A nurse is caring for a school-age child who has acute renal failure. Which of the following findings should the nurse expect?

Rationale for correct choices

• Increased intracranial pressure: Bacterial meningitis can cause inflammation of the meninges and cerebral edema, leading to increased intracranial pressure (ICP). The child’s symptoms—headache, nausea, nuchal rigidity, irritability, and lethargy—are indicative of meningeal irritation and potential early ICP. Monitoring for ICP is critical to prevent complications such as brain herniation and neurologic deterioration.

• Seizures: Inflammation and increased pressure in the central nervous system can precipitate seizures in children with bacterial meningitis. Elevated WBC count indicates active infection, which can disrupt normal neuronal function. Early identification and management of seizures are essential to minimize neurological damage and ensure patient safety.

Rationale for incorrect choices

• Hydrocephalus: Hydrocephalus may develop as a late complication of bacterial meningitis due to impaired cerebrospinal fluid absorption, but it is not the most immediate risk. The current presentation focuses on acute neurological compromise rather than chronic fluid accumulation.

• Disseminated intravascular coagulation: While DIC can occur with severe sepsis, there is no current evidence of coagulopathy, abnormal bleeding, or thrombocytopenia in this child. The immediate concern is neurological rather than hematologic complications.

• Hypothermia: The child is febrile (38.7° C / 101.7° F), making hypothermia unlikely. Fever is a hallmark of bacterial infection, and hypothermia would be inconsistent with the current presentation.

A. "My child should not participate in contact sports.": While certain precautions may be necessary to prevent injury during a sickle cell crisis, toddlers are generally encouraged to engage in age-appropriate physical activity. Avoiding all contact sports is not a standard recommendation for this age group.

B. "My child will need monthly blood transfusions.": Routine monthly blood transfusions are not required for all children with sickle cell anemia. Transfusions are reserved for specific indications, such as severe anemia or stroke prevention.

C. "My child will need to take daily medicine to prevent infections.": Children with sickle cell anemia are at increased risk for infections due to functional asplenia and are prescribed daily prophylactic antibiotics, such as penicillin, to reduce infection risk, which is a key aspect of disease management.

D. "My child should not receive immunizations.": Children with sickle cell anemia require all recommended immunizations, including additional vaccines like pneumococcal and meningococcal vaccines, to prevent serious infections. Avoiding immunizations would increase infection risk.