A nurse is planning care for a child who has varicella.
Which of the following interventions should the nurse plan to include?

Choice A rationale:

Moisten the mucosa with lemon glycerin swabs is not recommended because lemon glycerin swabs can be acidic and may irritate the oral ulcers further. It's important to avoid irritating substances in the oral cavity to promote healing.

Choice B rationale:

Cleaning the gums with saline-soaked gauze is a gentle and non-irritating method to maintain oral hygiene for a toddler with oral ulcers. Saline solution helps keep the oral cavity clean and reduces the risk of infection without causing further irritation.

Choice C rationale:

Administering oral viscous lidocaine is not recommended for routine use in managing oral ulcers in children. Lidocaine can be absorbed systemically and lead to toxicity, especially in young children. It should only be used under the guidance of a healthcare provider and in specific circumstances where the benefits outweigh the risks.

Choice D rationale:

Scheduling routine oral care every 8 hours is important, but the method of oral care is equally crucial. Using gentle methods like saline-soaked gauze to clean the gums ensures proper hygiene without causing discomfort to the child.

Choice A rationale:

Inserting an IV catheter is essential for administering medications and fluids but is not the immediate priority in this scenario. The toddler's airway and breathing are compromised, making airway management the top priority.

Choice B rationale:

Administering an antibiotic is necessary for treating a potential infection, but securing the airway takes precedence when a child is experiencing severe dyspnea and drooling. The toddler's ability to breathe effectively needs to be addressed urgently.

Choice C rationale:

Obtaining a blood culture is important for identifying the source of infection but does not address the toddler's immediate breathing difficulty. Securing the airway is the primary concern in this situation.

Choice D rationale:

Hyperpyrexia (extremely high fever) along with severe dyspnea and drooling suggests a potentially life-threatening condition like epiglottitis, which requires immediate intervention. Nasotracheal intubation ensures a patent airway, allowing the child to breathe adequately. Once the airway is secure, further assessments and treatments can be administered.