A nurse is providing teaching to an adolescent who has vulvovaginitis. Which of the following statements should the nurse include in the teaching?

Rationale for Correct Choices

• Give iron with vitamin C to increase absorption: Vitamin C enhances the solubility and bioavailability of iron, which is especially important for a child on a vegetarian diet where non-heme iron predominates. Taking iron with citrus juice or ascorbic acid reduces the risk of poor absorption and supports correction of anemia.

• Give iron through a straw to prevent staining of teeth: Liquid iron supplements can cause temporary discoloration of tooth enamel. Using a straw minimizes direct contact of iron with the teeth, helping to preserve dental appearance while ensuring the child still receives the full dose.

• Increase intake of iron-rich foods such as beans, leafy greens, and fortified cereals: A vegetarian child should be encouraged to consume a variety of non-heme iron foods. Combining these with vitamin C sources improves absorption and supports bone marrow production of healthy red blood cells.

Rationale for Incorrect Choices

• Give iron with milk to reduce stomach upset: Milk contains calcium and casein, both of which inhibit iron absorption, reducing the effectiveness of therapy.

• Administer iron on an empty stomach with no fluids: Iron is best absorbed on an empty stomach, but giving it without fluids increases gastric irritation and may cause poor adherence in children.

• Encourage brushing with baking soda after iron administration: Baking soda is abrasive and not recommended for children, as it may damage developing enamel while not significantly reducing iron staining.

• Mix iron with milk to reduce metallic taste: Mixing with milk impairs absorption, worsening anemia, and undermines the therapeutic purpose of supplementation.

• Restrict protein sources to avoid overworking bone marrow: Protein is essential for hemoglobin synthesis and red blood cell production; restricting it would worsen the child’s anemic state.

• Reduce iron-containing foods until medication is completed: Limiting dietary iron would prevent recovery from anemia and contradicts the goal of maximizing iron intake during supplementation.

A. Rapid respirations: While tachypnea is common in bacterial pneumonia due to increased oxygen demand, it does not directly increase aspiration risk. It reflects respiratory distress rather than impaired protective airway reflexes.

B. Neurological deficit: Children with neurological impairment may have reduced gag and swallow reflexes, poor airway clearance, or altered consciousness. These deficits significantly increase the risk for aspiration, making this the most concerning finding.

C. Elevated temperature: Fever is a systemic response to infection but does not contribute to aspiration risk. It signals the body’s inflammatory process rather than an impairment in airway protection.

D. Inspiratory wheezing: Wheezing indicates narrowed airways due to inflammation or obstruction but does not directly predispose to aspiration. It is a respiratory complication, not a swallowing or airway protection issue.