An infant will be discharged home following a cleft lip/palate repair. What teaching points should the nurse include for the parents to maintain skin integrity during the healing process? (Select all that apply)

Choice A reason: Liver and kidney function do not significantly differ in lead metabolism between young and older children. Lead is stored in bones and tissues, and all children are susceptible to toxicity. The older child’s lower exposure, not stronger organs, explains the difference, making this an incorrect explanation.

Choice B reason: There is no evidence that some children metabolize lead better after exposure. Lead absorption and toxicity depend on exposure, not individual metabolic differences. Younger children’s behaviors increase exposure risk, making this a vague and scientifically inaccurate explanation for the observed difference in lead levels.

Choice C reason: Assuming the older child had elevated lead levels earlier without evidence is speculative. Lead levels persist without intervention, and the older child’s normal levels likely reflect lower exposure due to behavior, not recovery, making this an incorrect and unsupported explanation for the mother.

Choice D reason: Younger children (7 months, 4 years) engage in floor play and hand-to-mouth behaviors, increasing ingestion of lead from dust or objects in contaminated environments. Older children (9 years) are less likely to exhibit these behaviors, reducing exposure, making this the correct and most accurate explanation.

Choice A reason: A blood lead level of 48 µg/dL in a 24-month-old is significantly elevated, requiring immediate chelation therapy to remove lead from the body. Even asymptomatic children are at risk for neurological damage, developmental delays, and organ toxicity, necessitating urgent hospitalization for chelating agents like EDTA or succimer to prevent long-term harm.

Choice B reason: Monitoring lead levels and providing nutritional counseling (e.g., calcium, iron) are appropriate for lower lead levels (10-20 µg/dL). A level of 48 µg/dL indicates acute toxicity, requiring immediate chelation therapy rather than monitoring alone, as untreated high levels can cause irreversible neurological and developmental damage in young children.

Choice C reason: No treatment is incorrect for a blood lead level of 48 µg/dL, even if asymptomatic. Lead is neurotoxic, causing subtle cognitive and developmental impairments without immediate symptoms. Levels above 45 µg/dL require urgent chelation therapy to prevent long-term brain damage, making this statement inappropriate for management.

Choice D reason: Environmental changes, such as removing lead sources (e.g., paint, water), are critical for preventing further exposure but are insufficient alone for a blood lead level of 48 µg/dL. This level indicates significant toxicity requiring immediate medical intervention like chelation therapy to reduce lead burden and prevent neurological damage.