A nurse is reinforcing teaching with the guardians of a preschooler who has leukemia. The nurse should identify that which of the following educational topics is the priority to include?

Rationale for Correct Choices:

• Fontanel finding: The sunken fontanel indicates signs of dehydration, which is the primary concern for this infant. Dehydration can lead to severe complications and should be addressed first through appropriate fluid resuscitation (IV fluids) to prevent further deterioration.
• Temperature: The infant has a fever of 38.4°C (101.1°F), which needs to be managed with acetaminophen as prescribed. While dehydration is the priority, the temperature should also be controlled to prevent worsening of the infant's condition and to make the child more comfortable.

Rationale for Incorrect Choices:

• Diaper area: While the excoriated diaper area is concerning, it is not the most urgent issue compared to dehydration, which can quickly worsen. Dehydration and fever management should be prioritized before addressing skin irritation.
• Stool culture results: The positive stool culture for Shigella is important for determining the infection, but addressing the infant's hydration status and fever is more urgent to stabilize the child. The results will guide further treatment but do not need immediate intervention over dehydration.
• Appetite history: While the infant's poor feeding history is significant, addressing dehydration and fever management should take precedence to stabilize the infant before evaluating feeding patterns in more detail.
• Activity tolerance finding: The infant’s fatigue is likely due to dehydration and fever. Stabilizing hydration and controlling the fever will improve the infant’s activity tolerance, making this secondary to the more urgent issues.

A. Give the infant a bottle immediately before the infant's bedtime: Feeding the infant immediately before bedtime can increase the risk of reflux as lying down soon after feeding can worsen gastroesophageal reflux. The infant should be kept upright after feeding.
B. Keep the infant at a 30-degree angle for 1 hour following each feeding: Keeping the infant upright at a 30-degree angle for about 30 to 60 minutes after feeding can help prevent the contents of the stomach from refluxing into the esophagus.
C. Limit the infant's formula feedings to every 6 hr: Infants with gastroesophageal reflux typically need more frequent feedings, not less. Limiting feedings to every 6 hours is not appropriate for a 2-month-old infant. Frequent, smaller feedings may help manage reflux.
D. Change the infant's formula to a soy-based formula: Switching to a soy-based formula is not a standard treatment for gastroesophageal reflux unless there is a specific allergy or intolerance to cow's milk protein. This should only be done if directed by the healthcare provider.