A nurse is reviewing the complete blood count results for a child who is receiving treatment for acute lymphoblastic leukemia. Which of the following findings should indicate to the nurse that the treatment is having a therapeutic effect?

The correct answer is D. Have the child flex his head when securing the ties.

Explanation:

When securing tracheostomy ties, flexing the head helps ensure the ties are snug but not too tight. This minimizes the risk of accidental dislodgement while allowing proper airway support.

Why the other options are incorrect:

• A. Use clean technique to change the tracheostomy tube – Incorrect. Sterile technique is required when changing the tracheostomy tube to prevent infection, especially in pediatric clients.

• B. Clean around the stoma with full-strength hydrogen peroxide – Incorrect. Diluted hydrogen peroxide or saline is recommended to avoid tissue irritation. Full-strength hydrogen peroxide can damage delicate skin around the stoma.

• C. Place the child in Trendelenburg position when performing care – Incorrect. The Trendelenburg position (head down, feet up) is not used for tracheostomy care and can increase the risk of aspiration or breathing difficulties.

Answer is choice C.

Choice A rationale: The rationale for Choice A involves understanding the principles of mobilization and rehabilitation following the application of an arm cast. While it is essential to limit strenuous activities involving the affected arm to prevent further injury or displacement of the fracture, completely immobilizing the fingers of the broken arm can lead to joint stiffness, muscle atrophy, and impaired circulation. Encouraging the client to move the fingers and elbow within the limits of comfort and physician instructions helps maintain joint mobility, prevent contractures, and promote blood flow, supporting the overall healing process.

Choice B rationale: Statement B pertains to the expected course of swelling following the application of an arm cast. While mild swelling is a common immediate response to trauma or immobilization, persistent or worsening swelling may indicate underlying complications such as compartment syndrome, vascular compromise, or infection. Monitoring and managing swelling are crucial aspects of post-cast care to prevent complications and ensure optimal healing outcomes. Therefore, expecting fingers to remain swollen for several days without further assessment or intervention may overlook potential issues requiring medical attention.

Choice C rationale: Elevating the broken arm on pillows at night is a fundamental aspect of post-cast care aimed at reducing swelling and promoting comfort and healing. Elevating the affected limb above the level of the heart helps enhance venous return and lymphatic drainage, thereby minimizing edema and alleviating discomfort associated with swelling. Additionally, maintaining proper elevation during periods of rest supports tissue perfusion and facilitates the resolution of inflammation, contributing to the overall recovery process. By expressing intent to elevate the arm on pillows at night, the client demonstrates comprehension of an essential self-care measure conducive to optimal healing and rehabilitation.

Choice D rationale: The statement regarding sprinkling baby powder into the cast if the arm itches reflects a misunderstanding of appropriate cast care practices. Introducing foreign substances, such as powders or objects, into the cast can create a conducive environment for bacterial growth, increase the risk of skin irritation or infection, and compromise the structural integrity of the cast. Instead of using powders, clients are advised to employ non-invasive techniques to alleviate itching, such as gently tapping or blowing cool air into the cast or seeking medical guidance for alternative solutions. Encouraging adherence to recommended cast care protocols helps minimize complications and promote favorable outcomes during the healing process.