A nurse is caring for an infant in an outpatient pediatrician's office.

Exhibits

Click to specify if each finding is indicative of fifth disease, measles, or rubella. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Rationale for Correct Choices:

• Acute glomerulonephritis: The child’s symptoms, such as dark brown urine (which indicates hematuria), recent history of streptococcal pharyngitis, swelling around the eyes, and slight weight loss — are highly suggestive of acute glomerulonephritis, a kidney condition that can follow a streptococcal infection. Elevated BUN and creatinine levels, along with proteinuria, also support this diagnosis.
• Encourage child to increase fluid intake: Hydration is important in managing acute glomerulonephritis, as it helps prevent further renal damage and supports kidney function. However, fluid intake should be monitored and balanced with any renal impairment and swelling.
• Restrict sodium intake: Sodium restriction is crucial in managing acute glomerulonephritis to prevent fluid retention, which can lead to worsening edema and hypertension. Given the child’s swelling and blood pressure readings, it’s important to minimize sodium intake.
• Monitor urine volume and appearance every shift: Monitoring the urine volume and appearance is key in assessing kidney function and detecting worsening of the child’s condition.
• Obtain daily weight: Daily weight monitoring helps detect fluid retention, which is common in acute glomerulonephritis due to edema. Significant weight changes may indicate worsening of kidney function or fluid balance.

Rationale for Incorrect Choices:

• Acute asthma exacerbation: While the child has a history of asthma and is showing some wheezing and a nonproductive cough, these symptoms are not the primary concern here. The child’s dark urine, swelling, and recent history of streptococcal infection are more consistent with acute glomerulonephritis than an asthma exacerbation.
• Bacterial pneumonia: Pneumonia is not indicated by the child’s symptoms. While the child has a cough and wheezing, the absence of fever, difficulty breathing, and other typical pneumonia symptoms makes this diagnosis unlikely.
• Urinary tract infection: The presence of dark urine, hematuria, and proteinuria, along with a recent streptococcal infection, points more toward acute glomerulonephritis rather than a urinary tract infection.
• Administer bronchodilators: While the child has wheezing, this is not the primary issue, as the main concern is the possible kidney involvement due to acute glomerulonephritis. Bronchodilators would be appropriate for asthma exacerbations but not for managing kidney issues.
• Administer antipyretics: There is no indication of fever at this time, and the primary concern is the renal condition. Antipyretics would only be useful if the child developed a fever.
• Administer an angiotensin-converting enzyme inhibitor : ACE inhibitors are used to treat hypertension and chronic kidney disease, but they are not typically prescribed immediately for acute glomerulonephritis without further evaluation. The child’s blood pressure is slightly elevated but not severely enough to warrant this treatment at this time.
• Monitor peak expiratory flow rate daily: This parameter is useful for monitoring asthma, but it is not relevant for assessing acute glomerulonephritis. The child’s respiratory issues are less concerning than the renal symptoms in this case.
• Obtain temperature every 4 hr: There is no indication that the child has a fever, and thus, temperature monitoring is not as critical as monitoring renal function through urine appearance, volume, and daily weight.
• Monitor oxygen saturation levels every 4 hr: While the child has some respiratory symptoms, the primary issue is related to kidney function. Oxygen saturation monitoring is more appropriate for managing respiratory conditions, not for assessing the severity of acute glomerulonephritis.

Rationale for Correct Choices:

• Ceftriaxone: The infant has a documented allergy to amoxicillin, and ceftriaxone is a cephalosporin antibiotic that has potential cross-reactivity with amoxicillin. Therefore, the nurse should clarify the prescription for ceftriaxone to ensure it’s safe for the infant.
• Allergy: The infant’s known allergy to amoxicillin suggests a potential allergy to ceftriaxone as well. Given the risk of anaphylaxis or other allergic reactions, the nurse must clarify the use of ceftriaxone with the healthcare provider.

Rationale for Incorrect Choices:

• Furosemide: Furosemide is a diuretic used to manage fluid retention, especially in conditions like heart failure or VSD. There are no contraindications based on the infant's current findings, such as the heart rate, medical history, or electrolyte values.
• Digoxin: Digoxin is used to help regulate heart function in infants with conditions like VSD. The infant's heart rate of 84/min is within an acceptable range for digoxin administration.
• Acetaminophen: Acetaminophen is used to manage the infant’s fever (39.2°C). Given that the infant’s temperature is elevated, acetaminophen is appropriate for fever reduction and does not require clarification.
• Ibuprofen: Ibuprofen could also be used for fever management, no immediate concerns require clarification for ibuprofen. The nurse should monitor the infant closely for any side effects, but it doesn't necessitate clarification.

• Diet: The infant's diet is not directly related to the concern about ceftriaxone administration. The infant is being fed via gastrostomy tube, and while this is a consideration for medication administration, it does not specifically affect the need to clarify ceftriaxone due to an allergy.
• Temperature: The infant’s temperature of 39.2°C indicates fever, but it is not directly related to the need to clarify the ceftriaxone prescription.
• Heart rate: The infant’s heart rate is within an acceptable range for digoxin administration (84/min), and there’s no concern regarding bradycardia or tachycardia that would require clarifying the prescription for digoxin.
• Medical history: While the infant has Down syndrome and a ventricular septal defect (VSD), which require ongoing care, the focus here is on the allergy to amoxicillin, which is directly relevant to the ceftriaxone prescription.