The nurse is caring for a child with chronic kidney disease who is experiencing renal osteodystrophy. Which outcome should the nurse explain to the parents about the sequela for their child with renal osteodystrophy?

Choice A reason: Instilling benzocaine otic drops regularly is not a recommended practice for preventing or treating otitis media. Benzocaine is a topical anesthetic that can temporarily relieve ear pain, but it does not address the underlying cause of the infection. Moreover, benzocaine can cause allergic reactions, skin irritation, or methemoglobinemia, a condition that reduces the oxygen-carrying capacity of the blood. The nurse should instruct the caregiver to avoid using benzocaine otic drops unless prescribed by a health care provider.

Choice B reason: Avoiding any smoking inside the house is a good practice for preventing otitis media. Smoking can irritate the respiratory tract and impair the function of the cilia, the hair-like structures that help clear mucus and bacteria from the middle ear. Smoking can also increase the risk of respiratory infections, allergies, and asthma, which are associated with otitis media. The nurse should praise the caregiver for avoiding smoking and encourage them to maintain a smoke-free environment for the infant.

Choice C reason: Giving the infant the full course of antibiotics is a necessary practice for treating otitis media. Antibiotics can help eliminate the bacteria that cause the infection and reduce the inflammation and pain in the middle ear. However, antibiotics should be used only when prescribed by a health care provider, and the caregiver should follow the instructions carefully. The nurse should remind the caregiver to give the infant the exact dose of antibiotics at the right time and for the entire duration of the treatment, even if the symptoms improve.

Choice D reason: Scheduling a visit for pneumococcal vaccine is a preventive measure for otitis media. Pneumococcal vaccine can protect the infant from the most common strains of Streptococcus pneumoniae, a bacterium that causes otitis media and other serious infections. The vaccine is recommended for all children under 2 years of age, and it is given in four doses at 2, 4, 6, and 12 to 15 months of age. The nurse should verify the infant's immunization status and advise the caregiver to follow the recommended schedule for the pneumococcal vaccine.

Choice A reason: Flaring of the nares is a sign of acute respiratory distress in children. It indicates that the child is using the accessory muscles of the nose to breathe, which is a sign of increased work of breathing. Flaring of the nares may be accompanied by other signs of respiratory distress, such as retractions, grunting, or cyanosis. The nurse should report this finding to the health care provider and monitor the child's oxygen saturation, respiratory rate, and level of consciousness.

Choice B reason: Diaphragmatic respirations are not a specific sign of acute respiratory distress in children. They are a normal pattern of breathing in infants and young children, who use their diaphragm more than their chest muscles to breathe. Diaphragmatic respirations may become more pronounced when the child is crying, feeding, or sleeping, but they are not indicative of respiratory distress.

Choice C reason: A resting respiratory rate of 35 breaths/min is not a sign of acute respiratory distress in children. It is within the normal range for a 1-year-old child, who typically has a respiratory rate of 20 to 40 breaths/min. A resting respiratory rate of more than 60 breaths/min may be a sign of respiratory distress in children, especially if it is associated with other symptoms, such as wheezing, coughing, or nasal flaring.

Choice D reason: Bilateral bronchial breath sounds are not a sign of acute respiratory distress in children. They are normal breath sounds that are heard over the trachea and the large bronchi. They are loud and high-pitched, and have a longer expiratory phase than inspiratory phase. Bilateral bronchial breath sounds do not indicate any lung pathology or obstruction.