NORCET 6 Prelims -2024: A child is on chemotherapy. The nurse should teach the mother about the following; except:

NORCET 6 Prelims -2024

Child Health Nursing (Pediatrics)

Hard

Appeared in: NORCET 6 Prelims -2024

Explanation

The instruction to 'Brush two times' is incorrect because it is too general and does not account for the common and serious side effects of chemotherapy.
Chemotherapy often causes mucositis (painful mouth sores) and thrombocytopenia (low platelet count), which makes routine brushing potentially harmful.
Specialized oral care is required, such as using a very soft toothbrush, and brushing may need to be suspended if platelet counts are dangerously low to prevent bleeding.
Therefore, simply telling a parent to 'brush two times' is incomplete and unsafe advice in this context.

Option A: Hand washing is a cornerstone of infection prevention, especially for an immunocompromised child. This is essential advice and should always be taught.
Option B: Avoiding crowded places is a critical measure to reduce the child's exposure to airborne pathogens and potential infections. This is a standard and correct part of neutropenic precautions.
Option D: A sitz bath is a therapeutic measure used to relieve discomfort, pain, and inflammation in the perineal area. It is a valid intervention if the child experiences side effects like diarrhea-induced skin irritation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient education for a pediatric patient undergoing chemotherapy, focusing on infection prevention and management of side effects to guide bedside assessment, documentation, and the next nursing action.
Nurses play a vital role in educating families of children with cancer. Clear, accurate, and specific instructions are crucial for patient safety at home.
A key nursing responsibility is to assess the patient's specific condition (e.g., daily blood counts, oral assessment) and tailor care instructions accordingly, rather than giving generic advice.
What if? If the child's platelet count was normal and they had no signs of mucositis, the advice to brush twice daily with a soft brush would be appropriate. However, the 'except' format asks for the option that is not universally correct, and standard brushing is the most likely to require modification.

How to Approach the Question

First, identify the core concept: care for a child on chemotherapy.
Note the keyword 'except'. This means you are looking for the option that is NOT a correct or appropriate piece of advice.
Evaluate each option based on the known side effects of chemotherapy: immunosuppression (neutropenia), bleeding risk (thrombocytopenia), and mucosal damage (mucositis).
Option A (Hand washing) and B (Avoid crowds) are standard infection control measures for immunosuppression. They are correct.
Option D (Sitz bath) is a plausible comfort measure for perineal irritation, a possible side effect. It is likely correct.
Option C (Brush two times) is a general hygiene instruction. Consider if it's safe for a chemo patient. Given the risk of bleeding and mouth sores, this advice is too simplistic and potentially dangerous without qualifications (e.g., use a soft brush, check platelet counts). This makes it the most likely incorrect statement.

Concept Tested & Keywords

Concept Tested: Patient education for a pediatric patient undergoing chemotherapy, focusing on infection prevention and management of side effects.
Stem keywords: child, chemotherapy, nurse, teach, mother
Lead-in keywords: except
Clinical cues: The patient is a child, which requires age-appropriate teaching and considerations.
Clinical cues: The patient is on chemotherapy, indicating a high risk for infection and other side effects.

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