The nurse is evaluating a female child with acute post-streptococcal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?

APSGN is characterized by inflammation of the glomeruli in the kidneys, which can lead to decreased kidney function and impaired urine output. As the condition begins to improve, one of the first signs is an increase in urine output. This is because the inflammation in the glomeruli starts to resolve, allowing the kidneys to filter blood more effectively and produce a higher volume of urine.

Now, let's discuss why the other options are incorrect:

A. Increased energy levels: While improved energy levels can be a positive sign in a child recovering from an illness, they are not typically the earliest sign of improvement in APSGN. Energy levels may improve as the child's overall condition gets better, but this improvement often follows an increase in urine output.

B. Decreased diarrhea: APSGN primarily affects the kidneys, not the gastrointestinal tract. Therefore, diarrhea is not a direct symptom of this condition. Improving kidney function and urine output would not directly impact diarrhea.

D. Increased appetite: Like increased energy levels, an improved appetite can be a positive sign in recovery, but it is not typically the earliest sign of improvement in APSGN. It is generally more related to overall recovery and feeling better after the acute phase of the illness.

In summary, while all of these signs can be positive indicators of a child's recovery, increased urine output is usually the earliest and most specific sign of improvement in acute post-streptococcal glomerulonephritis, as it directly reflects the resolution of kidney dysfunction.

Weight loss in a child with acute glomerulonephritis is often due to a reduction in edema (fluid retention and swelling). Acute glomerulonephritis can lead to significant edema, as the kidneys may not effectively filter excess fluid and waste products from the body. During hospitalization and treatment, interventions such as diuretics and improved kidney function may result in the gradual removal of excess fluid, leading to a decrease in edema and overall body weight.

The other options are less likely to be the primary cause of the weight loss:

A. Poor appetite: While acute glomerulonephritis can affect appetite, especially due to nausea or other symptoms, it is not typically the primary reason for significant weight loss over a short period.

B. Restriction to bed rest: While being on bed rest can lead to muscle atrophy and loss of lean body mass over an extended period, it is unlikely to result in an 8-pound weight loss in just 4 days unless there are additional factors at play.

C. Increased potassium intake: Increased potassium intake alone would not be a primary cause of significant weight loss. High potassium levels in the blood (hyperkalemia) can occur in kidney disease, but it is not typically associated with rapid weight loss.