A nurse in a pediatric clinic is providing teaching to the guardian of an infant who has a new prescription for digoxin. Which of the following manifestations should the nurse include as an indication of digoxin toxicity?

Choice A Reason:

Partial thromboplastin time (PTT): PTT is a test that evaluates the blood's ability to clot properly. While rheumatic fever can involve inflammation affecting various systems, it's not directly associated with significant changes in coagulation parameters like PTT.

Choice B Reason:

Blood urea nitrogen (BUN): BUN measures the amount of nitrogen in the blood that comes from urea, a waste product of the liver's metabolism of protein. It's commonly used to assess kidney function and hydration status. Rheumatic fever primarily involves inflammatory processes affecting the heart, joints, skin, and nervous system, and it typically doesn't have a direct impact on BUN levels.

Choice C Reason:

Erythrocyte sedimentation rate (ESR): Elevated ESR is a non-specific marker of inflammation and can be elevated in rheumatic fever due to the inflammatory response.

Choice D Reason:

C-reactive protein (CRP): Similar to ESR, CRP is an acute-phase reactant and tends to rise in response to inflammation, so elevated CRP levels can indicate an inflammatory process like rheumatic fever.

Choice E Reason:

Antistreptolysin O (ASO) titer: This test measures antibodies produced by the body against streptolysin O, a toxin produced by Streptococcus bacteria. Elevated ASO titers can indicate a recent streptococcal infection, which is a predisposing factor for rheumatic fever.

Choice A Reason:

Moisten the mucosa with lemon glycerin swabs. Lemon glycerin swabs might be too acidic and can cause irritation or discomfort in oral ulcers. Using them could exacerbate the toddler's condition.

Choice B Reason:

Cleanse the gums with saline-soaked gauze. This action can help maintain oral hygiene and reduce the risk of infection in the oral ulcers. Saline is gentle and can help keep the affected area clean without causing further irritation.

Choice C Reason:

Administer oral viscous lidocaine. Lidocaine is a local anesthetic that may be used in some cases for pain relief, but its use in oral ulcers for toddlers might not be recommended due to potential risks and concerns about ingestion, especially in young children.

Choice D Reason:

Schedule routine oral care every hour. While oral care is essential, performing it too frequently (every hour) might cause more discomfort and irritation to the already sensitive oral ulcers. Gentle, regular care is important, but excessive cleaning can be detrimental.