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?
A.
Reassess axillary temperature if it is higher than 99.7° F (37.6° C).
B.
Verify if the child has a fever by checking a rectal temperature.
C.
Notify for a temporal temperature greater than 100° F (37.8° C).
D.
Check temperature twice a day with an aural thermometer.
The Correct Answer and Explanation is:
The correct answer is A. Reassess axillary temperature if it is higher than 99.7° F (37.6° C).
Explanation:
Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the blood and bone marrow. Children with ALL are at increased risk for infections due to their compromised immune system, either from the leukemia itself or the intensive treatments used to manage it. Early detection of infections is crucial for preventing complications and ensuring timely treatment.
Here’s why option A is correct:
- Axillary Temperature Monitoring: In children with ALL, a temperature that exceeds 99.7°F (37.6°C) is a concern and should prompt further investigation. The axillary temperature, taken under the armpit, is a common and less invasive method for initial temperature assessment. If the axillary temperature is elevated, it should be reassessed using a different method to confirm the reading and assess the clinical significance of the temperature elevation.
- Infection Detection Threshold: The threshold for concern in these patients is typically a fever of 100.4°F (38°C) or higher. Monitoring for fevers and other signs of infection is critical because an elevated temperature can be an early sign of infection, which can rapidly escalate in immunocompromised children.
Why the other options are less appropriate:
- B. Verify if the child has a fever by checking a rectal temperature: While rectal temperatures can be accurate, they are not always preferred for routine monitoring due to discomfort and the risk of rectal bleeding in children with compromised blood counts. Non-invasive methods such as axillary or temporal thermometers are often used instead.
- C. Notify for a temporal temperature greater than 100° F (37.8° C): Although notifying for a temperature greater than 100°F (37.8°C) is important, the threshold for concern is generally 100.4°F (38°C). It is essential to adhere to established guidelines and thresholds for fever management in immunocompromised patients.
- D. Check temperature twice a day with an aural thermometer: Regular temperature checks are important, but twice a day may not be sufficient for detecting early signs of infection in a child with ALL. In these cases, more frequent monitoring may be necessary based on the child’s condition and the physician’s recommendations. Aural (ear) thermometers can be less reliable, particularly in younger children, and may not be the preferred method.
In summary, reassessing an elevated axillary temperature aligns with the guidelines for monitoring fever in immunocompromised children and is a practical approach for early infection detection.