A nurse is reinforcing teaching to a newly hired nurse about the management of care for the terminal illness of a child. Which of the following statements by the newly hired nurse indicates an understanding of the teaching?

Eczema (Atopic Dermatitis)

• Discomfort level: Pain 3/10 (more likely due to itching than infection)
• History of mosquito bites and prolonged scratching
• No fever (Temperature 37°C/98.6°F)
• Multiple scabs and lesions from scratching

Cellulitis

• Redness, warmth, and swelling on the left lower leg
• History of skin breakdown (scratching increases infection risk)
• Lesions present (Possible infection due to prolonged scratching)

Rationale:

Eczema (Atopic Dermatitis):

Eczema is a chronic inflammatory skin condition that causes itching, dryness, and irritation, often triggered by allergens or skin trauma. The child’s history of mosquito bites and excessive scratching aligns with eczema, as scratching worsens skin irritation and can lead to scabbed lesions. The absence of fever and a mild pain level (3/10) suggest this is primarily an inflammatory response rather than an infection.

Cellulitis:

Cellulitis is a bacterial skin infection that develops when bacteria enter through a break in the skin, often causing redness, warmth, swelling, and pain. The redness, warmth, and swelling on the left lower leg indicate possible early cellulitis, likely caused by bacteria introduced through scratching. However, the absence of fever and only mild pain suggest it may not be a severe infection yet.

A. "My family should use separate serving utensils for gluten-free foods." Cross-contamination is a serious concern for individuals with celiac disease. Using separate utensils and cookware helps prevent exposure to gluten and reduces the risk of intestinal damage.

B. "I can still enjoy oatmeal for breakfast." Regular oats are often contaminated with gluten due to cross-contact with wheat, barley, or rye during processing. Only certified gluten-free oats are considered safe for individuals with celiac disease, but even then, some people may still react due to the protein avenin found in oats.

C. "I need to avoid foods like bread, pasta, and cereal." Many traditional bread, pasta, and cereals contain wheat, barley, or rye, which must be strictly avoided in a gluten-free diet.

D. "I need to check food labels for hidden sources of gluten, like barley and rye." Gluten can be found in processed foods, sauces, seasonings, and even medications. Reading labels carefully is essential for managing celiac disease.