The nurse, caring for an infant whose cleft lip was repaired, should include which interventions in the infant's postoperative plan of care? (Select all that apply.).

The correct answer is choice B. Cardiac valve damage.

Choice A rationale:

Pulmonary hypertension is not a common complication of rheumatic fever. Rheumatic fever primarily affects the heart, joints, skin, and brain, and pulmonary hypertension is not a typical manifestation of this condition.

Choice B rationale:

Cardiac valve damage is a common and serious complication of rheumatic fever. Rheumatic fever is caused by an autoimmune reaction to untreated streptococcal infections, particularly Streptococcus pyogenes. The immune response targets not only the streptococcal bacteria but also the body's own tissues, especially heart valves. This can lead to inflammation of the heart valves, a condition known as rheumatic heart disease. Over time, repeated bouts of rheumatic fever can result in significant damage to the heart valves, leading to valve insufficiency or stenosis. This can ultimately cause heart failure and other cardiovascular complications.

Choice C rationale:

Seizures are not a common complication of rheumatic fever. Rheumatic fever primarily affects the heart and other body systems, but it does not typically lead to seizures.

Choice D rationale:

Cardiac arrhythmias are possible complications of rheumatic fever, but they are not as common or significant as cardiac valve damage. The inflammation and scarring caused by rheumatic fever can disrupt the electrical pathways of the heart, potentially leading to arrhythmias. However, the more prevalent and severe consequence of rheumatic fever is the damage to the heart valves.

The correct answer is choice A: Administer pancreatic enzymes between meals if at all possible.

Choice A rationale:

Administer pancreatic enzymes between meals if at all possible. This is the correct choice. When educating the parents and child with cystic fibrosis about the administration of pancreatic enzymes, it's important to emphasize that these enzymes should be given between meals whenever feasible. Administering them between meals, when the stomach is less acidic and less likely to release the enzymes prematurely, ensures optimal digestion of food and absorption of nutrients. This approach aligns with the physiological need to supplement pancreatic enzyme function due to the inadequate natural enzyme production in cystic fibrosis.

Choice B rationale:

Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. This choice is a valid option for administering pancreatic enzymes. While it's true that the enzymes can be taken either by swallowing the capsules whole or by opening them and sprinkling the contents on a small amount of food at the start of a meal, this method can vary based on individual preferences and abilities. However, the primary focus should be on timing (between meals) to achieve the best enzymatic action.

Choice C rationale:

Do not administer pancreatic enzymes if the child is receiving antibiotics. This statement is not accurate. There is no general contraindication to administering pancreatic enzymes while a child is on antibiotics. However, it's important for the healthcare provider to be aware of all the medications the child is taking to ensure there are no potential drug interactions or effects on absorption. Always consult with the healthcare team before adjusting the administration of any medication.

Choice D rationale:

Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools. This statement is not consistent with typical practice. If a child is experiencing frequent, bulky stools, it may actually indicate that the pancreatic enzyme dosage needs adjustment (increasing the dose rather than decreasing). Bulky stools can suggest poor digestion and absorption, which might require more enzymes to properly break down nutrients. Dosage adjustments should always be made under the guidance of the healthcare provider based on factors such as stool consistency, weight gain, and nutritional status.