A nurse is planning care for a toddler who has developed oral ulcers in response to chemotherapy. Which of the following actions should the nurse include in the plan of care?

Chemotherapy-induced oral ulcers (mucositis) occur due to damage to rapidly dividing mucosal cells in the oral cavity, leading to pain, inflammation, and increased risk of infection. In toddlers, this condition can significantly affect feeding, hydration, and comfort. Nursing care focuses on maintaining oral hygiene, reducing pain, and preventing secondary infection while avoiding irritants that may worsen mucosal injury. Gentle, non-irritating oral care is essential for promoting healing. Rationale: A. Cleansing the gums with saline soaked gauze is appropriate because normal saline is gentle, non-irritating, and helps maintain oral hygiene without damaging fragile mucosal tissue. It removes debris and reduces bacterial load, which lowers the risk of infection while promoting comfort and healing. This is a safe and effective intervention for chemotherapy-related mucositis. B. Administering oral viscous lidocaine is not routinely recommended in young children because it can impair swallowing and gag reflex, increasing the risk of aspiration. Additionally, excessive use may lead to systemic toxicity due to absorption through inflamed mucosa. Safer pain management strategies are typically preferred in toddlers. C. Scheduling routine oral care every 8 hours is insufficient because oral mucositis requires more frequent gentle care to prevent plaque buildup and infection. Oral hygiene is usually recommended multiple times per day, especially after meals and as tolerated. Infrequent care may allow worsening of discomfort and bacterial growth. D. Moisten the mucosa with lemon glycerin swabs is contraindicated because acidic and glycerin-based solutions can further irritate already inflamed oral tissues. Lemon products may worsen pain and delay healing in mucositis. These swabs are no longer recommended for oral care in chemotherapy patients due to their drying and irritating effects.