A nurse on an oncology unit is assessing a child who has a brain tumor. Which of the following findings should the nurse expect?

Choice A reason: Blood pressure is not the most reliable indicator of fluid loss, as it can be affected by many other factors, such as cardiac output, vascular resistance, and blood volume. Blood pressure may not change significantly until the fluid loss is severe and the compensatory mechanisms are overwhelmed.

Choice B reason: Respiratory rate is not the most reliable indicator of fluid loss, as it can be affected by many other factors, such as oxygen demand, carbon dioxide levels, acid-base balance, and respiratory infections. Respiratory rate may increase as a result of fluid loss, but it is not a specific or sensitive sign.

Choice C reason: Skin integrity is not the most reliable indicator of fluid loss, as it can be affected by many other factors, such as age, nutrition, hydration, and skin diseases. Skin integrity may deteriorate as a result of fluid loss, but it is not a quantitative or objective measure.

Choice D reason: Body weight is the most reliable indicator of fluid loss, as it reflects the changes in the total body water and electrolytes. Body weight can be measured easily and accurately, and it can be compared with the previous or baseline values. A loss of more than 5% of the body weight indicates moderate dehydration, and a loss of more than 10% indicates severe dehydration.

Choice A reason: Keeping the baby in an upright position after feedings is an effective strategy to prevent or reduce gastroesophageal reflux, as it allows gravity to help the stomach contents stay down. The parent should hold the baby upright for at least 20 to 30 minutes after each feeding, and avoid placing the baby in a car seat or swing, which can increase the abdominal pressure.

Choice B reason: Feeding the baby formula rather than breast milk is not necessary for gastroesophageal reflux, as breast milk is easier to digest and less likely to cause reflux than formula. The parent should continue to breastfeed the baby, unless there is a medical reason to switch to formula. The parent should also avoid overfeeding the baby, and burp the baby frequently during and after feedings.

Choice C reason: Positioning the baby lying on his stomach is not recommended for gastroesophageal reflux, as it can increase the risk of aspiration, suffocation, and sudden infant death syndrome (SIDS). The parent should place the baby on his back to sleep, and elevate the head of the crib or bassinet by 30 degrees to reduce the reflux.

Choice D reason: Thickening the baby's formula with honey is not advised for gastroesophageal reflux, as honey can cause botulism, a serious and potentially fatal illness, in infants under one year of age. The parent should not add any thickening agents to the formula, unless prescribed by the provider. Some studies suggest that thickening the formula with rice cereal may reduce the reflux, but the evidence is inconclusive and the practice may have adverse effects, such as increased caloric intake, constipation, or food allergies.