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Placing a child in a supine position with a pillow under her back is not recommended for managing a nosebleed, especially in a child with von Willebrand disease. This position can cause blood to flow down the throat, which may lead to choking or swallowing blood, potentially causing nausea or vomiting. The supine position does not help in controlling the bleeding effectively.

Applying ice at the base of the nose for 5 minutes can help constrict blood vessels and reduce bleeding. However, it is not the most effective method for stopping a nosebleed in a child with von Willebrand disease. The primary action should be to apply direct pressure to the nose, which is more effective in controlling the bleeding.

Placing the child in a sitting position with her head tilted back is not recommended. Tilting the head back can cause blood to flow down the throat, which may lead to choking or swallowing blood. This position does not help in effectively controlling the bleeding and can make it difficult to assess the severity of the nosebleed.
 

Using a 20-gauge needle is not appropriate for administering vaccines to preschoolers. The recommended needle gauge for intramuscular injections in children is typically between 22 and 25 gauge. A 20-gauge needle is too large and can cause unnecessary pain and tissue damage.

Inserting the needle at a 15-degree angle is incorrect for intramuscular injections. Intramuscular injections should be administered at a 90-degree angle to ensure the vaccine is delivered into the muscle tissue. A 15-degree angle is more appropriate for intradermal injections, not intramuscular.

Inserting the needle just below the acromion process is not the correct technique. The correct injection site in the deltoid muscle is about 2-3 finger widths below the acromion process. This ensures the vaccine is administered into the thickest part of the muscle, reducing the risk of hitting bone or other structures.

Tracking an object with the eyes is a normal developmental milestone for an 8-month-old infant and does not indicate cerebral palsy. Infants typically develop the ability to follow moving objects with their eyes by around 3 to 4 months of age. This skill shows that the infant’s visual and motor coordination is developing appropriately.

Smiling when a parent appears is another normal developmental milestone and is not a sign of cerebral palsy. Infants usually begin to smile socially by around 6 to 8 weeks of age. This behavior indicates healthy emotional and social development.

Using a pincer grasp to pick up a toy is a normal developmental milestone for an 8-month-old infant and does not indicate cerebral palsy. The pincer grasp, which involves using the thumb and forefinger to pick up small objects, typically develops between 8 to 12 months of age. This skill demonstrates fine motor development.

“I want to learn how to empty my child’s urinary catheter bag.” This statement does not indicate an understanding of the teaching related to Hirschsprung disease, as urinary catheters are not typically associated with this condition. Hirschsprung disease affects the colon and rectum, not the urinary system.

“I’m glad my child will have normal bowel movements now.” While this statement shows optimism, it does not fully reflect an understanding of the teaching. After the initial surgery, the child may still experience irregular bowel movements until the second surgery is completed and the bowel function is fully restored.

“I want to learn how to use my child’s feeding tube as soon as possible.” This statement is not relevant to Hirschsprung disease, as feeding tubes are not typically required for this condition. Hirschsprung disease primarily affects bowel movements and does not usually necessitate the use of a feeding tube.
 

Respiratory system: Kawasaki disease primarily affects the blood vessels and the heart. While respiratory symptoms can occur, they are not the primary concern. The main complications of Kawasaki disease involve the cardiovascular system, including inflammation of the coronary arteries, myocarditis, and pericarditis.

Integumentary system: While Kawasaki disease does cause skin symptoms such as rash and peeling, these are not the primary complications that need monitoring. The integumentary symptoms are more diagnostic rather than complications that require ongoing monitoring.

Gastrointestinal system: Gastrointestinal symptoms like abdominal pain, vomiting, and diarrhea can occur in Kawasaki disease, but they are not the primary complications. The cardiovascular system remains the main focus for monitoring due to the risk of severe complications.
 

Improved hydration: While maintaining hydration is important in managing croup, it is not a direct indicator of the effectiveness of the cool mist tent treatment. Improved hydration can be achieved through various means, such as oral fluids or intravenous therapy, and does not specifically reflect the reduction of airway inflammation.

Decreased temperature: Fever can be a symptom of croup, but a decrease in temperature is not a primary indicator of the effectiveness of the cool mist tent treatment. The main goal of the cool mist tent is to reduce airway inflammation and improve breathing, rather than to control fever.

Barking cough: A barking cough is a characteristic symptom of croup. While the cool mist tent can help soothe the airways and reduce coughing, the presence or absence of a barking cough alone is not a definitive indicator of treatment effectiveness. The primary focus is on reducing airway obstruction and improving airflow.

The statement “I will report a change in her breathing” is appropriate. Changes in breathing can indicate worsening of the upper respiratory infection or complications such as diabetic ketoacidosis (DKA), which requires immediate medical attention. Reporting such changes is crucial for timely intervention.

The statement “I will notify the doctor if her temperature is not controlled with acetaminophen” is also appropriate. Persistent fever despite acetaminophen can indicate a more serious infection or other complications that need medical evaluation. This ensures that the child receives appropriate care and treatment.

The statement “I will encourage her to drink half a cup of water or sugar-free fluids every 30 minutes” is correct. Staying hydrated is essential, especially for a child with diabetes, to prevent dehydration and help manage blood sugar levels. Sugar-free fluids are recommended to avoid spikes in blood sugar.

Nephrotic syndrome is a kidney disorder that causes the body to excrete too much protein in the urine. It is characterized by symptoms such as swelling (edema), particularly around the eyes and in the ankles and feet, foamy urine due to excess protein, and weight gain due to fluid retention. While nephrotic syndrome can occur in children, it is less likely to be the primary suspicion in a 1-year-old presenting with acute symptoms such as severe abdominal pain, vomiting, and bloody stools, which are more indicative of intussusception.

Pyloric stenosis is a condition that affects infants, typically between birth and 6 months of age. It involves the thickening of the pylorus muscle, which blocks food from entering the small intestine. Symptoms include projectile vomiting, dehydration, and weight loss. Although pyloric stenosis is a serious condition that requires medical attention, it is less likely to be suspected in a 1-year-old child compared to intussusception, which is more common in this age group.

Reason: Anoxia refers to an absence of oxygen supply to an organ or a tissue. While it is a serious condition, it is not a typical finding specifically associated with tracheoesophageal fistula (TEF). TEF primarily affects the esophagus and trachea, leading to issues with feeding and breathing, but not directly causing anoxia. Anoxia could be a secondary complication if the infant experiences severe respiratory distress, but it is not a primary symptom.

Reason: Apnea, or temporary cessation of breathing, is another expected finding in infants with tracheoesophageal fistula. The abnormal connection can cause aspiration of saliva or food into the lungs, leading to respiratory distress and apnea. This is a critical symptom that requires immediate medical attention to prevent severe complications.

Reason: A sunken abdomen is not typically associated with tracheoesophageal fistula. In fact, infants with TEF might present with abdominal distension due to air entering the stomach through the fistula. A sunken abdomen could indicate other conditions such as dehydration or malnutrition, but it is not a characteristic finding of TEF.