A nurse is contributing to the plan of care for a toddler who is receiving intermittent enteral feedings. Which of the following interventions should the nurse include?

A. Promoting nutrition: While nutrition is important, preventing infections is more urgent in a preschooler with leukemia. Leukemia and its treatments, such as chemotherapy, can significantly weaken the immune system, making the child more susceptible to infections.
B. Preventing infections: Preventing infections is critical for children with leukemia because their immune systems are compromised, either by the disease itself or by treatments like chemotherapy. Educating the guardians on how to prevent infections (e.g., hand hygiene, avoiding crowds, keeping the environment clean) is crucial to avoid serious complications.
C. Supporting psychological wellness: While psychological support is important, the priority for a preschooler with leukemia is to focus on preventing infections and ensuring their physical well-being, as infections can lead to severe consequences.
D. Managing mucosal ulcerations: Mucosal ulcerations can be a concern for children undergoing cancer treatment, but preventing infections is a more immediate and potentially life-saving priority. Once infections are controlled, mucosal ulcerations can also be addressed.

Rationale for Correct Choices:

• Blood pressure: The adolescent's blood pressure has decreased significantly from 116/60 mm Hg to 88/50 mm Hg, indicating hypotension. This is a priority, as low blood pressure can lead to poor perfusion of vital organs and can worsen the overall condition. Immediate action, such as fluid resuscitation, is necessary.
• Temperature: The adolescent has a persistent high fever (39°C or 102.2°F), which needs to be managed to prevent complications such as febrile seizures or increased intracranial pressure, especially given the suspected meningitis. Fever management will help improve comfort and reduce metabolic demand on the body.

Rationale for Incorrect Choices:

• Nausea: While nausea is an uncomfortable symptom, it is not as urgent as hypotension. Managing blood pressure and stabilizing the adolescent's circulation takes priority before addressing nausea.
• Level of consciousness: The adolescent is lethargic but responsive to verbal stimuli. While their level of consciousness is important to monitor, it is primarily related to the underlying infection (likely meningitis). Stabilizing blood pressure and fever should be prioritized.
• Abdominal findings: The adolescent's abdominal findings (soft, flat abdomen with active bowel sounds) are not immediately concerning. The priority is managing the acute symptoms related to suspected meningitis and hypotension, rather than abdominal issues.