What interventions will the nurse perform when feeding a child with pyloric stenosis? (Select all that apply)

Choice A reason: A positive antistreptolysin titer suggests post-streptococcal glomerulonephritis, not nephrosis (minimal change disease). Nephrosis is typically idiopathic, not infection-related, and lacks streptococcal association. Edema and proteinuria are hallmark features due to hypoalbuminemia, making this an incorrect characteristic for nephrosis, as it reflects a different renal pathology.

Choice B reason: Bacteriuria indicates urinary tract infection, not a characteristic of nephrosis, which involves sterile proteinuria and hypoalbuminemia. Infections may occur as complications due to immunosuppression, but bacteriuria is not a primary feature. Edema and proteinuria define nephrosis, making bacteriuria an incorrect symptom for this condition.

Choice C reason: Edema is a hallmark of nephrosis, resulting from massive proteinuria causing hypoalbuminemia, reducing plasma oncotic pressure. Fluid leaks into interstitial spaces, causing periorbital or generalized edema. This is a primary symptom, reflecting the pathophysiological fluid shift, making it a key characteristic in children with nephrosis.

Choice D reason: Massive proteinuria is a defining feature of nephrosis, particularly minimal change disease, where glomerular damage allows excessive protein filtration. This leads to hypoalbuminemia, edema, and hyperlipidemia. Proteinuria is a core diagnostic criterion, making it a characteristic symptom essential for identifying and managing nephrosis in children.

Choice A reason: Diabetic ketoacidosis (DKA) presents with flushing, drowsiness, and dry skin due to severe hyperglycemia, ketosis, and dehydration from osmotic diuresis. In children, insulin deficiency increases glucose and ketone production, causing metabolic acidosis and lethargy. DKA is life-threatening, requiring urgent insulin and fluid therapy to correct metabolic imbalances and prevent coma.

Choice B reason: The Somogyi phenomenon involves rebound hyperglycemia after nocturnal hypoglycemia, typically causing morning symptoms like sweating or shakiness, not flushing or drowsiness. Dry skin and progressive worsening suggest sustained hyperglycemia, as in DKA, not a transient rebound, making this an incorrect diagnosis for the child’s acute presentation.

Choice C reason: Water intoxication results from excessive water intake, causing hyponatremia, seizures, or confusion, not flushing or dry skin. The child’s symptoms indicate hyperglycemia and dehydration, consistent with DKA, not water overload. This condition is unrelated to diabetes pathophysiology, making it an incorrect explanation for the clinical presentation.

Choice D reason: The Dawn phenomenon involves morning hyperglycemia due to nocturnal growth hormone surges, not flushing, drowsiness, or dry skin. These symptoms suggest severe metabolic decompensation, as in DKA, with dehydration and acidosis. The Dawn phenomenon is less acute and does not match the child’s progressive deterioration.