Ch. 26: Renal Disorders Flashcards
The glomeruli are inflamed, which impairs the kidney to filter the urine properly
Acute glomerulonephritis (AGN)
An antibody antigen disease that occurs as a result of certain trains of the group A b-hemolytic streptococcal infection and is most commonly seen in children between age 2-7
Acute post-streptococcal glomerulonephritis (APSGN)
What is risk factor for APSGN?
Strep infection with specific strain of group A b-hemolytic strep
What kinda urine is seen with AGN?
Cloudy, tea colored and decreased urine output
How is the mood and appearance with AGN?
Irritabile and ill appearance, lethargy
How is the eating like with AGN?
Anorexia
What kind of discomfort may AGN pts have?
Vague–headache, ab pain, dysuria
What kind of edema may be seen with AGN?
Periorbital edema
Facial edema that is WORSE in the AM but then spreads to EXTREMITIES and ABDOMEN with progresion of the day
Do AGN pts have cardiac issues?
Mild-severe HTN
AGN: What will lab tests show for renal function?
Elevated BUN and creatinine
AGN: What test is a positive indicator for presence of strep antibodies?
ASO titer
AGN: How often is weight checked?
Daily weights—weigh child on same scale with the same amount of clothing daily
AGN: Encourage adequate nutritional intake. What does this mean?
- Possible restriction of Na and fluid
- Restrict foods high in K during periods of oliguria!!
- Small, frequent meals of fav foods due to decrease in appetite
- Avoid added salt and salty foods (ex: chips)
*refer to dietary consulation if necessary
AGN: When would fluids be restricted?
Periods of edema and HTN
AGN: What meds may be given? Why?
Diuretics and anti-hTN to remove accumulated fluid and manage HTN
AGN: What SE may occur with anti-HTN meds?
Dizziness
Alteratons in the glomerular membrane allow proteins (especially albumin) to pass into the urine, resulting in decreased osmotic pressure
Nephrotic Syndrome
What is peak incidence of MCNS (minimal change neprhrotic syndrome)?
2-7 y
When does secondaary nephrotic syndrome occur?
After or is associated with glomerular damage guess to a known cause
Is MCNS have a known cause?
No, but may be immune mediated or biochemical
**Nephrotic syndrome will be abbreviated= NS
NS: Is there weight gain? Explain.
Yes, weight gain over a period of days or weeks
NS: What kind of edema?
Facial and periorbital edema–decreased throughout day
Edema in the ankles too
NS: How is abdomen?
Ascites
NS: How is nutrition and bathroom stuff?
Nutrition: Anorexia
Bathroom stuff: Diarrhea; decreased frothy urine
NS: How is mood?
Irritable
Lethargy
NS: What does BP look like?
W/in expected reference range or slightly below
**NS: What does the lab test look like for urinalysis/24-hr urine collection? (4)
Proteinuria: protein greater than 2+ on dipstick
Hyaline casts
FEW RBC
Oval fat bodies
**NS: What does lab test look like for serum chemistry? (5)
- Hypoalbuminemia: reduced serum protein and albumin
- Hyperlipidemia: Elevated serum lipid levels
- Hemoconcentration: Elevated Hgb, Hct, and platelets
- Possible hyponatremia: reduces Na
- GFR: Normal or high
What diagnostic procedure is indicated ONLY if NS is unresponsive to steroid therapy? What will it show?
Kidney biopsy
Shows damage to epithelial cells lining basement membrane of kidney
NS: How often is child weighted?
Daily–weigh child on same scale with the same amount of clothing
NS: How often is edema and abdominal girth measured?
Daily—measure at the widest area, usually at or above the imbeciles
Assess degree of pitting, color, and texture of skin
NS: When would salt and fluids be restricted?
During edematous phase
NS: What are 4 types of meds that may be given?
- Corticosteroid: Prednisone
- Diuretic: Furosemide
- 25% albumin
- Cyclophosphamide
NS: What are adverse effects of prednisone? When it is administered?
AE: Hirsutism, slowed linerar growth, HTN, GI bleeding, infection, hyperglycemia
Administered: With meals
NS: What is some client education about furosemide?
It eliminated excess fluid from body
Encourage child to eat foods high in K
Monitor serum electrylote levels periodically
NS: Why do we give 25% albumin?
Increases plasma volume and decreases edema
NS: Who would get cyclophosphamide?
Children who cannot tolerate prednisone or who have repeated relapses of MCNS
What are some complications to NS?
- Sepsis/infection (prednisone increase risk)
- Circulation insufficiency
- Thromboembolism
A nurse is caring for a child. Which of the following are clinical manifestations of nephrotic syndrome? (SATA)
A. Dipstick protein 1+ B. Edema in ankles C. Hyperlipidemia D. Weight loss E. Anorexia
B, C, E
A nurse is caring for a child. Which of the following are clinical manifestations of APSGN? (SATA)
A. Frothy urine B. Periorbital edema C. Ill appearance D. Decreased creatinine E. HTN
B, C, E
A nurse is caring for a 10 yr old child who has AGN. Which of the following findings should the nurse report to the provider?
A. Serum BUN 8mg/dL
B. Serum creatinine 1.3 mg/dL
C. BP 100/74
D. Urine output 550mL over 24 hours
B
A nurse is caring for a 10 year old child who has NS. Which of the following findings should the nurse report to the provider?
A, Serum protein 5.0g/dL
B. HGB 14.5 g/dL
C. HCT 40%
D. Platelet 200,000 mm^3
A
