The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?

Choice A reason:

A specific gravity of 1.010 indicates that the child’s urine is adequately diluted, suggesting proper hydration. Normal urine specific gravity ranges from 1.005 to 1.030. A value of 1.010 falls within this range and indicates that the kidneys are functioning well and the child is not dehydrated.

Choice B reason:

Moist mucous membranes are a sign of adequate hydration. When a child is well-hydrated, the mucous membranes in the mouth and other areas remain moist. This is a positive indicator that oral rehydration therapy has been effective in restoring the child’s fluid balance.

Choice C reason:

Capillary refill time of less than 3 seconds is another indicator of proper hydration and good peripheral perfusion. This means that the blood is circulating well throughout the body, and the tissues are receiving adequate oxygen and nutrients. A capillary refill time of less than 3 seconds is considered normal and suggests effective rehydration.

Choice D reason:

A sunken anterior fontanelle is a sign of dehydration in infants. When the fontanelle is sunken, it indicates that the child has lost a significant amount of fluid. Therefore, this finding does not indicate that oral rehydration therapy has been effective. Instead, it suggests that the child may still be dehydrated.

Choice E reason:

A heart rate of 146/min is elevated for an 8-month-old child1. Normal heart rates for infants range from 80 to 160 beats per minute. While this heart rate is within the upper limit of normal, it can also be a sign of dehydration or other stressors. Therefore, it is not a definitive indicator of effective rehydration therapy.

Choice A reason:

Monitor your child’s temperature daily: Monitoring temperature is important for children with sickle cell anemia as they are prone to infections. A fever can be an early sign of infection, which can be serious for these children. Normal body temperature for children ranges from 36.5°C to 38°C. However, while monitoring temperature is important, it is not the most critical daily advice compared to ensuring adequate hydration.

Choice B Reason:

Restrict outdoor play to 1 hour per day: Limiting outdoor play is not typically necessary unless the child is experiencing extreme fatigue or pain. Physical activity is generally encouraged to maintain overall health, but it should be balanced with rest and hydration. Therefore, this advice is not as crucial as ensuring the child stays hydrated.

Choice C Reason:

Apply cold compresses when your child expresses pain: Cold compresses are not recommended for managing pain in sickle cell anemia. Instead, warm compresses or heating pads are often suggested to help relieve pain by improving blood flow. Cold can cause vasoconstriction, which may worsen pain and complications.

Choice D Reason:

Offer your child fluids frequently to meet their daily fluid goals: Staying well-hydrated is essential for children with sickle cell anemia. Adequate hydration helps prevent sickle cell crises by reducing blood viscosity and promoting better blood flow. This is the most appropriate and critical advice for daily care.