A child is admitted with a suspected diagnosis of Wilms tumor. The nurse should place a sign with which of the following warnings over the child's bed?

Here's how we can find the desired flow rate:

1. Total volume to infuse (in minutes):
   • We need to convert the infusion time from hours to minutes.
   • Time (minutes) = Time (hours) x 60 minutes/hour
   • Time (minutes) = 2 hours x 60 minutes/hour
   • Time (minutes) = 120 minutes
2. Total volume to infuse (in mL):
   • Given volume = 250 mL
3. Drop factor (gtts/mL):
   • Given drop factor = 15 gtts/mL
4. Flow rate (gtts/minute):
   • Flow rate = Total volume (mL) / Time (minutes) x Drop factor (gtts/mL)
   • Flow rate = 250 mL / 120 minutes x 15 gtts/mL

To simplify the calculation, we can divide all values by 5 (as long as we perform the division on both sides of the equation, the answer won't change):

• Flow rate = (250 mL / 5) / (120 minutes / 5) x (15 gtts/mL / 5)
• Flow rate = 50 mL / 24 minutes x 3 gtts/mL
• Flow rate = 2.0833... gtts/minute (round to nearest whole number)

1. Rounded flow rate (gtts/minute):
   • Flow rate = 2 gtts/minute

Therefore, the nurse should adjust the flow rate to deliver approximately 2 gtts/minute.

A. Polyuria: Polyuria, or excessive urination, is not typically associated with cervical spinal cord injury. In fact, urinary retention or neurogenic bladder is more commonly observed due to disruption of bladder control. Clients with cervical spinal cord injury often experience bladder dysfunction, which can lead to urinary retention rather than polyuria.
B. Hypotension: Hypotension is a common complication of cervical spinal cord injury, particularly in cases involving injury above the level of T6. Damage to the sympathetic nervous system can result in neurogenic shock, characterized by vasodilation and bradycardia, leading to hypotension. Monitoring for signs of hypotension, such as decreased blood pressure and altered mental status, is essential for early intervention and prevention of complications.
C. Weakened gag reflex: Cervical spinal cord injury can impair the gag reflex due to disruption of the glossopharyngeal nerve (CN IX) and vagus nerve (CN X) function. This impairment can lead to difficulty swallowing, aspiration risk, and increased susceptibility to respiratory complications such as aspiration pneumonia. Therefore, monitoring the gag reflex and assessing for signs of dysphagia are crucial in clients with cervical spinal cord injury to prevent respiratory compromise and aspiration-related complications.
D. Hyperthermia: Hyperthermia is less commonly associated with cervical spinal cord injury. However, in some cases, autonomic dysreflexia—a potentially life-threatening condition—can occur, leading to increased body temperature among other symptoms. This is more common in injuries above the T6 level.
E. Absence of bowel sounds: Neurogenic bowel dysfunction, including the absence of bowel sounds, is a common complication of cervical spinal cord injury. Disruption of autonomic nervous system function can lead to decreased peristalsis and absent bowel sounds.