A nurse is assisting with developing a dietary plan for a 2-year-old toddler whose family is from another country. Which of the following recommendations should the nurse make?

A. Speech-language pathologist: Speech-language pathologists (SLPs) are trained to assess and manage dysphagia, including swallowing difficulties after a stroke. They evaluate swallowing function, recommend safe feeding techniques, and provide exercises to improve swallowing ability, directly addressing the client’s expressed concern.

B. Physical therapist: Physical therapists focus on mobility, balance, and strengthening exercises. While important for post-stroke rehabilitation, they do not specialize in swallowing assessment or management. Referral to a PT would not address the client’s immediate swallowing difficulties.

C. Social worker: Social workers provide support for psychosocial needs, discharge planning, and community resources. Although valuable for overall care, they are not responsible for evaluating or treating swallowing disorders.

D. Occupational therapist: Occupational therapists assist with activities of daily living, adaptive equipment, and fine motor skills. While they may help with feeding techniques, the primary assessment and management of dysphagia require an SLP.

A. Negative urine ketones: Diabetic ketoacidosis (DKA) is characterized by increased production of ketone bodies due to insulin deficiency and enhanced lipolysis. Ketones accumulate in the blood and spill into the urine, producing positive urine ketone results. The absence of urine ketones does not support the presence of ketoacidosis, as ketosis is a defining metabolic feature.

B. Kussmaul respirations: Kussmaul respirations are deep, rapid breathing patterns that occur as a compensatory response to metabolic acidosis. In DKA, excess ketone production leads to accumulation of hydrogen ions and decreased serum bicarbonate. The respiratory system compensates by increasing ventilation to eliminate carbon dioxide.

C. Hypoglycemia: DKA is associated with hyperglycemia due to insufficient insulin, which prevents glucose from entering cells and leads to elevated serum glucose levels. Hypoglycemia involves low blood glucose and does not trigger the ketone overproduction seen in DKA. The pathophysiology of DKA centers on insulin deficiency and high circulating glucose.

D. Hypertension: Clients with DKA often experience osmotic diuresis from severe hyperglycemia, leading to dehydration and volume depletion. This intravascular fluid loss more commonly results in hypotension rather than elevated blood pressure. The hemodynamic changes in DKA are primarily related to dehydration and electrolyte imbalance.