A nurse is teaching the parent of an infant who has a new diagnosis of heart failure about nutrition. Which of the following instructions should the nurse include in the teaching?

A. The nurse should weigh the child once per day, preferably in the morning and using the same scale and clothing, to monitor fluid status and response to treatment. Weight is the most accurate indicator of fluid balance in children with nephrotic syndrome.
B. Positioning the child supine at bedtime is not specifically indicated for the acute stage of nephrotic syndrome. This can worsen edema and respiratory distress.
C. Limiting calorie intake to 45 cal/kg/day is too low and can cause malnutrition and growth failure. The nurse should provide a high-calorie, high-protein, low-sodium diet to meet the child's nutritional needs and prevent muscle wasting.
D. Increasing fluid intake to 2 L/day is contraindicated in a child with nephrotic syndrome, as it can exacerbate edema and fluid overload. The nurse should restrict fluid intake according to the provider's orders and based on the child's weight and urine output.

A. Administer IV fluids intake: Hydration is a key intervention during a vaso-occlusive crisis. IV fluids help reduce blood viscosity and promote better circulation, which decreases the risk of further sickling.

B. Give oral hydroxyurea: Hydroxyurea reduces the frequency of sickling episodes by increasing fetal hemoglobin levels. It is part of long-term therapy and may be continued during acute care.

C. Administer meperidine IV for pain: Meperidine is avoided because its metabolite, normeperidine, can cause neurotoxicity and seizures. Opioids such as morphine or hydromorphone are preferred.

D. Instructing the parent to ensure the pneumococcal vaccine is current: Children with sickle cell disease are functionally asplenic and at high risk for infection. Ensuring vaccines are up to date is an important component of overall care.

E. Place the client on strict bedrest: Limiting activity helps reduce oxygen demand and pain caused by movement during a crisis. Bedrest supports recovery and comfort.

F. Apply cold compresses to the affected joints: Cold therapy causes vasoconstriction, which can worsen sickling. Warm compresses are preferred to improve blood flow and relieve pain.

G. Monitor oxygen saturation continuously: Monitoring oxygen saturation allows for early detection of hypoxia, which can trigger or exacerbate sickling episodes. Prompt intervention helps prevent complications.