A nurse is performing a physical assessment for a preschooler. Which of the following actions should the nurse take?

Given the clinical presentation and the context, the most appropriate words to fill in the blanks are "pyelonephritis" and "renal scarring."

So, the sentence should read: "The child is at risk for developing pyelonephritis and renal scarring."

Rationale for each choice:

1. Pyelonephritis: The child presents with a fever and lethargy, which are common signs of a urinary tract infection (UTI). The use of a sterile straight catheter to obtain a urine sample suggests that the healthcare provider is investigating a potential UTI, which in children can progress to pyelonephritis if not promptly treated. Pyelonephritis is an infection of the kidneys and is more severe than a simple bladder infection, requiring careful management to prevent complications.

2. Renal scarring: If pyelonephritis occurs, it can lead to renal scarring, especially in young children. Renal scarring is a long-term complication of recurrent or severe kidney infections, which can affect kidney function and lead to chronic kidney disease. Early diagnosis and treatment of UTIs are crucial to prevent renal scarring.

Rationale against other choices:

Nephrotic syndrome: This condition is characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema. While it is a serious kidney disorder, the child's symptoms (fever, lethargy, decreased appetite) are more indicative of an acute infection rather than nephrotic syndrome.

Acute glomerulonephritis: This condition typically presents with hematuria, proteinuria, hypertension, and edema. It is often a post-infectious condition (e.g., following a streptococcal infection) and less likely to present with just fever and lethargy in isolation. The current presentation suggests an acute infection rather than glomerulonephritis.

Polycystic kidney: This is a genetic disorder characterized by the growth of numerous cysts in the kidneys. It typically presents with signs of chronic kidney disease over time, rather than acute symptoms like fever and lethargy.

A. "You should use a mild detergent for your child's laundry.": Correct. Using a mild detergent helps to minimize irritation and sensitivity, especially for children with skin conditions like eczema, which may benefit from pimecrolimus cream.
B. "You can apply gloves to your child's hands.": Correct. Applying gloves can prevent scratching and further irritation to the skin, especially if the child has lesions or eczema on their hands.
C. "You should cut and file your child's fingernails frequently.": Correct. Keeping the child's fingernails short and filed can prevent accidental scratching and trauma to the skin, reducing the risk of exacerbating skin lesions.
D. "You should apply emollients to your child's skin after bathing.": Correct. Emollients help to moisturize the skin and prevent dryness, which can be beneficial for children with skin conditions like eczema. Applying emollients after bathing helps to lock in moisture.
E. "You should apply a thick layer of pimecrolimus cream to your child's lesions.": Incorrect. Pimecrolimus cream should be applied in a thin layer to the affected skin areas, as directed by the healthcare provider. Using a thick layer may not improve efficacy and could increase the risk of side effects.
F. "Your child's condition is contagious when lesions are present.": Correct. It's important for the guardian to understand that certain skin conditions, such as eczema, may not be contagious themselves but can become infected if lesions are present and scratched, leading to bacterial or viral infections.
G. "Your child will experience occasional flare-ups of this condition.": Correct. Skin conditions like eczema often have a chronic and relapsing course, with periods of exacerbation (flare-ups) and remission. Providing this information helps the guardian understand the chronic nature of the condition and the need for ongoing management and monitoring.