A 24 month old comes into the clinic to get his first flu vaccination. The nurse notices what food allergy in the patient's chart that would make this vaccine contraindicated?

A. Wheezing: Wheezing is a common symptom associated with asthma, which can be exacerbated by gastroesophageal reflux (GER) in infants. GER occurs when stomach contents flow back into the esophagus, leading to irritation and inflammation of the airways. This inflammation can cause wheezing sounds during breathing, especially if the refluxed material reaches the lower respiratory tract.

B. Rigid abdomen: While gastroesophageal reflux (GER) primarily affects the upper gastrointestinal tract, it typically does not cause a rigid abdomen. A rigid abdomen may indicate other underlying gastrointestinal issues such as bowel obstruction, intussusception, or peritonitis. These conditions are not typically associated with GER in infants.

C. Pallor: Pallor, or paleness of the skin, is not a common symptom of gastroesophageal reflux (GER) in infants. GER primarily affects the upper gastrointestinal tract and is characterized by symptoms such as spitting up, regurgitation, and irritability. Pallor may be indicative of other health issues such as anemia or circulatory problems but is not directly related to GER.

D. Weight loss: Weight loss can occur in infants with gastroesophageal reflux (GER) if frequent vomiting leads to inadequate intake of nutrients. However, it is not a direct symptom of GER itself. Infants with GER may experience feeding difficulties, irritability, and discomfort associated with feeding, which can contribute to poor weight gain over time if not managed effectively.

E. Vomiting: Vomiting is a common symptom of gastroesophageal reflux (GER) in infants. It occurs when stomach contents flow back up into the esophagus and sometimes out of the mouth. Infants with GER may spit up or vomit frequently after feeding or during burping, which can lead to discomfort and irritability. Vomiting may also contribute to poor weight gain and nutritional deficiencies if not managed effectively.

A. "Take a hot shower daily to relieve itching."

This instruction is not recommended because hot water can exacerbate itching and worsen the condition. Hot showers can strip the skin of its natural oils, leading to further dryness and irritation, which may aggravate the itching associated with scabies.

B. "Wear loose fitting clothing while you are experiencing itching."

This instruction is appropriate because loose-fitting clothing can help minimize friction and irritation on the skin affected by scabies. Tight clothing can exacerbate itching and discomfort, so wearing loose clothing can provide relief and allow the skin to breathe.

C. "Add fabric softener to linens when they are washed."

This instruction is not recommended because fabric softeners may contain chemicals or fragrances that can irritate the skin, especially for someone with pruritus or scabies. It's best to use gentle, fragrance-free laundry detergent to wash linens and clothing to minimize potential irritation.

D. "Use a soft bristle brush to gently rub the affected areas."

This instruction is not recommended because using a brush, even if it has soft bristles, can further irritate the skin and potentially spread the scabies mites to other areas of the body. It's best to avoid any abrasive or vigorous rubbing of the affected areas and instead focus on gentle cleansing and moisturizing techniques.