A home health nurse is providing teaching about postseizure management to the parents of a school-age child who has epilepsy and experiences tonic-clonic seizures. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A. Measuring the child's abdominal circumference:

This is the correct action. Assessing the child's abdominal circumference is essential in monitoring the size of the Wilms' tumor and evaluating for any signs of abdominal distention or growth. Changes in abdominal circumference can provide valuable information about the progression of the tumor and any potential complications.

B. Palpating the child's abdomen:

Palpating the child's abdomen is an essential part of the physical examination to assess for the presence of a mass or any tenderness. However, in the case of a child with a known Wilms' tumor, palpation should be performed gently to avoid causing discomfort or disturbing the tumor.

C. Providing clear liquids up to 1 hr prior to surgery:

Providing clear liquids up to 1 hour prior to surgery is not appropriate for a child undergoing surgery, especially if anesthesia is involved. Preoperative fasting guidelines typically require clear liquids to be stopped a few hours before surgery to reduce the risk of aspiration.

D. Continuously monitoring the child's oxygen saturation:

Continuous monitoring of the child's oxygen saturation is an essential aspect of perioperative care, but it is not specific to the preoperative assessment for a child with Wilms' tumor. Oxygen saturation monitoring is typically performed throughout the perioperative period to ensure adequate oxygenation during surgery and recovery.

A. "Avoid immunizing your child with the meningococcal vaccine."

This statement is incorrect. Children with sickle cell anemia are at increased risk of infections, including meningococcal disease. Immunization with the meningococcal vaccine is recommended to help prevent this serious infection.

B. "Restrict the time your child spends playing outdoors."

While it's important for children with sickle cell anemia to avoid extreme temperatures and stay hydrated to prevent triggering a vaso-occlusive crisis, completely restricting outdoor playtime may not be necessary. It's essential to encourage appropriate hydration and dress warmly in cold weather but allowing outdoor play in moderation can be beneficial for physical activity and socialization.

C. "Increase your child's intake of oral fluids."

This is a correct statement. Adequate hydration is crucial for children with sickle cell anemia to help prevent vaso-occlusive crises and maintain overall health. Increasing oral fluid intake, particularly water, can help prevent dehydration and promote circulation of sickle-shaped red blood cells.

D. "Provide your child with a high-protein diet."

This is also a correct statement. A diet rich in high-quality protein can help support healthy growth and development in children with sickle cell anemia. Protein is important for building and repairing tissues, including red blood cells. However, it's essential to ensure a balanced diet that includes a variety of nutrients, not just protein.