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:

Partial thromboplastin time (PTT) measures the time it takes for blood to clot and is used to monitor conditions like bleeding disorders or the effectiveness of anticoagulant therapy. PTT is not specific to rheumatic fever and does not contribute to confirming this diagnosis.

Choice B rationale:

Blood urea nitrogen (BUN) measures the amount of nitrogen in the blood that comes from urea. It is a marker of kidney function and hydration status. BUN levels are not directly related to rheumatic fever and do not play a role in confirming this diagnosis.

Choice C rationale:

Erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation in the body. Elevated ESR levels indicate the presence of inflammation but do not confirm a specific diagnosis. In the context of suspected rheumatic fever, elevated ESR levels, along with other clinical findings, can support the diagnosis.

Choice D rationale:

Antistreptolysin O (ASO) titer measures the level of antibodies against streptolysin O, a toxin produced by group A Streptococcus bacteria. Elevated ASO titers indicate a recent streptococcal infection, which is a common trigger for rheumatic fever. Positive ASO titers, along with clinical symptoms and other laboratory findings, contribute to confirming the diagnosis of rheumatic fever.

Choice E rationale:

C-reactive protein (CRP) is another marker of inflammation in the body. Elevated CRP levels indicate the presence of inflammation but do not confirm a specific diagnosis. In the context of suspected rheumatic fever, elevated CRP levels, along with other clinical and laboratory findings, can support the diagnosis by indicating the presence of inflammation.

Choice A rationale:

Attaching the feeding bag tubing to the end of the NG tube is a step in the enteral feeding process, but it is not the first action the nurse should take. First, the nurse needs to assess the pH of the gastric secretions to confirm the NG tube placement in the stomach. If the pH is acidic (usually below 5.5), it indicates that the NG tube is in the stomach. If the pH is alkaline, it may suggest the tube is in the respiratory tract, and feeding should not be initiated. Therefore, this choice is not the correct first action.

Choice B rationale:

Flushing the tube with water is important to ensure it is clear and not clogged. However, it is not the first action the nurse should take. Checking the pH of the gastric secretions is crucial to confirm the NG tube placement before any other interventions. If the nurse encounters resistance while flushing the tube, it could indicate a misplaced tube, emphasizing the importance of checking the pH first.

Choice C rationale:

Checking the pH of the gastric secretions is the correct first action before administering enteral feeding. Gastric secretions are acidic (usually below 5.5), confirming the tube's placement in the stomach. This step ensures the safety of the feeding process and prevents complications such as aspiration pneumonia. Once the placement is confirmed, the nurse can proceed with other steps, such as attaching the feeding bag tubing and setting the administration rate on the feeding pump.

Choice D rationale:

Setting the administration rate on the feeding pump is a necessary step in enteral feeding but should only be done after confirming the tube placement by checking the pH of the gastric secretions. If the nurse administers the feeding without confirming the tube placement, there is a risk of aspiration, which can be life-threatening.