A nurse is collecting data from the chart of a child who has streptococcal pharyngitis after being admitted for suspected rheumatic fever. Which of the following findings should the nurse identify as an indication of possible rheumatic fever? (Select All that Apply)

A. Print out a copy of the asthma action plan and thoroughly review it with the child and the school nurse prior to discharge. While an asthma action plan is essential, it is not sufficient if the parent is not actively engaged. The parent also needs education and support to properly manage the child's condition at home.

B. Write out a detailed schedule of the child's medications and a list of their healthcare providers’ addresses and phone numbers in case they should need it. Providing a medication schedule is helpful, but it does not address the root issue—parental disengagement. Simply handing out information does not ensure the parent understands or feels empowered to manage the child's asthma.

C. Empower the child's parent to help manage the asthma by offering comprehensive education on the condition, treatment plan, and managing potential complications at home. Parental education and engagement are crucial for managing uncontrolled asthma. Offering clear explanations, demonstrating medication use (such as inhalers and spacers), and discussing signs of worsening asthma can help the parent feel more confident and involved in their child’s care.

D. Contact child protective services to intervene in the family since the child's parent does not seem adequately prepared to manage the client's illness at home. CPS involvement is not appropriate unless there are signs of medical neglect (e.g., refusal to seek care, persistent non-adherence). In this case, the best first step is education and support to encourage parental involvement.

A. Administering the insulin injection quickly to minimize discomfort. Administering an injection quickly may reduce discomfort, but it does not address the emotional and psychological aspects of atraumatic care. The goal is to minimize fear and distress, not just physical pain.

B. Explaining the procedure in simple terms to the client before administering the insulin. Providing a clear, age-appropriate explanation helps reduce anxiety and fosters trust between the child and the nurse. Understanding what to expect allows the child to feel a sense of control, which is a key principle of atraumatic care.

C. Asking the client to look away during the injection to reduce anxiety. While looking away may help some children, it does not promote understanding or involvement in their care. Instead, explaining the procedure allows the child to develop coping strategies and feel more secure.

D. Using a larger needle to ensure accurate insulin delivery. Insulin is administered using a small-gauge needle to minimize pain. A larger needle is unnecessary and could increase discomfort, contradicting the principles of atraumatic care.