A nurse in a provider’s office is caring for a 1-year-old toddler.

The child is at risk for developing

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and

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. Drag words from the choices below to fill in each blank in the following sentence.

Choice A rationale: Pyelonephritis is a type of urinary tract infection (UTI) that affects the kidneys. It is a serious condition that can occur when bacteria from a lower urinary tract infection, such as a bladder infection, travel up to the kidneys. The toddler’s history of multiple UTIs and current symptoms, including fever and lethargy, suggest that the infection may have progressed to the kidneys. Pyelonephritis can cause significant kidney damage if not treated promptly.

Choice B rationale: Polycystic kidney disease is a genetic disorder characterized by the growth of numerous cysts in the kidneys. These cysts can lead to kidney enlargement and impaired kidney function over time. However, this condition is not typically associated with recurrent UTIs or vesicoureteral reflux. The toddler’s symptoms and medical history do not indicate the presence of polycystic kidney disease.

Choice C rationale: Renal scarring can occur as a result of recurrent UTIs and vesicoureteral reflux. When urine flows backward from the bladder into the ureters and kidneys, it can cause repeated infections and inflammation, leading to scarring of the kidney tissue. Renal scarring can impair kidney function and increase the risk of chronic kidney disease. The toddler’s history of UTIs and vesicoureteral reflux puts them at risk for developing renal scarring.

Choice D rationale: Nephrotic syndrome is a kidney disorder characterized by excessive protein loss in the urine, leading to low blood protein levels, swelling, and increased cholesterol levels. It is not typically associated with recurrent UTIs or vesicoureteral reflux. The toddler’s symptoms and medical history do not suggest nephrotic syndrome.

Choice E rationale: Acute glomerulonephritis is an inflammation of the glomeruli, the tiny filters in the kidneys. It can be caused by infections, autoimmune diseases, or other conditions. While it can lead to kidney damage, it is not typically associated with recurrent UTIs or vesicoureteral reflux. The toddler’s symptoms and medical history do not indicate acute glomerulonephritis.

Choice A rationale:

A hoarse voice is consistent with the child’s condition. The child has a frequent cough and stridor, which can cause irritation and inflammation of the vocal cords, leading to a hoarse voice.

Choice B rationale:

Nasal flaring is a sign of respiratory distress. It indicates that the child is working harder to breathe, which is consistent with the observed symptoms of stridor, cough, and mild intercostal retractions.

Choice C rationale:

Increased appetite is not consistent with the child’s condition. The child is refusing to eat or drink and appears fatigued, which is typical in cases of respiratory distress and illness.

Choice D rationale:

Sitting upright and leaning forward is a common position adopted by children in respiratory distress. This position helps to open the airway and makes breathing easier.

Choice E rationale:

Decreased respiratory rate is not consistent with the child’s condition. The child’s respiratory rate has increased from 20/min to 24/min, indicating increased effort to breathe due to respiratory distress.