0800: A 9-year-old female is admitted with lethargy and fever. The client has a history of spina bifida, myelomeningocele, L2 level diagnosed at birth. History of recurrent UTIs, daily in-and-out catheterization at home, and chronic constipation. Home meds include oxybutynin 5 mg bid, polyethylene glycol 3350 daily, and acetaminophen PRN.
0815: Assessment complete. The child wakes up easily, reports pain 4/10, and points to the left, lower flank area when asked to point to the site of pain. A phlebotomist is at the bedside to collect blood specimens for laboratory orders.
0830: In and out (straight) urinary catheterization completed to collect urine specimens. 30 mL of urine was noted when catheterized.
0820
- In & out catheterization
- Urinalysis (UA) with reflex to culture & sensitivity
- Complete Blood Count (CBC) with differential
- Blood cultures (BC) x 2 sets
- Computed tomography (CT) scan with contrast of abdomen and pelvis
0815: Assessment complete. The child wakes up easily, reports pain 4/10, and points to the left, lower flank area when asked to point to the site of pain. A phlebotomist is at the bedside to collect blood specimens for laboratory orders.
0830: In and out (straight) urinary catheterization completed to collect urine specimens. 30 mL of urine was noted when catheterized.
1100: Child crying and restless in bed. When asked to rate pain, the child rates pain 10/10 and points to the lower left flank area and indicates it extends to the left lower abdomen. The provider at the bedside confirms a diagnosis of pyelonephritis.
1000
CT Abdomen and Pelvis Report with Contrast
Results:
- Left kidney is enlarged with areas of decreased perfusion (wedge-shaped hypodense cortical regions), consistent with focal areas of inflammation.
- No renal calculi or hydronephrosis observed.
- Right kidney is normal in size and enhancement.
- Bladder is distended, with mild wall thickening—no intraluminal mass or calculi.
- No evidence of abscess, obstruction, or free fluid.
1045
Urine Culture Preliminary Results:
Heavy growth of lactose-fermenting gram-negative rods
Blood Culture Preliminary Results:
No growth
1100
- Insert peripheral IV
- Infuse D5W ½ NS at 20 mL/hr
- Strict intake and output
- Acetaminophen 10 mg/kg by mouth q6 PRN pain or temperature greater than 101.0 oF (38.3 oC)
- Oxybutynin 5 mg orally q8h
- Cefotaxime 50 mg/kg every 6 hours IV infusion
- Clean Intermittent Catheterization (CIC) q4-6 hours
The nurse is planning care for the client.
➢ For each potential intervention, click to indicate whether the intervention is indicated or not indicated to include in the client’s plan of care. Each row must have only one response option selected.
- A. Initiate intravenous cefotaxime infusion.
- B. Perform intermittent urinary catheterization every 4 to 6 hours.
- C. Limit daily oral fluid intake.
- D. Implement strict monitoring of intake and output.
- E. Obtain a prescription for a scheduled NSAID.
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