The client is a 12-year-old male who sustained a gunshot wound to the abdomen and underwent surgical repair of a perforated small intestine 4 days ago. The client weighs 112.4 lb (51 kg) and has a nasogastric tube, a left femoral central line, and a peripheral IV.

At 1600, the nurse reviews the following data:

• Intake (past 8 hr): 800 mL IV fluids
• Output (past 8 hr): 1,500 mL (including 900 mL from nasogastric tube)
• Urine output: 20 mL/hr
• Sodium: 150 mEq/L (high)
• Potassium: 3.2 mEq/L (low)
• BUN: 28 mg/dL (elevated)

Based on this information, which symptoms should the nurse anticipate? Select all that apply.

A. Administering pain medication based on the FACES pain scale is not the most relevant intervention in the preoperative period for a Wilms' tumor. Pain management may be addressed postoperatively, as needed.

B. Including the prone position in the every 2-hour turning schedule may not be the most appropriate intervention, as it may not be suitable for an infant with a Wilms' tumor, considering the location and potential size of the tumor.

C. Careful bathing and handling that avoids abdominal manipulation.

Wilms' tumor, also known as nephroblastoma, is a pediatric kidney cancer. Prior to surgery, it's crucial to handle the infant with care and avoid any abdominal manipulation to prevent any further complications or disruption to the tumor. This involves gentle handling and avoiding activities that may put pressure on the tumor or cause discomfort to the infant.

D. Giving antiemetic medications to prevent nausea and vomiting is a potential intervention, but it may be more relevant in the postoperative period, and its necessity would depend on the infant's individual condition and the surgical plan.

The priority during the preoperative period for an infant with a Wilms' tumor is to handle the infant carefully and avoid any actions that could exacerbate the condition or cause discomfort. The specific surgical plan and other preoperative preparations would be determined by the healthcare provider.

A. Weight loss can occur in acute glomerulonephritis due to decreased appetite and fluid imbalances, but it is not as immediately concerning as low blood pressure.

B. A positive rapid strep test of the oropharynx suggests streptococcal infection, which can be a cause of acute glomerulonephritis. It's important to report this finding to the healthcare provider, but the low blood pressure is of more immediate concern.

C. Blood pressure 88/50 mm Hg.

Acute glomerulonephritis can lead to various signs and symptoms, including fatigue, facial puffiness, decreased appetite, and dark urine, due to the presence of blood and protein in the urine. However, the drop in blood pressure (88/50 mm Hg) is a significant finding that may suggest potential complications or worsening renal function. Low blood pressure can result from fluid shifts, reduced circulating blood volume, and decreased cardiac output in acute glomerulonephritis. It should be reported to the healthcare provider for further evaluation and management.

D. A maculopapular rash over the trunk of the body is not a typical finding associated with acute glomerulonephritis. While it may be significant for other reasons, it may not be directly related to the child's kidney condition.

Monitoring and addressing blood pressure changes is a crucial aspect of managing acute glomerulonephritis, and the healthcare provider should be informed promptly to assess and address this issue.