A nurse is caring for a 3-year-old child who was admitted with acute diarrhea and dehydration. Which of the following findings indicates that oral rehydration therapy has been effective?

Choice A reason: Insulin therapy and fluid replacement are the main treatments for DKA, as they lower the blood glucose level and correct the dehydration and electrolyte imbalance caused by osmotic diuresis and acidosis.

Choice B reason: Glucagon injection and potassium supplements are not indicated for DKA, as they may worsen the hyperglycemia and the hyperkalemia. Glucagon stimulates the liver to release more glucose into the bloodstream, while potassium supplements may increase the risk of cardiac arrhythmias.

Choice C reason: Bicarbonate infusion and sodium restriction are not the first-line treatments for DKA, as they may have adverse effects on the acid-base balance and the fluid status. Bicarbonate infusion may cause paradoxical cerebral acidosis and hypokalemia, while sodium restriction may exacerbate the hyponatremia and the hypovolemia.

Choice D reason: Dextrose infusion and diuretics are contraindicated for DKA, as they may increase the blood glucose level and the dehydration. Dextrose infusion may trigger a rebound hyperglycemia, while diuretics may cause further fluid and electrolyte loss.

Choice A reason: Encouraging the child to take a 45 min nap daily is not a helpful instruction, as it may interfere with the child's normal sleep pattern and school schedule. The child may benefit from regular rest periods throughout the day, but not necessarily a long nap. ⁵

Choice B reason: Administering prednisone on an alternate day schedule is a helpful instruction, as it is a common way of prescribing corticosteroids for children with juvenile idiopathic arthritis. Corticosteroids are used to reduce inflammation and control symptoms, but they have many side effects, such as growth suppression, weight gain, and osteoporosis. Giving the medication every other day may reduce some of these side effects and improve compliance. ⁶

Choice C reason: Applying cool compresses for 20 min every hour is not a helpful instruction, as it may cause skin damage and discomfort. Cool compresses may be useful for acute inflammation, but not for chronic arthritis. Warm compresses or baths may be more soothing and beneficial for the child's joints. ⁷

Choice D reason: Allowing the child to stay at home on days when her joints are painful is not a helpful instruction, as it may lead to social isolation, academic difficulties, and reduced physical activity. The child should be encouraged to attend school and participate in activities as much as possible, with appropriate accommodations and modifications if needed. The child may also benefit from physical therapy, occupational therapy, and pain management strategies. ⁸