Question

A 7-year-old boy is brought to the clinic because of facial edema. He reports that he has been voiding small amounts of dark, cloudy, tea-colored urine. The parents state that their son had a sore throat 2 weeks earlier, but it has resolved. After assessing the child's vital signs and weight, what intervention should the nurse implement next?

Answer 1

The best next step in managing a 7-year-old boy presenting with facial edema and dark urine is to perform a urinalysis and blood tests. These can help diagnose conditions such as acute post-streptococcal glomerulonephritis, which could arise after a sore throat.

Step-by-step explanation:

The clinical presentation of a 7-year-old boy with facial edema and dark, tea-colored urine following a recent sore throat suggests a post-infectious complication such as acute post-streptococcal glomerulonephritis (APSGN). The initial vital signs and weight assessment are important to evaluate the child's current status and fluid retention.

The next intervention should be to obtain a urine sample for urinalysis to inspect for proteinuria and hematuria, common signs of glomerulonephritis. This should be accompanied by a blood test to measure renal function (including serum creatinine, blood urea nitrogen) and to check for evidence of streptococcal infection (e.g., antistreptolysin O titer). Additional tests may include a throat culture and a complete blood count (CBC).

Given the association between streptococcal infection and APSGN, a history of sore throat is highly relevant and should be a key element in the differential diagnosis. The presence of hematuria (red blood cell casts), proteinuria, and hypertension would further support the diagnosis of APSGN, warranting immediate management, which may include antibiotics, diuretics, blood pressure control, and possibly dietary sodium restriction based on the assessment.