A nurse is collecting data from a child who has acute glomerulonephritis. Which of the following findings should the nurse expect?

Rationale for correct choices:

• Dehydration: The child has ongoing vomiting and six watery stools within 24 hours, along with fever and decreased activity, all of which increase fluid loss. Clinical findings such as sunken eyes, elevated heart rate, weight loss of 0.5 kg, elevated hemoglobin and hematocrit, and increased urine specific gravity indicate hemoconcentration. Reduced urine output over 24 hours further reflects inadequate fluid balance. These findings support worsening dehydration.
• Bowel elimination: Frequent watery stools secondary to Escherichia coli infection significantly increase fluid and electrolyte losses. Diarrhea accelerates intestinal transit, reducing absorption of water and sodium. Continuous gastrointestinal losses place toddlers at high risk for rapid volume depletion. Altered bowel elimination is the primary contributing factor to dehydration.

Rationale for incorrect choices

• Seizures: Although electrolyte imbalance can contribute to seizure risk, this child’s sodium level remains within normal limits. There is no evidence of neurological irritability, altered consciousness beyond drowsiness from illness, or severe hyponatremia. The primary concern is fluid volume loss rather than neurologic instability.
• Malnutrition: The child has had decreased appetite for two days, but malnutrition develops over a longer period of inadequate intake. The more urgent issue is acute fluid loss rather than caloric deficiency. Short-term decreased intake combined with diarrhea primarily leads to dehydration.
• Respiratory distress: The child’s oxygen saturation remains stable at 95–98% on room air, and respiratory findings do not indicate compromise. Although respiratory rate is mildly elevated, this can be related to fever or metabolic compensation. There are no signs of increased work of breathing or hypoxia. Respiratory distress is not supported by the data.
• Appetite: While decreased appetite contributes to reduced oral intake, it is not the main mechanism causing rapid fluid depletion. The significant losses are occurring through persistent diarrhea and vomiting. Appetite changes alone would not account for the weight loss and concentrated urine. Bowel elimination is the stronger contributing factor.
• Oxygenation status: Oxygen saturation levels are within acceptable limits and do not indicate impaired gas exchange. There is no cyanosis, retractions, or abnormal lung findings reported. Oxygenation does not contribute to the child’s fluid imbalance.

A. The client was discharged to home without developing complications of immobility: Repositioning a client every 2 hours is a key intervention to prevent pressure injuries, improve circulation, and reduce the risk of complications such as skin breakdown, deep vein thrombosis, and pneumonia. Achieving discharge without immobility-related complications indicates that preventive measures were effective.

B. The client returned to the facility 2 days after being discharged due to a urinary tract infection: Development of a urinary tract infection shortly after discharge may be related to catheter use, incontinence, or urinary stasis, but frequent repositioning does not directly prevent UTIs. This outcome suggests a complication occurred despite nursing interventions.

C. The client developed a rash on their back and lower extremities: Skin rashes may indicate irritation, allergic reactions, or moisture-associated skin damage. Repositioning helps relieve pressure and reduce friction but does not directly prevent all types of rashes. The appearance of a rash reflects a complication related to skin integrity rather than an expected outcome.

D. The client refuses to eat because they are nauseated: Nausea and refusal of food are unrelated to repositioning frequency. While immobility can contribute to gastrointestinal stasis, this outcome does not reflect the effectiveness of repositioning interventions for preventing pressure injuries or related complications.