A nurse is caring for a 3-year-old toddler who has heart failure. Which of the following actions should the nurse take to promote rest for the toddler?

Rationale for correct choices

• Crohn’s exacerbation: The adolescent presents with acute worsening of diarrhea, abdominal cramping, and decreased intake, consistent with a flare of Crohn’s disease. Laboratory findings show elevated WBC (15,000/mm³) and C-reactive protein (2.1 mg/dL), indicating an active inflammatory response. Positive stool occult blood further supports gastrointestinal mucosal involvement.

• Inflammation: Crohn’s disease flares are driven by intestinal inflammation, which damages the mucosa and leads to diarrhea, abdominal pain, and systemic responses like tachycardia and low-grade fever. Elevated inflammatory markers (CRP, WBC) provide objective evidence of active inflammation. Targeting the inflammatory process is central to management through medications and supportive care.

Rationale for incorrect choices

• Gastroenteritis: Although diarrhea and abdominal cramping can occur with viral gastroenteritis, the adolescent’s chronic history of Crohn’s disease, positive stool occult blood, and elevated inflammatory markers indicate a flare rather than an acute viral infection. Gastroenteritis usually presents with sudden onset, fever, vomiting, and is self-limiting in otherwise healthy children.

• Constipation: The adolescent is experiencing diarrhea, not constipation. Constipation presents with hard, infrequent stools, abdominal bloating, and discomfort, which are not consistent with the current presentation. Focusing on constipation would not address the inflammatory flare.

• Viral infection: No evidence of viral infection, such as high fever, vomiting, or systemic malaise, is present. Laboratory findings do not indicate viral etiology, making this an unlikely cause of symptoms. The diarrhea and abdominal pain are more consistent with Crohn’s disease exacerbation.

• Dietary triggers: Although diet can influence Crohn’s symptoms, there is no recent change in dietary intake reported. The primary driver of the flare appears to be inflammatory activity rather than a new dietary trigger. Management focuses on inflammation control rather than diet alone.

A. Insert a tongue blade between the teeth: Inserting a tongue blade during a seizure can cause dental injury, choking, or aspiration. It is no longer recommended, as it does not prevent tongue swallowing and poses a significant safety risk. Parents should be instructed to avoid placing objects in the child’s mouth.

B. Clear the area of hard objects: Removing nearby hard or sharp objects is essential to prevent injury during a seizure. Creating a safe environment minimizes the risk of trauma from falls, bumps, or involuntary movements, which is the highest priority during a seizure.

C. Place the child in a prone position: Placing a child in a prone (face-down) position can compromise airway patency and increase the risk of aspiration. The recommended position is on the side (recovery position) to maintain an open airway and allow secretions to drain safely.

D. Minimize movement of the limbs: Restricting or holding a child’s limbs during a seizure can cause musculoskeletal injuries or fractures. Allowing the child to move freely while ensuring safety is safer than attempting to restrain movements.