A nurse is teaching the guardian of a toddler about discipline. Which of the following statements by the guardian indicates an understanding of the teaching?

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. Administer ceftriaxone. Correct. The CSF analysis shows elevated pressure, cloudy appearance, increased WBC count, elevated protein, and decreased glucose levels, which are indicative of bacterial meningitis. Ceftriaxone is a broad-spectrum antibiotic that is commonly used to treat bacterial meningitis, especially in infants and young children. Immediate administration of antibiotics is crucial to treat the infection and prevent complications.

Other Options:

B. Initiate serum glucose testing every 1 hr. Incorrect. Although the CSF glucose is low, this finding is associated with bacterial meningitis rather than a primary glucose metabolism issue in this context. Regular glucose monitoring every 1 hour is not warranted for managing meningitis. The priority is to address the underlying infection with antibiotics.

C. Administer pneumococcal conjugate vaccine. Incorrect. Vaccination is a preventive measure, not an immediate treatment for an ongoing infection. This infant likely already needs treatment for a current infection, and vaccination would be inappropriate at this stage.

D. Initiate neutropenic precautions.Incorrect. Neutropenic precautions are used for patients with significantly low neutrophil counts to prevent infection. The CSF results do not suggest neutropenia; instead, they suggest an active bacterial infection. The focus should be on treating the infection, not on precautions for low neutrophil count.