The parents of a child with acute lymphoblastic leukemia (ALL) are learning to care for their child at home. Which statement made by the parents should the nurse recognize as correct monitoring for early signs of an infection in the child?

Choice A reason: Weight gain of 0.5 kg/day is not a sign of a therapeutic response. It may indicate fluid retention, which is a common complication of nephrotic syndrome. Fluid retention occurs when the kidneys lose protein in the urine, leading to low blood protein levels and reduced oncotic pressure. This causes fluid to leak from the blood vessels into the tissues, resulting in edema and weight gain. The nurse should monitor the child's weight, fluid intake and output, and edema status.

Choice B reason: Decreased urinary output is not a sign of a therapeutic response. It may indicate kidney damage, which is a possible consequence of nephrotic syndrome. Kidney damage occurs when the glomeruli, the filtering units of the kidneys, become inflamed and scarred due to the loss of protein in the urine. This reduces the kidney's ability to filter waste and excess fluid from the blood, resulting in oliguria or anuria. The nurse should measure the child's urine specific gravity, creatinine, and blood urea nitrogen levels.

Choice C reason: Decreased periorbital edema is a sign of a therapeutic response. It indicates that the salt-poor human albumin IV is working to restore the blood protein levels and oncotic pressure. This helps to draw fluid back from the tissues into the blood vessels, reducing the swelling around the eyes and other parts of the body. The nurse should assess the child's skin turgor, capillary refill, and blood pressure.

Choice D reason: Increased periods of rest is not a sign of a therapeutic response. It may indicate fatigue, which is a common symptom of nephrotic syndrome. Fatigue occurs when the body loses protein and energy in the urine, leading to malnutrition and anemia. This causes the child to feel weak, tired, and lethargic. The nurse should provide the child with a high-protein, low-sodium diet, iron supplements, and adequate rest.

Choice A reason: Rhabdomyolysis is not the probable cause of the findings. Rhabdomyolysis is a condition that occurs when damaged muscle tissue breaks down and releases substances into the bloodstream that can harm the kidneys. It is usually caused by trauma, infection, drugs, or extreme exercise. It does not cause radial ossification in the soft tissues, but rather dark urine, muscle weakness, and kidney failure.

Choice B reason: Osteosarcoma is the probable cause of the findings. Osteosarcoma is a type of bone cancer that usually affects the long bones of the arms and legs. It is more common in adolescents and young adults. It can cause pain, swelling, and limping in the affected area, as well as radial ossification in the soft tissues, which is a sign of tumor invasion.

Choice C reason: Growing pains are not the probable cause of the findings. Growing pains are a common cause of leg pain in children and adolescents, but they are not associated with any physical abnormality or disease. They usually occur in both legs, not just one, and they are more likely to affect the calves, shins, or thighs, not the knees. They do not cause swelling, tenderness, or radial ossification in the soft tissues.

Choice D reason: Hemosiderosis is not the probable cause of the findings. Hemosiderosis is a condition that occurs when excess iron deposits in the tissues, usually as a result of repeated blood transfusions or hemolytic anemia. It can affect various organs, such as the liver, lungs, heart, and skin, but not the bones. It does not cause pain, swelling, or radial ossification in the soft tissues, but rather fatigue, shortness of breath, chest pain, and skin discoloration.