A 2 -year-old girl is brought to

A 2 -year-old girl is brought to the office with a 1-day history of fever (temperature of 39.4°C [103°F]), vomiting, and mild diarrhea. No history exists of any change in her urinary habits, and she still wears diapers. The child has been somewhat irritable but fully alert. Physical examination reveals an ill-appearing toddler. Her temperature is 39.2°C (102.6°F), heart rate is 122 beats per minute, respiratory rate is 30 breaths per minute, and blood pressure is 90/60 mm Hg. The neck is supple. Head, eye, ear, nose, throat, chest, heart, abdomen, and genital examinations are normal. Urinalysis shows specific gravity of 1.025, pH 6.0, leukocyte esterase and nitrite both strongly positive, protein trace, and blood trace; the sediment has 15 to 20 white blood cells and 2 to 4 red blood cells per high-power field. The Gram stain shows more than 100,000 gram- negative rods, and the urine culture result is pending. 1. What are the possible diagnose for the child with positive leukocyte esterase on urinalysis? 2. What are the indications for hospital admission for the child with a urinary tract infection? 3. What antibiotics are used in the management of urinary tract infection? 4. What is the appropriate diagnostic workup for the child with suspected urinary tract infection? 5. When should renal ultrasonography and voiding cystourethrography be done in the child with a urinary tract infection? 6. If the workup is positive for vesicoureteral reflux, how should the child be treated in the long term? SCIENCE HEALTH SCIENCE NURSING NURS 101

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