Chapter 31: Caring for the Child With a Genitourinary Condition Flashcards
The Kidney
- outer cortex and inner cortex
- surrounded by adipose tissue to protect it from trauma, but can be injured by blows to the abdomen
- receive their blood supply through a single renal artery that comes from each side of the aorta, one to each kidney
- the renal artery subdivides into 5 segmental arteries that feed each kidney; each segmental artery further subdivides into multiple branches several times; smallest are afferent arterioles which feed the glomeruli
The outer cortex of the kidney
composed of the glomeruli and convoluted tubules of the nephron and blood vessels
Medulla
composed of the renal pyramid
-urine leaves the papilla of a pyramid to collect in the minor calyx; the minor calyces come together to make the major calyces and then the renal pelvis
The glomerulus
tuft of capillaries in a thin-walled capsule termed Bowman’s capsule
>while blood flows into the glomerulus through the afferent arteriole, it leaves through the efferent arteriole
-fluid and blood particles are filtered through capillary membranes into a fluid-filled space in Bowman’s capsule; filtered blood = filtrate
The Tubular Components of the Nephron
divided into 4 parts
- Proximal convoluted tubule (first part; coiled portion), drains Bowman’s capsule
- Loop of Henle (second part; thin loop)
- Distal convoluted tubule (third part)
- Collecting tubule, joins several tubules together to collect filtrate
Function of the Kidneys
- removal of waste products
- filtering the blood
- maintaining fluid and electrolyte balance (e.g. sodium, potassium, calcium and phosphorus)
- maintaining acid-base balance
- releasing hormones (Renin, Calcitriol, and Erythropoietin)
What Hormones does the Kidneys Release?
- Renin: blood pressure regulation
- Calcitriol: Vitamin D activation for healthy bones
- Erythropoietin: RBC production
How to Monitor Kidney Function
> Glomerular filtration rate (GFR): amount of blood filtered by the glomeruli
-125 mL/min
> Creatinine Clearance (reflects GFR)
-85 to 135 mL/min
> Creatinine
-0.5 to 1.5 mL/min
> BUN
-10 to 30 mg/dL
> Urine specific gravity
UA (no protein, blood)
Fluid and Electrolyte Balance
- children are at risk for imbalance b/c they have a greater amount of body water, require more fluid intake, and excrete more fluid
- a fluid deficit occurs when fluids are lost by diaphoresis, vomiting, diarrhea, or hemorrhage
- fluid overload occurs from conditions that create impaired fluid excretion (e.g. kidney disease, congestive heart failure), and excessive administration of IV fluids
Why are Children at greater risk for Fluid and Electrolyte Imbalances?
- greater body surface area
- higher percentage of total body water (the volume of total body water decreases with increasing age)
- greater potential for fluid loss via the GI tract and skin
- increased incidence of fever, upper respiratory infections, and gastroenteritis
- greater metabolic rate
- immature kidneys that are inefficient at excreting waste products
- kidneys that have a decreased ability to concentrate urine
- increased risk for developing hypernatremia based on their inability to verbalize thirst
Calculation of daily maintenance fluid requirements
100 ml/kg of body weight
1000 mL + 50 mL/kg for each kg >10
1000 mL + 20 mL/kg for each kg >20
X= (100x10) + (50x 10) + (20x\_\_) ex: child weighs 50 kg 100x10= 1000 50x10= 500 20x 30 (remaining kg)= 600 X= 2100 for 24 hr daily fluid requirement
Growth and Development
child with a genitourinary condition may experience alterations in mastery of growth and developmental milestones such as potty training
- hypospadias, ambiguous genitalia, and renal and bladder disorders predispose the child to alterations in elimination
- disturbances in elimination or surgical repair of the GU system can have a negative impact on growth and development
- nurse should provide education about surgical repair and other treatments as appropriate
- encourage coping and acceptance of the disease process
- problems with the “private parts” can be embarrassing and emotional for the child; provide appropriate psychosocial and emotional support for the parents and child
- nurse should explore for feelings of guilt or blame and refer to a counselor if needed
Expected Urinary output range
1-2 mL/kg per day ex: child weighs 22lbs what is the expected urinary output range for this child for 12 hours? 22/2.2= 10kg 10x1=10 10x2= 20
10x12= 120 20x12= 240
answer= 120-240
Dehydration
the body is continually losing water in urine and stool and by evaporation from the skin and lungs
-if the child is not taking in enough fluids to make up for the amount lost, they can become hydrated
>dehydration occurs when the amount of fluids leaving the body is greater than the amount of fluids being taken in
-classified as isotonic, hypotonic, or hypertonic
Isotonic Dehydration
occurs when electrolyte and water deficits are present in balanced proportions (sodium and water are lost in equal amounts)
-serum sodium remains in normal limits (130-150 mEq/L)
>hypovolemic shock is of greatest concern
