair should be done before the child is potty-trained: Surgical correction of hypospadias is typically recommended before the child reaches the age of 18 months, ideally between 6 and 12 months. This timing ensures that the child has not yet developed any psychological awareness of the surgery and helps avoid complications during toilet training. Repair before potty training is important to prevent urinary dysfunction and psychosocial issues.

(B) The urethral repair should be done after sexual maturity: Delaying surgical repair until after sexual maturity is not recommended. Early repair is crucial to ensure normal urinary and sexual function, and delaying it could lead to complications such as difficulty with urination and psychological distress.

(C) Surgery should be done by one month to prevent bladder infections: While preventing urinary tract infections is important, performing surgery as early as one month is not typically necessary or recommended. The optimal timing is closer to 6 to 12 months of age when the child is more resilient to surgery but still before the developmental milestones of potty training.

(D) Delaying the repair until school age reduces castration fears: Delaying the surgery until school age can actually increase psychological stress and fear of castration. Early surgical correction is preferred to minimize psychological impact and to allow the child to develop normally without the need for complex explanations or fear of surgery later in life.