The nurse is caring for a child admitted with head trauma after falling off of a swing. Which early assessment finding would alert the nurse to possible increased ICP in the child?

Rationale for correct choices:

• Dexamethasone: This corticosteroid is often used as an adjunct antiemetic in chemotherapy-induced nausea and vomiting, particularly when standard agents like ondansetron are insufficient. It reduces inflammation and influences the chemoreceptor trigger zone to help control symptoms.\

• Begin parenteral nutrition: This supplies nutrients intravenously, bypassing the gastrointestinal tract, which is beneficial when severe vomiting prevents oral or enteral feeding. It ensures adequate caloric and nutrient intake during prolonged intolerance to GI feeding.

Rationale for incorrect choices:

• Phenergan: This antihistamine is effective for motion sickness or mild nausea but is less preferred for severe chemotherapy-induced symptoms in pediatric patients due to sedative and anticholinergic effects. It is not a first-line adjunct to ondansetron in oncology cases.

• Protonix: This proton pump inhibitor reduces gastric acid secretion and is used for GERD or ulcer prevention, not for managing chemotherapy-related nausea and vomiting. Its mechanism does not address the cause of the patient’s symptoms.

• Flagyl: This antimicrobial targets anaerobic bacterial infections and certain protozoa. It has no role in treating chemotherapy-induced nausea or vomiting and would not alleviate the patient’s acute symptoms.

• Initiate enteral feeding: This provides nutrition via a feeding tube if oral intake is insufficient, but persistent severe vomiting makes tolerance poor. Enteral feeding is avoided until nausea is controlled.

• Consult a dietitian: Involving a dietitian can help develop nutritional strategies, but it is an indirect intervention. If weight loss continues with ongoing vomiting, more immediate nutritional support is required.

• Increase caloric intake: Advising increased calories is ineffective if the patient cannot tolerate food due to persistent nausea and vomiting, making parenteral or other specialized interventions more appropriate

Rationale:

A. Antacids and milk increase absorption: Calcium in milk and the alkaline nature of antacids actually interfere with iron absorption. Taking iron with these can significantly reduce its effectiveness in correcting anemia.

B. May turn stool a bright red or dark red color: Iron supplements do not cause bright red or dark red stools; those findings could indicate gastrointestinal bleeding. Iron may darken stools to a black or dark green hue, which is harmless and expected.

C. Short Term: Only 1 to 2 months to replenish iron stores: Iron deficiency anemia often requires several months (typically 3–6 months or longer) of supplementation to replenish both hemoglobin levels and iron stores. Stopping too soon increases the risk of relapse.

D. Orange Juice (Vitamin C) increases absorption: Vitamin C enhances the solubility and absorption of non-heme iron from supplements, making orange juice a beneficial choice to take with the iron pill. This can help improve treatment outcomes.

E. Antacids and milk decrease absorption: Both interfere with iron uptake in the gut calcium in dairy products binds with iron, and antacids raise stomach pH, reducing iron solubility. The patient should avoid taking these within a couple of hours of their iron dose.

F. Can cause constipation- Add a stool softener: Iron supplements frequently cause gastrointestinal side effects, especially constipation. Encouraging stool softeners, hydration, and dietary fiber can improve adherence and comfort.

G. Best absorbed on full stomach - Take with meals: Although taking with food may reduce gastrointestinal upset, it also decreases absorption by up to 50%, so this is not the preferred method unless stomach irritation is severe.

H. Best absorbed on empty stomach- Take 1 hr before meals: Iron is most effectively absorbed on an empty stomach when stomach acid levels are higher. Taking it about an hour before meals maximizes absorption, provided the patient tolerates it without excessive stomach discomfort.