A parent calls a clinic and reports to a nurse that his 2-month-old infant is hungry more than usual but is projectile vomiting immediately after eating. Which of the following responses should the nurse make?

Choice A: Muscular dystrophy is not an example of a neural tube defect, but rather a group of genetic disorders that cause progressive weakness and loss of muscle mass. Muscular dystrophy affects the skeletal muscles that control movement and may also affect the heart, lungs, or other organs. Muscular dystrophy is caused by mutations in genes that encode proteins that protect muscle fibers from damage.

Choice B: Spina bifida is an example of a neural tube defect, which is a birth defect that occurs when the neural tube, which is the structure that develops into the brain and spinal cord, does not close completely during the first month of pregnancy. Spina bifida causes an opening in the spine that exposes the spinal cord and nerves and may result in physical and mental disabilities. Spina bifida can be prevented by taking folic acid before and during pregnancy.

Choice C: Hydrocephalus is not an example of a neural tube defect, but rather a condition that causes accumulation of cerebrospinal fluid (CSF) in the brain. Hydrocephalus can increase the pressure inside the skull and damage the brain tissue and function. Hydrocephalus can be caused by congenital defects, infections, injuries, tumors, or bleeding in the brain.

Choice D: Cerebral palsy is not an example of a neural tube defect, but rather a group of disorders that affect movement, balance, and posture. Cerebral palsy is caused by damage to the developing brain before, during, or after birth. Cerebral palsy can affect muscle tone, coordination, reflexes, or speech. Cerebral palsy can be caused by infections, injuries, lack of oxygen, or genetic mutations.

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.