What nursing action would be avoided when caring for a child diagnosed with Wilms’ tumor?

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: Enterocolitis, an inflammatory bowel condition, causes diarrhea and abdominal pain, typically in premature infants or those with Hirschsprung’s disease. It does not cause coughing or choking during feeding, as it affects the intestines, not the airway or esophagus, making it an incorrect diagnosis for this newborn’s feeding-related symptoms.

Choice B reason: Pyloric stenosis causes projectile vomiting due to pyloric muscle hypertrophy, obstructing gastric emptying. It does not typically cause coughing or choking during feeding, as the issue is distal to the esophagus. Tracheoesophageal atresia directly affects airway and esophageal continuity, making it a more likely cause of these symptoms.

Choice C reason: Tracheoesophageal atresia involves an abnormal connection between the trachea and esophagus, causing aspiration during feeding. In newborns, this leads to coughing and choking as milk enters the airway. This congenital defect disrupts normal swallowing, making it the most likely condition causing these symptoms during the first feeding.

Choice D reason: Celiac disease, a gluten-sensitive enteropathy, causes malabsorption, diarrhea, and failure to thrive, typically after gluten introduction. It does not cause coughing or choking during feeding in newborns, as it affects the small intestine, not the airway or esophagus, making it an incorrect diagnosis for these acute symptoms.