Chapter 04: Ellie Raymore: Urinary Tract Infection and Pyelonephritis

A 3-year-old child has been admitted to the hospital with a diagnosis of pyelonephritis with dehydration. The child weighs 30 lb (13.6 kg). The nurse anticipates the health care provider will prescribe intravenous maintenance fluids. How many milliliters should the nurse expect to infuse over 24 hours? Record your answer using a whole number.

1180

A 3-year-old child is hospitalized with a diagnosis of pyelonephritis. The health care provider has prescribed ceftriaxone 60 mg/kg/day in three divided doses. The child weighs 32 lb (14,5 kg). How many milligrams should the nurse administer in each dose? Record your answer using a whole number.

290

A nurse is providing care to a toddler hospitalized with pyelonephritis and dehydration. The health care provider has prescribed intravenous maintenance fluids of 1300 ml over 24 hours. What rate should the nurse set the infusion pump? Record your answer using a whole number.

34

A 24-month-old child is hospitalized with a diagnosis of pyelonephritis. The child has a temperature of 104.2°F (40.1°C). The health care provider has prescribed ibuprofen 5 mg/kg q 6 hours PRN for a temperature greater than 103°F (39.4°C). The child weighs 26 lb (11.8 kg). How many milligrams should the nurse administer? Record your answering using a whole number.

59

A nurse is providing parental teaching on measures to prevent urinary tract infections in toddlers. Which statement made by the parents indicates to the nurse that teaching has been successful? a. "Drinking cranberry juice can make the urine unreceptive to bacteria." b. "I should give my toddler the prescribed antibiotic until the symptoms disappear." c. "Colas and other drinks with caffeine help to prevent urinary tract infections." d. "I should teach my toddler to wipe from back to front after voiding."

ANS: A Rationale: Drinking cranberry juice acidifies the urine, making it inhospitable to bacteria. Prescribed antibiotics should be taken until the full course is finished, not just until the toddler's symptoms have disappeared. This will prevent a rebound infection. Colas and other caffeine drinks may irritate the bladder. Toddlers should be taught to wipe from front to back to avoid introducing bacteria from the rectum into the urethra.

A 36-month-old child who was recently adopted is brought to the pediatric clinic for an initial well-child visit. The parents are elated with their new child but are not sure what to expect from a 36-month-old child. What information about a toddler's development should the nurse give the parents? Select all that apply. a. Mimics parents and others b. Names familiar things c. Dresses and undresses self d. Rides a tricycle E. Shows increased concern for others

ANS: A, B, C, D Rationale: Three-year-old toddlers will mimic the behaviors of their parents, siblings and others. They have the ability to name familiar things in their environment. They are able to dress and undress themselves and are able to ride a tricycle. They will start to show increased concern for others as a preschooler.

A community health nurse is teaching a parenting class on growth and development of toddlers. What information should the nurse convey to the parents to promote appropriate growth and development? Select all that apply. a. Develop daily routines for the toddler. b.Set aside regular time for reading with the toddler. c. Encourage the toddler to participate in cooperative play. d. Socialize the toddler to other same-aged children. e. Expect that the toddler will share his or her belongings with others.

ANS: A, B, D Rationale: Developing daily routines for toddlers provides them with a sense of security and helps them to know what to expect, which can avoid confrontation. Reading with toddlers helps to promote language development. Socialization with other toddlers is important because they will watch, learn, and mimic others. Toddlers engage in parallel play; school-aged children engage in cooperative play (such as sports). Toddlers are egocentric in nature and find it difficult to share toys and other belongings. Sharing comes along as they become a preschooler.

A nurse is providing care to a toddler with a diagnosis of pyelonephritis. The nurse plans to focus care on urinary elimination. Which intervention(s) is applicable to the plan of care? Select all that apply. a. Monitor strict intake and output. b. Restrict oral fluids to 500 ml per day. c. Keep the child NPO until the condition resolves. d. Monitor vital signs every hour. e. Assess for signs of constipation.

ANS: A, E Rationale: The focus of the plan of care is urinary elimination. Applicable interventions should include monitoring strict intake and output, and monitoring the client for signs of constipation because it can obstruct urinary elimination. Oral fluids would be encouraged as tolerated, not restricted. There is no indication to keep the child NPO or to monitor vital signs every hour.

A 3-year-old child is admitted to the hospital with a diagnosis of pyelonephritis. During the admission assessment, which question is most important for the nurse to ask the parents? a. "What time was the child's last meal?" b. "Does the child have any allergies to medication?" c. "Can you tell me what your child's urine looks and smells like?" d. "Does your child take medications easily?"

ANS: B Rationale: A child hospitalized with pyelonephritis will require treatment with intravenous antibiotics, so it is important for the nurse to determine if the child has any allergies to medications. During the admission assessment the nurse may ask when the child last ate, what the urine looked or smelled like, or if the child has difficulty taking medication, but asking about medication allergies is the priority.

A parent has brought the toddler to the urgent care center with reported "signs of a bladder infection." The parent states "I am not sure how to deal with this. None of my other kids got bladder infections." What is the nurse's best response? a. "Urinary tract infections can run in families, so I am surprised your other children never had one." b. "Can you tell me why you think your child has a bladder infection?" c. "Is this the first time your child has shown these symptoms?" d. "What technique do you use to clean the child after going to the bathroom?"

ANS: B Rationale: Asking the parent to tell why he or she thinks the child has a bladder infection will give the nurse more information about the child's symptoms. Although a predisposition to urinary tract infections (UTIs) can run in families, that statement will not give the nurse more information about this child's symptoms. Asking if this is the first time the child has had these symptoms is appropriate to ask but it does not provide information about the child's current symptoms. Asking about the parent's cleansing technique after voiding is also appropriate but does not provide information about the child's current symptoms.

A pediatric clinic nurse is reviewing the charts of the children who were seen that day. The nurse is concerned that one of the toddlers requires referral for not meeting developmental milestones. Which toddler should the nurse refer for follow-up on appropriate developmental milestones? a.18-month-old who feeds self finger foods b. 28-month-old who has a 5- to 10-word vocabulary c. 30-month-old who entertains self by scribbling on paper d. 36-month-old who can say his name and age

ANS: B Rationale: At 28 months of age, a toddler should be using at least two-word sentences and has a vocabulary of 40 to 50 words. The other toddlers display age-appropriate developmental milestones.

A nurse is providing discharge instructions to the parents of a toddler hospitalized with a diagnosis of pyelonephritis. Which instruction is most important for the nurse to include? a. Encourage oral fluids. b. Complete the entire course of antibiotics. c. Encourage the toddler to void often. d. Avoid constipation.

ANS: B Rationale: It is most important for the toddler to complete the entire course of antibiotics even if the toddler feels better or the symptoms subside. Failure to do so can result in a rebound infection. It can also result in the bacteria becoming resistant to that antibiotic. Encouraging the toddler to increase oral fluids, to avoid constipation, and to void often are all important to include in the discharge instructions, but completing the antibiotic is most important.

A nurse is providing care for a 3-year-old child diagnosed with pyelonephritis. The child is fussy, has pain on urination, and is receiving intravenous maintenance fluids. Based on this information, what is the nurse's priority in the child's care? a. Administering analgesics b. Monitoring intravenous infusion c. Providing diversional activities d. Educating the parents on the treatment plan

ANS: B Rationale: Monitoring the intravenous infusion is the priority to prevent complications such as infiltration and inflammation of the IV site. It is also important to make sure the infusion is running at the correct rate even though it is on an infusion pump. Making the child comfortable with analgesics and diversional activities and educating the parents on the treatment plan are all important to the child's care but are not the priority.

A nurse completes an assessment with the above findings on a toddler diagnosed with pyelonephritis. The toddler weighs 31 lb (14 kg) and is receiving intravenous maintenance fluids. Which action should the nurse take? a. Document the findings as within normal parameters. b. Notify the health care provider of the toddler's output. c. Check the electronic health record for the last time an analgesic was administered. d. Ask the health care provider to prescribe an antipyretic.

ANS: B ]Rationale: A toddler's urinary output should be 1 ml/kg/hour; this toddler should void at least 14 ml/hr, not 6 ml/hr (6 x 4 = 24). This should be reported to the health care provider. There is no indication to administer an analgesic, and there is no indication to ask for a prescription for an antipyretic. Current guidelines are to not treat a temperature below 103°F (39.4°C).

A nurse is caring for a family with a 3-year-old child who has been diagnosed with cystitis. The family asks the nurse how to tell if the child has cystitis. What information should the nurse include in the response? Select all that apply. a. Flank pain is an early sign of cystitis. b. Frequency with small amounts of urine passed at a time. c. There is burning or pain when urinating. d. Child's behavior will be unchanged. e. Daily urinary output is decreased.

ANS: B, C Rationale: Tell-tale signs of cystitis (bladder infection) include having to urinate frequently but passing just a small amount of urine and having burning or pain on urination. Other signs include cloudy and/or foul-smelling urine. Flank pain is not an early sign of cystitis, but it is a sign of pyelonephritis (kidney infection). Although the child may only void small amounts at a time with cystitis, the overall daily amounts are not decreased unless the child becomes dehydrated. Parents will notice a change in the child's behavior (lethargy, poor appetite, fussiness).

A nurse is providing care to a 3-year-old toddler who was recently adopted. The child's family is very attentive and seems very interested in the child's plan of care. What nursing consideration(s) is necessary to the family's plan of care? Select all that apply. a. Determine if the birth parent's identities are known. b. Reassure them that support is available to the family as they become acclimated to becoming parents. c. Stress to the adoptive parents the importance of finding as much information about the birth family as possible. d. Expect that the family will require counseling to successfully adapt to the adoption. e. Treat the adoptive parents like any other parents with a hospitalized child.

ANS: B,E Rationale: The adoptive family can benefit from available support from support groups and other resources as they become acclimated to the new family structure. Adoptive families should not be treated differently than other families. Their birth children should not be distinguished from the adopted children. While it is important to have as much information as possible about the birth family, the information may be unavailable. The parents should not feel pressured to find the information or guilty if the information is unavailable. Counseling may or may not be necessary to successfully adapt to an adoption. What is important is that the family has access to resources if they should need them. Whether or not the birth parents are known or unknown will not impact the family's plan of care.

A nurse is providing care for a 30-month-old child diagnosed with pyelonephritis. The nurse has completed an assessment with the above findings. What action should the nurse take? a. Immediately call the health care provider. b. Administer an analgesic. c. Document the findings as normal. d. Adjust the pulse oximeter probe.

ANS: C Rationale: All of the assessment findings are within normal parameters and can be documented as such. There is no indication to call the health care provider, adjust the pulse oximeter probe, or administer an analgesic.

3. A 3-year-old child is hospitalized with suspected pyelonephritis. The nurse is reviewing the child's history. Which finding should the nurse consider most indicative of a diagnosis of pyelonephritis? a. Vomiting b.Fever c. Flank pain d. Dysuria

ANS: C Rationale: All of the options may be present in pyelonephritis but flank pain is most indicative of the disorder. Vomiting and fever are associated with other conditions; dysuria can indicate a bladder infection without progression to pyelonephritis.

A 2-year-old child is brought to the pediatric clinic with reports of decreased urine output and fever over the past 3 days. As the nurse begins an assessment, the child is crying and moving about in the parent's arms. Which action should the nurse take first? a. Ask the parent to place the child on the exam table. b. Request a prescription for an antipyretic. c. Ask the parent when the child voided last. d. Use the FLACC scale to assess the child for pain.

ANS: C Rationale: The nurse's initial action should be to find out more about the child's condition over the past 3 days, particularly about the decreased urinary output. Until the nurse obtains a temperature reading, there is no need to request an antipyretic. Using the FLACC scale to assess pain is an appropriate action but is not the first action the nurse should take. Because the child is upset, it would be best for the parent to try and calm the child before placing him or her on the exam table. In fact, once the child is calm, the assessment could be performed with the child in the parent's arms.

A nurse is instructing a parent how to obtain a clean-catch urine sample from the toddler. The parent's primary language is not the dominant language, but the parent speaks, understands, and reads the dominant language well. How can the nurse evaluate the parent's understanding of the teaching? a. Demonstrate the procedure on a doll or manikin. b. Provide the parent with written instructions in the client's primary language. c. Ask the parent if he or she understands the instructions. d. Observe the parent as he or she demonstrates the procedure.

ANS: D Rationale: The best way to evaluate the effectiveness of the teaching is to have the parent give a return demonstration of the procedure. Demonstrating the procedure on a doll or providing written instructions in the client's primary language will reinforce the teaching but these actions do not evaluate how well the parent understands. Asking the parent if he or she understands the instructions will elicit a yes/no answer and does not evaluate how well the parent understands the instructions.