A nurse on a pediatric intensive care unit is caring for a toddler who weighs 12 kg (26.5 lb) and is postoperative following open heart surgery. Which of the following findings should the nurse report to the provider?

A. Nephrotic syndrome typically presents with edema, proteinuria, hypoalbuminemia, and hyperlipidemia, rather than the symptoms described in the scenario.
B. Renal scarring can occur as a complication of untreated or recurrent urinary tract infections (UTIs), particularly pyelonephritis. The presence of fever and lethargy in the child, along with the history of decreased appetite, raises concerns for a urinary tract infection that could lead to renal scarring if left untreated.
C. Polycystic kidney disease typically presents later in life and is not typically associated with acute febrile illness in a 1-year-old toddler.
D. While acute glomerulonephritis can occur following certain infections such as streptococcal infections, it is less commonly associated with fever and lethargy compared to pyelonephritis.

E. Pyelonephritis is a bacterial infection of the kidneys commonly associated with fever and lethargy, especially in young children. The fever and lethargy reported by the parent, along with the urine sample obtained, suggest a concern for pyelonephritis.

Rationale:

A. Cyanosis can occur in children with heart failure due to inadequate oxygenation of tissues.

B. Weight gain or fluid retention is more common in children with heart failure.

C. Bounding pulses are more commonly associated with conditions such as hypertension or hyperthyroidism, rather than heart failure.

D. Dyspnea, or difficulty breathing, is a common symptom of heart failure due to fluid buildup in the lungs.

E. Tachycardia, or a rapid heart rate, can occur as a compensatory mechanism in response to decreased cardiac output in heart failure.