The nurse is caring for a school age child whose parent reports concern for the child's weight gain and obesity status. Which historical finding should the nurse recognize as potentially contributing to early obesity?

A. Muscle aches and pains. Muscle pain is not a primary concern related to melanoma recurrence. While melanoma can metastasize to other organs, localized muscle pain is not the most important characteristic to monitor post-resection.
B. Appearance of any moles. Malignant melanoma is strongly associated with abnormal moles. The client should monitor existing moles and new skin lesions using the ABCDE rule:Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, Evolving changes (size, shape, or symptoms like itching or bleeding), Early detection of new or changing moles is critical for identifying recurrence or new melanoma development.
C. Pigmentation of the skin. Changes in overall skin pigmentation (such as tanning or lightening) are not a primary concern. Localized pigmentation changes around moles may indicate malignancy, but generalized pigmentation shifts are not the focus for melanoma monitoring.
D. Elasticity of the skin. Skin elasticity is affected by aging and sun exposure but is not a key factor in melanoma surveillance. Monitoring moles and skin lesions is far more important for early detection of recurrence.

A. Monitor the client's white blood cell count. An elevated white blood cell (WBC) count indicates infection and inflammation. Since MRSA is a bacterial infection, monitoring WBC levels helps assess the severity of the infection and response to treatment.

B. Send wound drainage for culture and sensitivity. A wound culture and sensitivity test confirm the presence of MRSA and determine the most effective antibiotic therapy. This is essential to ensure appropriate treatment and prevent antibiotic resistance.

C. Institute contact precautions for staff and visitors. MRSA is transmitted via direct contact, especially through wound drainage. Contact precautions include wearing gloves and gowns when handling the patient or contaminated materials to prevent the spread of infection.

D. Explain the purpose of a low bacteria diet. A low-bacteria diet (neutropenic diet) is used for immunocompromised patients, such as those undergoing chemotherapy, but it is not relevant for MRSA. The focus should be on infection control and wound care rather than dietary restrictions.

E. Use standard precautions and wear a mask. While standard precautions should always be followed, a mask is not necessary unless performing aerosol-generating procedures or if MRSA is present in the respiratory tract. In this case, contact precautions (gown and gloves) are the primary infection control measures.