A nurse is providing discharge instructions to a parent and his school-age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include?

Choice A: This statement indicates an understanding of the teaching, as washing all recently used clothing, bedding, and towels in hot water can help eliminate lice and nits (eggs). Lice and nits can survive on fabrics for up to two days and can spread from one person to another through direct or indirect contact. Washing items in hot water can kill lice and nits by exposing them to high temperatures.

Choice B: This statement indicates a lack of understanding of the teaching, as nits will not always be present after treatment. Nits are tiny white or yellow oval-shaped eggs that are attached to the hair shaft near the scalp. Nits can hatch into nymphs (young lice) within seven to ten days and mature into adult lice within nine to twelve days. Nits can be removed by using a fine-toothed comb or by applying products that loosen their grip on the hair.

Choice C: This statement indicates a lack of understanding of the teaching, as treating all family members may not be necessary or effective. Treating all family members can expose them to unnecessary chemicals or medications that may have side effects or cause resistance. Treating all family members may also not prevent reinfestation if there are other sources of exposure such as school or daycare. Only family members who have evidence of lice or nits should be treated.

Choice D: This statement indicates a lack of understanding of the teaching, as throwing out toys that can't be dry cleaned or washed may not be required or practical. Throwing out toys can cause emotional distress or financial burden for the child or the parents. Throwing out toys may also not prevent reinfestation if there are other sources of exposure such as clothing or bedding. Toys that can't be dry cleaned or washed can be sealed in plastic bags for two weeks to suffocate the lice and nits.

Choice A: This instruction is incorrect, as withholding insulin dose if feeling nauseous can cause hyperglycemia, which is high blood sugar, and diabetic ketoacidosis, which is a life-threatening condition that occurs when the body breaks down fat for energy and produces ketones. Ketones are acidic substances that can cause nausea, vomiting, abdominal pain, dehydration, or coma. The child should take their insulin dose as prescribed and monitor their blood sugar levels more frequently when they are sick.

Choice B: This instruction is unnecessary, as notifying the provider if blood glucose levels are within normal parameters does not require any action or intervention. The child and the parents should notify the provider if blood glucose levels are above or below the target range, which is usually 70 to 180 mg/dL for children with type 1 diabetes mellitus. The child and the parents should also notify the provider if they have any signs or symptoms of hypoglycemia, hyperglycemia, or diabetic ketoacidosis.

Choice C: This instruction is incorrect, as limiting fluid intake during mealtime can cause dehydration, which can worsen the symptoms and complications of type 1 diabetes mellitus. Dehydration can cause increased thirst, dry mouth, fatigue, headache, or dizziness. The child should drink plenty of fluids during meal time and throughout the day to hydrate their body and flush out excess glucose and ketones.

Choice D: This instruction is correct, as testing the urine for ketones can help detect diabetic ketoacidosis, which is a life-threatening condition that occurs when the body breaks down fat for energy and produces ketones. Ketones are acidic substances that can cause nausea, vomiting, abdominal pain, dehydration, or coma. The child should test their urine for ketones when their blood sugar levels are above 240 mg/dL or when they are sick. The child and the parents should notify the provider if the urine test shows moderate or large amounts of ketones.