A nurse is planning care for a 10-year-old child who has rubeola. Which of the following interventions should the nurse plan to include?

Cystic fibrosis is an inherited disorder that affects the exocrine glands, causing thick secretions in the lungs, pancreas, and gastrointestinal tract. Pancreatic enzyme deficiency commonly occurs because thick mucus blocks pancreatic ducts, preventing digestive enzymes from reaching the intestines. This leads to malabsorption of fats, proteins, and fat-soluble vitamins. Home management includes nutritional support, pancreatic enzyme replacement, adequate fluids, and increased salt intake.

Rationale:
A. Restricting sodium is incorrect because children with cystic fibrosis lose excessive sodium and chloride through sweat due to abnormal chloride channel function. They are at increased risk for dehydration and electrolyte imbalance, especially during hot weather or exercise. These children usually require increased salt intake rather than sodium restriction.

B. Pancreatic insufficiency prevents proper digestion and absorption of nutrients, especially fats and proteins. Enzyme replacement must be given with all meals and snacks to improve digestion, promote weight gain, and reduce symptoms such as steatorrhea and malnutrition. This is a key part of long-term cystic fibrosis management.

C. Preparing low-fat meals with limited protein is incorrect because children with cystic fibrosis require a high-calorie, high-protein, and often high-fat diet to support growth and compensate for malabsorption. Restricting fat and protein would worsen nutritional deficiencies and poor weight gain. Nutritional intake should be increased, not limited.

D. Limiting daily fluid intake is incorrect because adequate hydration is essential to help thin respiratory secretions and reduce the risk of mucus plugging. Children with cystic fibrosis are also prone to fluid loss through excessive sweating. Increased fluid intake supports airway clearance and helps maintain proper hydration status.

A vaso-occlusive crisis in sickle cell disease occurs when sickled erythrocytes obstruct blood flow in small vessels, leading to ischemia, severe pain, and tissue hypoxia. Management prioritizes relieving pain, improving oxygenation, maintaining hydration, and preventing further sickling episodes. Pain control is a cornerstone of therapy because uncontrolled pain increases stress responses, which can worsen vaso-occlusion. Nursing care focuses on timely and consistent analgesia along with supportive measures.

Rationale:
A. Ambulating the child in the halls four times each day is inappropriate during an acute vaso-occlusive crisis because physical activity increases oxygen demand and can worsen tissue hypoxia and pain. During crisis, the child should be encouraged to rest to reduce metabolic demands and prevent further sickling of red blood cells.

B. Restricting the child’s fluid intake is contraindicated because dehydration increases blood viscosity and promotes sickling of red blood cells. Adequate hydration is essential to improve circulation and reduce vaso-occlusion. Fluid restriction would worsen the condition and increase pain and complications.

C. Applying cold compresses to painful extremities is inappropriate because cold causes vasoconstriction, which can further reduce blood flow and worsen ischemia in already compromised tissues. Warm compresses are generally preferred to promote vasodilation and improve circulation in affected areas.

D. Administering prescribed pain medication around the clock is correct because consistent analgesia is essential in managing vaso-occlusive crisis. Scheduled pain control prevents pain escalation, reduces physiologic stress, and helps minimize further sickling triggered by stress responses. Effective pain management is a priority intervention in sickle cell crisis care.