A 5-year-old child is admitted to the emergency department with partial-thickness burns covering the face and neck after a kitchen accident.
Which assessment should the nurse prioritize upon the child's arrival?

Choice A rationale

Nephrotic syndrome typically has a gradual onset of symptoms, developing over days to weeks, as protein loss in the urine accumulates. An abrupt onset is less characteristic.

Choice B rationale

Proteinuria, the presence of abnormally high levels of protein in the urine (normal range is less than 150 mg/24 hours), is a defining characteristic of nephrotic syndrome. Damage to the glomeruli in the kidneys leads to increased permeability and leakage of protein into the urine.

Choice C rationale

Hypoalbuminemia in the blood (normal range is 3.5 to 5.5 g/dL) is a key feature of nephrotic syndrome. The excessive loss of protein in the urine leads to a decrease in serum albumin levels.

Choice D rationale

Fever is not typically a primary symptom of nephrotic syndrome. While children with nephrotic syndrome can develop infections, fever is not a direct consequence of the underlying kidney dysfunction.

Choice E rationale

Hyperlipidemia, an elevated level of lipids (fats) in the blood (normal total cholesterol is less than 200 mg/dL), is commonly associated with nephrotic syndrome. The liver increases lipoprotein synthesis in response to the decreased serum albumin levels.

Choice F rationale

While a positive Group A beta-hemolytic streptococcal infection can lead to post-streptococcal glomerulonephritis, which can sometimes present with nephrotic features, it is not a common finding directly associated with the primary diagnosis of nephrotic syndrome itself.

Choice G rationale

Anasarca, which is severe generalized edema characterized by widespread swelling due to fluid retention, is a common finding in nephrotic syndrome. The low serum albumin levels reduce oncotic pressure in the blood vessels, leading to fluid shifting into the interstitial spaces. .

Choice A rationale

Washing bedding and recently worn clothing in hot water (above 54°C or 130°F) helps to kill lice and their nits (eggs) that may be present on these items, preventing re-infestation or spread to others. The heat denatures the proteins essential for the lice's survival.

Choice B rationale

Sealing non-washable items in a plastic bag for 2 weeks suffocates any lice and allows any hatched nymphs to die due to lack of a blood meal. Lice cannot survive for extended periods away from a human host.

Choice C rationale

Both washing bedding and clothing in hot water and sealing non-washable items are crucial steps in eliminating head lice and preventing recurrence or transmission. Therefore, all of the above instructions should be provided to parents.

Choice D rationale

Notifying the school allows for screening of other children and implementation of appropriate measures to prevent further spread of the head lice within the school environment. While important for public health, it is an action separate from the direct treatment and environmental control measures that parents should undertake at home.