A nurse is planning care for a preschooler who has leukemia. After reviewing the child's information, which of the following potential issues should the nurse identify that the child is at risk for developing? (Select all that apply.)

Choice A reason: Acidic odors are not a sign of a perforated appendix, but rather a possible indication of gastroesophageal reflux disease (GERD), which is a condition that causes stomach acid to flow back into the esophagus¹.

Choice B reason: Sudden decrease in abdominal pain is a sign of a perforated appendix, which is a serious complication of acute appendicitis. When the appendix ruptures, the pressure inside the abdomen is released, causing a temporary relief of pain. However, this is followed by severe inflammation and infection of the peritoneum, which is the membrane that lines the abdominal cavity². This can lead to sepsis, shock, and death if not treated promptly.

Choice C reason: Narrow fever is not a term that is commonly used in medicine. Fever is a general sign of infection or inflammation, and it can be present in both acute appendicitis and perforated appendix. However, fever alone is not a reliable indicator of the severity or location of the problem³.

Choice D reason: Rigid abdomen is a sign of peritonitis, which is a possible consequence of a perforated appendix. Peritonitis causes the abdominal muscles to contract and become stiff, making the abdomen hard and tender to touch². However, rigidity can also occur in other conditions that cause intra-abdominal inflammation, such as pancreatitis or cholecystitis⁴.

Choice E reason: Nausea is a common symptom of acute appendicitis, but it is not specific to a perforated appendix. Nausea can be caused by irritation of the stomach or the nerves that control vomiting. It can also occur in other gastrointestinal disorders, such as gastritis or gastroenteritis⁵.

Choice A reason: This test will confirm if your child had a recent streptococcal infection, as it measures the level of antibodies that the body produces against the streptolysin O enzyme, which is produced by some strains of streptococcal bacteria. A high ASO titer indicates a recent or current streptococcal infection, which can trigger rheumatic fever in some children.

Choice B reason: This test will not indicate if your child has rheumatic fever, as it does not measure the inflammation or damage to the heart, joints, or other organs that rheumatic fever can cause. Rheumatic fever is diagnosed based on the presence of two major or one major and two minor criteria, as well as evidence of a preceding streptococcal infection.

Choice C reason: This test will not indicate if your child has a therapeutic blood level of an aminoglycoside, as it does not measure the concentration of this type of antibiotic in the blood. Aminoglycosides are used to treat serious infections caused by gram-negative bacteria, and their blood levels need to be monitored to prevent toxicity and ensure efficacy.

Choice D reason: This test will not confirm if your child has immunity to streptococcal bacteria, as it does not measure the level of protective antibodies that can prevent future infections. ASO antibodies are not protective, but rather indicate a past or present exposure to streptococcal bacteria.