LPN Nursing · GI and Renal Disorders in Children · Practice question
A nurse in an emergency department (ED) is assisting in the care of a 4- year-old child. Select from the choices below to specify what condition the child is most likely experiencing ____, 2 actions the nurse should take to address that condition____ and ____, and 2 parameters the nurse should monitor to check the child's progress ____ and ____.
Nurses' Notes
0930:
Child presents to ED with parents. Parents report child has had a fever for 2 days and cries during urination. Parents also report child has had to urinate frequently for the last 24 hr and is febrile and lethargic. Child is cooperative during light palpation and percussion of the costovertebral angle.
0945:
Provider notified of parental reports and fever. New prescriptions received.
1000:
Urine sample obtained via straight catheterization.
Provider Prescriptions
0945:
Obtain urine sample for urinalysis and culture and sensitivity. Obtain comprehensive metabolic panel and CBC.
Vital Signs
0930:
Temperature 38.2° C (100.7° F)
Heart rate 118/min.
Respiratory rate 25/min
Diagnostic Results
1030:
Urinalysis:
pH 8.2 (4.6 to 8.0)
Appearance cloudy, dark amber (clear, amber yellow)
Specific gravity 1.035 (1.005 to 1.030)
Leukocyte esterase present (negative)
Nitrites present (none)
WBC 10 (0 to 4)
Protein 6 mg/dL (0 to 8 mg/dL)
Comprehensive metabolic panel:
Glucose 70 mg/dL (60 to 100 mg/dL)
Sodium 140 mEq/L (136 to 145 mEq/L)
Potassium 4.5 mEq/L (3.4 to 4.7 mEq/L)
Alanine transaminase 22 international units (4 to 36 international units)
Aspartate aminotransferase 40 units/L (15 to 60 units/L)
BUN 16 mg/dL (5 to 18 mg/dL)
Creatinine 0.2 mg/dL (0.1 to 0.4 mg/dL)
CBC:
WBC count 12,000/mm3 (6,200 to 17,000/mm3)
Hgb 10 g/dL (9.5 to 14 g/dL)
Hct 35% (30% to 40%)
Platelet count 250,000/mm3 (150,000 to 400,000/mm3)
Answer & explanation
Correct:
The clinical picture points clearly to a urinary tract infection involving the upper urinary tract — that is, pyelonephritis. The 4-year-old has a 2-day fever, dysuria (crying during urination), urinary frequency, lethargy, and a urinalysis showing an alkaline pH of 8.2, cloudy dark-amber appearance, elevated specific gravity of 1.035, positive leukocyte esterase, positive nitrites, and WBCs of 10 (well above the normal 0–4). Tenderness with costovertebral angle palpation and percussion further supports upper tract involvement. Lower UTI is less likely given the systemic signs; acute glomerulonephritis would show hematuria and significant proteinuria; acute kidney injury would show elevated BUN and creatinine, which are normal here. The two appropriate nursing actions are requesting a prescription for antibiotics (bacterial infection requires antimicrobial treatment) and encouraging increased fluid intake (hydration promotes bacterial flushing and addresses the elevated specific gravity indicating concentration). Obtaining an antistreptolysin titer is relevant to glomerulonephritis, kayexalate addresses hyperkalemia not present here, and hemodialysis is not indicated. For monitoring progress, the child's report of urgency tracks improvement in lower urinary symptoms, and urine odor reflects ongoing infection resolution. Protein in urine, daily weight, and potassium level are parameters more relevant to glomerulonephritis or acute kidney injury, which are not the diagnosis here.
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