After a tonsillectomy, a 7-year-old girl begins to swallow excessively.
Which intervention is most important for the practical nurse to implement?

Choice A rationale

Sweet potatoes are a gluten-free root vegetable. They are rich in vitamins, minerals, and fiber, and their consumption is safe for individuals with celiac disease or gluten sensitivity. The presence of antigliadin and antiendomysial antibodies indicates a gluten-related disorder, necessitating avoidance of gluten-containing grains, not sweet potatoes.

Choice B rationale

Wheat bread contains gluten, a protein complex found in wheat, barley, and rye. Antigliadin and antiendomysial antibodies are serological markers for celiac disease, an autoimmune disorder triggered by gluten ingestion, leading to small intestinal damage. Therefore, individuals with these antibodies must avoid gluten-containing foods like wheat bread to prevent symptomatic flares and intestinal damage.

Choice C rationale

Orange juice is a gluten-free beverage, primarily composed of water, sugars, and vitamins. It does not contain any gluten-derived proteins. Its consumption is safe for individuals with celiac disease or gluten sensitivity, as it will not elicit an immune response or contribute to intestinal damage in those with antigliadin and antiendomysial antibodies.

Choice D rationale

Swiss cheese is a dairy product and naturally gluten-free. It consists primarily of milk proteins, fats, and calcium, with no gluten-containing grains. Individuals with celiac disease or gluten sensitivity can safely consume Swiss cheese without triggering an immune response, as it does not contain the specific proteins that activate antigliadin and antiendomysial antibodies.

Choice A rationale

Administering ibuprofen, an NSAID, can alleviate pain by inhibiting prostaglandin synthesis, reducing inflammation. However, increased pain and pressure postpartum, especially with a laceration, could indicate complications like a hematoma. Normal pain is expected, but increasing pain warrants further assessment, as it could mask a worsening condition and delay necessary intervention.

Choice B rationale

Increased pain and pressure postpartum after a vaginal delivery, especially with a second-degree perineal laceration, could signal a perineal hematoma. This condition involves blood accumulation in the tissue, causing significant pain and pressure. Notifying the healthcare provider is crucial for immediate assessment, diagnosis, and potential intervention to prevent further complications.

Choice C rationale

Applying an ice pack to the perineum is a common intervention for pain and swelling after a vaginal delivery and laceration repair. Cold therapy induces vasoconstriction, which reduces blood flow to the area, thereby minimizing edema and inflammation. This can provide localized pain relief, but for increasing pain, it might only offer symptomatic relief without addressing the underlying cause.

Choice D rationale

Routine perineal care, including cleansing and hygiene, is essential for preventing infection and promoting healing after a vaginal delivery and laceration. It helps remove lochia and bacteria, maintaining a clean environment. While crucial for recovery, routine care does not directly address or alleviate increasing pain and pressure that could indicate a complication like a hematoma.