A pediatric nurse is concerned that her patient is exhibiting signs of infective endocarditis. Which of the following symptoms would lead the nurse to suspect that diagnosis?

Creatinine is a waste product generated by muscle metabolism and excreted by the kidneys. It is commonly used as a marker of renal function because it is filtered by the glomeruli and almost entirely excreted in the urine. When there is a reduction in GFR, as in acute renal failure, creatinine levels in the blood tend to rise. Elevated serum creatinine levels are indicative of impaired kidney function and a decreased GFR.

The other options are not direct indicators of GFR:

A. Protein level: While proteinuria (elevated protein levels in urine) can be a sign of kidney dysfunction, it is not a direct measurement of GFR. Proteinuria can occur for various reasons, including glomerular damage, but it doesn't provide a precise assessment of GFR.

C. Osmolality: Urine osmolality reflects the concentration of solutes in urine but is not a direct measure of GFR. It can provide information about the concentrating ability of the kidneys, but it doesn't assess the overall filtration rate.

D. pH: Urine pH is a measure of the acidity or alkalinity of urine and is not a direct indicator of GFR. It can be influenced by factors such as diet and renal tubular function but does not directly measure the filtration rate of the glomeruli.

Force fluids appropriate in age: It's important to ensure that the child receives an appropriate amount of fluids, taking into consideration their age and weight. This helps prevent dehydration and maintain adequate circulation.
In addition to option A, other important nursing care measures for infants and children with congestive heart failure include:
B. Organize activities to allow for uninterrupted sleep: Infants and children with heart failure may become fatigued easily, so it's important to create an environment that allows for sufficient rest and sleep.
C. Monitor respirations during active periods: Monitoring the child's respiratory rate and effort during active periods helps assess for signs of respiratory distress, which can be a manifestation of congestive heart failure.
D. Give smaller, more frequent feedings to conserve energy: Smaller, more frequent feedings can help reduce the energy expenditure required for digestion, making it easier for the child to eat and conserve energy for growth and development.
The focus of nursing care is to manage the symptoms of heart failure, support the child's overall well-being, and prevent complications. The specific interventions may vary based on the child's age, the severity of heart failure, and the underlying cause.