A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux (GER). Which of the following instructions should the nurse include?

Choice Areason: Increasing phosphorus intake is not advisable for clients with chronic kidney disease, as they may have hyperphosphatemia, a condition of high phosphorus levels in the blood. Hyperphosphatemia can cause bone loss, calcification of soft tissues, and itching.

Choice Breason: Increasing potassium intake is not advisable for clients with chronic kidney disease, as they may have hyperkalemia, a condition of high potassium levels in the blood. Hyperkalemia can cause muscle weakness, numbness, tingling, and cardiac arrest.

Choice C reason: Limiting protein intake is advisable for clients with chronic kidney disease, as protein metabolism produces urea, which is excreted by the kidneys. High protein intake can increase the workload and damage of the kidneys, and cause uremia, a condition of high urea levels in the blood. Uremia can cause nausea, vomiting, fatigue, and mental confusion.

Choice D reason: Limiting calcium intake is not advisable for clients with chronic kidney disease, as they may have hypocalcemia, a condition of low calcium levels in the blood. Hypocalcemia can cause muscle spasms, seizures, and cardiac arrhythmias.

Choice A reason: Tilt your head forward while you eat is a correct instruction for dysphagia. This position can help prevent choking by closing the airway and directing food and fluids to the back of the mouth and throat.

Choice B reason: Obtain your vitamins in liquid form is not a correct instruction for dysphagia. Liquid vitamins can be too thin and watery for people with dysphagia, as they can easily enter the airway and cause aspiration. Vitamins should be taken in pill or chewable form, or crushed and mixed with thickened liquids or pureed foods.

Choice C reason: Cool foods down to room temperature before consuming is not a correct instruction for dysphagia. Food temperature does not affect the risk of choking for people with dysphagia, as long as the food is not too hot or too cold. Food texture and consistency are more important factors for safe swallowing.

Choice D reason: Drink water with each bite of food is not a correct instruction for dysphagia. Water can also be too thin and watery for people with dysphagia, as it can also enter the airway and cause aspiration. Water should be thickened to a nectar-like, honey-like, or pudding-like consistency, depending on the individual's needs and preferences.