A child has thrombocytopenia secondary to chemotherapy treatments. Based on this finding, what should the nurse do?
1. Avoid administering intramuscular injections (IM).
2. Monitor intake and output.
3. Use palpation as a component of assessment.
4. Avoid performing oral hygiene.
1
Rationale 1: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding.
Rationale 2: Intake and output should be measured for all children receiving chemotherapy but not due to the thrombocytopenia.
Rationale 3: Gentle palpation should still be included in physical assessments unless a Wilms' tumor has been diagnosed or is suspected. However, it is not related to the thrombocytopenia.
Rationale 4: Oral hygiene care should be done with a soft toothbrush.
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