A nurse is reinforcing teaching about the dying process to prepare a family for when their terminally ill child dies. Which of the following statements should the nurse include?

A. Atrial fibrillation on the cardiac monitor. Rheumatic fever can cause carditis, but atrial fibrillation is not a typical finding. Instead, valvular damage, tachycardia, or murmurs are more commonly observed.

B. Elevated BUN and creatinine on morning laboratory results. Rheumatic fever primarily affects the heart, joints, skin, and brain, not the kidneys. Elevated BUN and creatinine are more indicative of post-streptococcal glomerulonephritis, a separate complication of streptococcal infection.

C. Involuntary movements of extremities. Sydenham’s chorea, characterized by involuntary, jerky movements, is a classic neurologic manifestation of rheumatic fever. It results from inflammation affecting the basal ganglia of the brain.

D. Alopecia. Rheumatic fever does not cause alopecia. Hair loss is more commonly associated with autoimmune diseases such as lupus, not post-streptococcal complications.

E. Report of chest pain. Chest pain can indicate carditis, a major criterion for rheumatic fever. Inflammation of the heart's endocardium, myocardium, or pericardium may lead to pain, murmurs, or heart failure symptoms.

F. Oliguria. Decreased urine output is more commonly seen in post-streptococcal glomerulonephritis rather than rheumatic fever, as rheumatic fever primarily affects the heart, joints, and nervous system.

A. Provide frequent and routine verbal updates with the parents. Regular updates help reduce parental anxiety and build trust between the healthcare team and the family. Keeping parents informed reassures them that their child is receiving appropriate care.

B. Encourage the parents to participate in the toddler's plan of care when appropriate. Involving parents in simple caregiving tasks (e.g., soothing the child, assisting with feedings) fosters a sense of control and connection, easing their distress.

C. Perform more frequent health care rounds on the toddler. Increased monitoring ensures early detection of respiratory complications and reassures parents that their child's condition is being closely managed.

D. Conduct interprofessional rounds at the child's bedside so the parents can be included. Including parents in bedside rounds allows them to hear updates from multiple specialists, ask questions, and feel more engaged in decision-making regarding their child's care.

E. Reinforce education to the parents on all nursing interventions to alleviate added anxiety about tasks they are unfamiliar with. While educating parents is important, overwhelming them with detailed explanations of every intervention may actually increase anxiety rather than alleviate it. Teaching should be concise and tailored to what the parents need to know at the moment.

F. Provide the parents with the nurse's personal cell phone number to contact if they have questions while they are away from the hospital. Personal phone numbers should not be given out for professional and ethical reasons. Instead, parents should be provided with the hospital unit’s contact information for any concerns.