A nurse is caring for a 6-month-old infant diagnosed with congenital adrenal hyperplasia (CAH). The parents express concern about their child's condition and ask about long-term management. Which nursing intervention should be the priority?

The parents of a 6-month-old with congenital adrenal hyperplasia (CAH) require comprehensive education focusing on the lifelong nature of the condition and the critical role of hormone replacement. The priority is to ensure they understand the rationale for treatment and how to prevent adrenal crisis.

• Lifelong Therapy: Emphasize that CAH is a permanent genetic condition requiring daily glucocorticoid (e.g., hydrocortisone) and, in salt-wasting forms, mineralocorticoid (e.g., fludrocortisone) replacement. Doses are carefully titrated to balance cortisol deficiency and androgen excess.
• Sick Day Rules: Instruct parents to double or triple the usual glucocorticoid dose during febrile illness, injury, or procedures. Provide a written emergency plan and a prescription for injectable hydrocortisone for use if the child is vomiting or unresponsive.
• Medical Identification: Advise the parents to have the child wear a medical alert bracelet indicating adrenal insufficiency. This ensures emergency providers can rapidly administer stress-dose steroids.
• Signs of Crisis: Teach parents to recognize early signs of adrenal crisis, including vomiting, lethargy, dehydration, and hypotension. Immediate administration of emergency intramuscular hydrocortisone and transport to the emergency department is required.
• Routine Monitoring: Explain the need for regular follow-up with a pediatric endocrinologist to monitor growth velocity, bone age, and serum hormone levels (17-hydroxyprogesterone, androstenedione) to adjust therapy and avoid complications from under- or overtreatment.