A child is admitted to the pediatric unit after reported symptoms of bloody diarrhea, purpura, hypertension and an elevated blood urea nitrogen. Based on the clinical data what orders would the nurse anticipate?

A. Insert a Foley catheter is correct. Accurate measurement of urine output is essential in children with suspected hemolytic uremic syndrome (HUS) or acute kidney injury. The catheter allows continuous monitoring, helping to detect oliguria or anuria early, which are key indicators of worsening renal function. Urine output also guides fluid management and helps prevent complications such as fluid overload. B. Administer a broad-spectrum antibiotic is incorrect. Antibiotics are generally avoided in HUS caused by E. coli O157:H7 because they can increase the release of Shiga toxins, worsening renal injury and increasing the risk of complications. Antibiotics are only used in specific situations and under strict physician guidance. C. Initiate intravenous hydration is correct. Children with HUS may become dehydrated due to vomiting, diarrhea, or reduced oral intake. IV fluids help maintain intravascular volume, support kidney perfusion, and stabilize blood pressure, which is particularly important in the context of hypertension and acute kidney injury. Hydration must be carefully monitored to avoid fluid overload. D. Monitor blood urea nitrogen and creatinine is correct. These lab values are primary indicators of renal function. Monitoring trends in BUN and creatinine helps assess the severity and progression of acute kidney injury, guide fluid and electrolyte management, and determine the need for interventions such as dialysis. E. Place the patient on droplet precautions is incorrect. HUS is not transmitted via respiratory droplets. Standard precautions, including proper hand hygiene and contact precautions if diarrhea is present, are sufficient to prevent spread. F. Monitor hemoglobin and hematocrit is correct. HUS involves hemolytic anemia, resulting in the destruction of red blood cells. Regular monitoring of hemoglobin and hematocrit allows the healthcare team to assess anemia severity, guide transfusion decisions, and track disease progression.