Ch. 26: Renal Disorders

Question 1

The glomeruli are inflamed, which impairs the kidney to filter the urine properly

Answer 1

Acute glomerulonephritis (AGN)

Question 2

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

Answer 2

Acute post-streptococcal glomerulonephritis (APSGN)

Question 3

What is risk factor for APSGN?

Answer 3

Strep infection with specific strain of group A b-hemolytic strep

Question 4

What kinda urine is seen with AGN?

Answer 4

Cloudy, tea colored and decreased urine output

Question 5

How is the mood and appearance with AGN?

Answer 5

Irritabile and ill appearance, lethargy

Question 6

How is the eating like with AGN?

Answer 6

Anorexia

Question 7

What kind of discomfort may AGN pts have?

Answer 7

Vague–headache, ab pain, dysuria

Question 8

What kind of edema may be seen with AGN?

Answer 8

Periorbital edema

Facial edema that is WORSE in the AM but then spreads to EXTREMITIES and ABDOMEN with progresion of the day

Question 9

Do AGN pts have cardiac issues?

Answer 9

Mild-severe HTN

Question 10

AGN: What will lab tests show for renal function?

Answer 10

Elevated BUN and creatinine

Question 11

AGN: What test is a positive indicator for presence of strep antibodies?

Answer 11

ASO titer

Question 12

AGN: How often is weight checked?

Answer 12

Daily weights—weigh child on same scale with the same amount of clothing daily

Question 13

AGN: Encourage adequate nutritional intake. What does this mean?

Answer 13

• 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

Question 14

AGN: When would fluids be restricted?

Answer 14

Periods of edema and HTN

Question 15

AGN: What meds may be given? Why?

Answer 15

Diuretics and anti-hTN to remove accumulated fluid and manage HTN

Question 16

AGN: What SE may occur with anti-HTN meds?

Answer 16

Dizziness

Question 17

Alteratons in the glomerular membrane allow proteins (especially albumin) to pass into the urine, resulting in decreased osmotic pressure

Answer 17

Nephrotic Syndrome

Question 18

What is peak incidence of MCNS (minimal change neprhrotic syndrome)?

Answer 18

2-7 y

Question 19

When does secondaary nephrotic syndrome occur?

Answer 19

After or is associated with glomerular damage guess to a known cause

Question 20

Is MCNS have a known cause?

Answer 20

No, but may be immune mediated or biochemical

Question 21

**Nephrotic syndrome will be abbreviated= NS

NS: Is there weight gain? Explain.

Answer 21

Yes, weight gain over a period of days or weeks

Question 22

NS: What kind of edema?

Answer 22

Facial and periorbital edema–decreased throughout day

Edema in the ankles too

Question 23

NS: How is abdomen?

Answer 23

Ascites

Question 24

NS: How is nutrition and bathroom stuff?

Answer 24

Nutrition: Anorexia

Bathroom stuff: Diarrhea; decreased frothy urine

Question 25

NS: How is mood?

Answer 25

Irritable | Lethargy

Question 26

NS: What does BP look like?

Answer 26

W/in expected reference range or slightly below

Question 27

**NS: What does the lab test look like for urinalysis/24-hr urine collection? (4)

Answer 27

Proteinuria: protein greater than 2+ on dipstick Hyaline casts FEW RBC Oval fat bodies

Question 28

**NS: What does lab test look like for serum chemistry? (5)

Answer 28

- 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

Question 29

What diagnostic procedure is indicated ONLY if NS is unresponsive to steroid therapy? What will it show?

Answer 29

Kidney biopsy Shows damage to epithelial cells lining basement membrane of kidney

Question 30

NS: How often is child weighted?

Answer 30

Daily--weigh child on same scale with the same amount of clothing

Question 31

NS: How often is edema and abdominal girth measured?

Answer 31

Daily---measure at the widest area, usually at or above the imbeciles Assess degree of pitting, color, and texture of skin

Question 32

NS: When would salt and fluids be restricted?

Answer 32

During edematous phase

Question 33

NS: What are 4 types of meds that may be given?

Answer 33

1. Corticosteroid: Prednisone 2. Diuretic: Furosemide 3. 25% albumin 4. Cyclophosphamide

Question 34

NS: What are adverse effects of prednisone? When it is administered?

Answer 34

AE: Hirsutism, slowed linerar growth, HTN, GI bleeding, infection, hyperglycemia Administered: With meals

Question 35

NS: What is some client education about furosemide?

Answer 35

It eliminated excess fluid from body Encourage child to eat foods high in K Monitor serum electrylote levels periodically

Question 36

NS: Why do we give 25% albumin?

Answer 36

Increases plasma volume and decreases edema

Question 37

NS: Who would get cyclophosphamide?

Answer 37

Children who cannot tolerate prednisone or who have repeated relapses of MCNS

Question 38

What are some complications to NS?

Answer 38

- Sepsis/infection (prednisone increase risk) - Circulation insufficiency - Thromboembolism

Question 39

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 ```

Answer 39

B, C, E

Question 40

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 ```

Answer 40

B, C, E

Question 41

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

Answer 41

B

Question 42

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

Answer 42

A