A nurse is planning care for a toddler who has developed oral ulcers in response to chemotherapy. Which of the following actions should the nurse include in the plan of care?

Choice A Reason:

Encourage frequent physical activity to increase bone mass: While physical activity is generally beneficial for overall health, in the case of osteomyelitis, encouraging excessive or frequent physical activity might exacerbate pain, discomfort, and the risk of further bone injury. Controlled and appropriate physical activity may be recommended, but it should be individualized based on the child's condition and the affected area.

Choice B Reason:

Provide a high-calorie, low-protein diet: In osteomyelitis, a balanced and nutritious diet is important to support the child's overall health and aid in recovery. However, a high-calorie, low-protein diet would not be suitable for combating infection or supporting healing. Adequate protein intake is essential for tissue repair and immune function.

Choice C Reason:

Initiate contact precautions for the child: Osteomyelitis is not typically transmitted from person to person. It's an infection within the bone that doesn't require contact precautions for prevention of spread among individuals. Treatment primarily involves antibiotics and sometimes surgical drainage, but it doesn't necessitate isolation precautions.

Choice D Reason:

Maintain a patent intravenous catheter: Antibiotics are the mainstay of treatment for osteomyelitis, and they are usually administered intravenously for an extended period to effectively eradicate the infection. Maintaining a patent intravenous catheter ensures continuous access for medication administration.

Choice A Reason:

Increased expectoration is correct. Increased expectoration (coughing up and clearing mucus) could indicate improved airway clearance, which is a primary goal of chest physiotherapy in cystic fibrosis. Effective therapy would facilitate the removal of mucus from the airways, making it easier for the child to clear secretions.

Choice B Reason:

Reduced pain is incorrect. While reducing pain is important for overall comfort, chest physiotherapy's primary goal in cystic fibrosis is to improve airway clearance and lung function. Pain reduction might not be the primary indicator of the therapy's effectiveness in this context.

Choice C Reason:

Increased heart rate is incorrect. An increased heart rate might not directly indicate the effectiveness of chest physiotherapy for cystic fibrosis. The focus is primarily on improving respiratory function and airway clearance rather than affecting heart rate.

Choice D Reason:

Increased urine output is incorrect. Increased urine output is not typically a direct indicator of the effectiveness of chest physiotherapy in cystic fibrosis. Chest physiotherapy aims to improve respiratory function rather than affecting urine output.