A nurse is reviewing the laboratory results of a school-age child who has glomerulonephritis. Which of the following laboratory findings should the nurse expect?

Rationale for correct choices

• Increased intracranial pressure: Meningitis causes inflammation of the meninges, which restricts cerebrospinal fluid flow and leads to cerebral edema. Symptoms such as headache, lethargy, irregular respirations, and nuchal rigidity point toward elevated ICP risk.

• Seizures: CNS irritation from infection increases neuronal excitability. The child’s fever, irritability, and lethargy make them especially prone to seizures, which are a common complication in pediatric bacterial meningitis.

Rationale for incorrect choices

• Disseminated intravascular coagulation: Although petechiae are present, DIC is not the most immediate or common complication in meningitis. It is more often linked to meningococcemia with fulminant sepsis rather than early bacterial meningitis.

• Hydrocephalus: This may occur in chronic or untreated meningitis, but it is not the most acute risk. The more pressing concerns are cerebral edema and ICP elevation rather than long-term ventricular dilation.

• Hypothermia: The child currently has fever and chills, indicating hyperthermia. Hypothermia may occur in overwhelming sepsis or late-stage shock, but it is not the primary complication expected at this stage.

A. Place the IV catheter on the dominant arm: Using the dominant arm may limit the child’s ability to play or perform daily activities comfortably. The nondominant arm is usually preferred to preserve function and reduce frustration.

B. Apply vapocoolant spray before the IV insertion: Vapocoolant sprays or topical anesthetics are effective in reducing pain and anxiety during IV insertion in children. This intervention helps improve cooperation and decreases procedural distress.

C. Ask the child to hold their breath while the IV catheter is placed: Breath-holding is not an appropriate distraction or coping technique for preschoolers during IV insertion. It does not provide pain relief and may increase anxiety.

D. Explain the procedure to the child in detail: Preschoolers have limited understanding of complex explanations, and too much detail can increase fear. Instead, age-appropriate, simple explanations with reassurance and distraction techniques are more effective.