The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which instruction should be included in the teaching?

 

Calculation Steps

Step 1: Determine the total urine output in mL.

• Total urine output = 360 mL

Step 2: Determine the child’s weight in kg.

• Weight = 15 kg

Step 3: Determine the time period in hours.

• Time = 12 hours

Step 4: Calculate the urine output in mL/kg/hour.

• Urine output (mL/kg/hour) = Total urine output ÷ (Weight × Time)

Step 5: Perform the multiplication inside the parentheses first.

• Weight × Time = 15 kg × 12 hours = 180 kg·hours

Step 6: Perform the division.

• Urine output (mL/kg/hour) = 360 mL ÷ 180 kg·hours = 2 mL/kg/hour

Result

The child’s urine output is 2 mL/kg/hour.

Choice A reason:

Compartment syndrome is a condition where increased pressure within a muscle compartment leads to decreased blood flow, which can cause muscle and nerve damage. It is typically associated with severe trauma, fractures, or crush injuries. The symptoms include severe pain, swelling, and decreased sensation or movement in the affected limb. In this case, the child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are more indicative of an infection rather than compartment syndrome.

Choice B Reason:

Osteomyelitis is an infection of the bone, which can occur following an injury or infection elsewhere in the body. The symptoms include redness, swelling, tenderness, and pain in the affected area, along with fever and elevated WBC. Given the child’s history of a spider bite and the presence of redness, swelling, tenderness, and elevated WBC, osteomyelitis is the most likely diagnosis. The unremarkable X-ray does not rule out osteomyelitis, as early stages of the infection may not show changes on X-ray.

Choice C Reason:

Osteogenesis imperfecta, also known as brittle bone disease, is a genetic disorder characterized by fragile bones that break easily. It is not associated with infections or elevated WBC. The symptoms of osteogenesis imperfecta include frequent fractures, blue sclerae, and hearing loss. The child’s symptoms of redness, swelling, and tenderness following a spider bite, along with an elevated WBC, are not consistent with osteogenesis imperfecta.

Choice D Reason:

Juvenile idiopathic arthritis (JIA) is a type of arthritis that occurs in children. It is characterized by persistent joint inflammation, pain, and swelling. While JIA can cause joint tenderness and swelling, it is not typically associated with a recent injury or infection, such as a spider bite. Additionally, JIA does not usually cause elevated WBC. The child’s symptoms are more indicative of an infection, making osteomyelitis the more likely diagnosis.