A nurse is assisting in the care of a 6-year-old child. Exhibits Click to highlight the findings that the nurse should report to the provider. To deselect a finding, click on the finding again. Nurses' Notes 1000: On assessment, the child is lethargic and pale for ethnicity. Lungs clear bilaterally, heart murmur noted, abdomen slightly distended, soft, bowel sounds normoactive. Child voided 50 mL of tea-colored urine. The child reports that their head hurts and rates their pain as 6 on the FACES pain scale. Vital Signs 0930: Temperature 37.5° C (99.5° F) Heart rate 115/min Respiratory rate 24/min Blood pressure 129/84 mm Hg Oxygen saturation 97% on room air

Rationale for correct findings: Periorbital puffiness: Puffiness around the eyes, especially after a recent streptococcal infection, is a classic sign of post-streptococcal glomerulonephritis (PSGN). It indicates fluid retention due to impaired kidney function. Lethargy and pallor: These may indicate anemia, poor perfusion, or systemic illness. In the context of recent infection and abnormal urine, this could reflect declining renal function or systemic effects of hypertension. Tea-colored urine: Dark, tea-colored urine is a hallmark sign of hematuria due to glomerular damage. It strongly supports the diagnosis of PSGN and needs prompt evaluation. Blood pressure 129/84 mm Hg: This is elevated for a 6-year-old child and may indicate hypertension secondary to renal dysfunction. Hypertension in children, especially following strep infection, is clinically significant and must be addressed immediately. Abdominal distension: A distended abdomen can reflect fluid retention (ascites) or early signs of edema related to nephritic syndrome. It requires provider awareness for further evaluation. Headache rated 6/10: Headache in a child with elevated blood pressure could be a symptom of hypertensive encephalopathy. This warrants urgent provider notification for blood pressure management. Incorrect Findings: Lungs clear bilaterally: Normal lung sounds indicate no current respiratory distress or pulmonary fluid overload, so this does not require urgent follow-up. Heart murmur noted: The murmur is a known condition in the child’s history. Unless new or changed in character, it is not urgent unless associated with new cardiac symptoms. Temperature 37.5° C (99.5° F): This is within the normal range and does not suggest active fever or infection at this time. Respiratory rate 24/min and O2 sat 97% on room air: These are within normal limits for a 6-year-old and indicate stable respiratory function.