Chapter 31: Caring for the Child With a Genitourinary Condition

Question 1

The Kidney

Answer 1

• 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

Question 2

The outer cortex of the kidney

Answer 2

composed of the glomeruli and convoluted tubules of the nephron and blood vessels

Question 3

Medulla

Answer 3

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

Question 4

The glomerulus

Answer 4

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

Question 5

The Tubular Components of the Nephron

Answer 5

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

Question 6

Function of the Kidneys

Answer 6

• 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)

Question 7

What Hormones does the Kidneys Release?

Answer 7

• Renin: blood pressure regulation
• Calcitriol: Vitamin D activation for healthy bones
• Erythropoietin: RBC production

Question 8

How to Monitor Kidney Function

Answer 8

> 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)

Question 9

Fluid and Electrolyte Balance

Answer 9

• 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

Question 10

Why are Children at greater risk for Fluid and Electrolyte Imbalances?

Answer 10

• 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

Question 11

Calculation of daily maintenance fluid requirements

Answer 11

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

Question 12

Growth and Development

Answer 12

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

Question 13

Expected Urinary output range

Answer 13

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

Question 14

Dehydration

Answer 14

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

Question 15

Isotonic Dehydration

Answer 15

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

Question 16

Hypotonic Dehydration

Answer 16

occurs when the electrolyte deficit exceeds the water deficit
-serum sodium concentration is less than 130 mEq/L

Question 17

Hypertonic Dehydration

Answer 17

most dangerous type

• occurs when water loss is in excess of electrolyte loss
• sodium concentration greater than 150 mEq/L
• seizures likely to occur

Question 18

Causes, S/S, and Nursing Care Measures for fluid Deficit

Answer 18

> Diminished fluid intake

• S/S: dry skin
• Nursing: determine underlying cause

> Diaphoresis

• S/S: dry mucous membranes
• Nursing: Replace fluids

> Vomiting

• S/S: poor skin turgor
• Nursing: Replace electrolytes

> Diarrhea

• S/S: thirst; scaphoid abdomen (squeezed or depressed inward)
• Oral hydration

> NG suctioning

• S/S: poor perfusion
• IV hydration

> Fever

• decreased urinary output
• measure I’s & O’s

> Hemorrhage

• weight loss
• monitor vital signs

> General fluid deficit

• S/S: fatigue, tachycardia, tachypnea, decreased blood pressure, high urine specific gravity, high hematocrit
• monitor laboratory values (electrolytes)

Question 19

Pathophysiology of Dehydration

Answer 19

> Reduced intake or fluid losses

• Vomiting, diarrhea, fever, hyperventilation, burns, trauma/shock, hemorrhage, diabetes
• –>Sudden, rapid ECF loss—>imbalance in electrolytes—>loss of ICF—>Cellular Dysfunction—>Hypovolemic Shock—>Death

Question 20

Main Electrolytes

Answer 20

Sodium (primary electrolyte of ECF) and Potassium (primary in ICF)
-keep body in balance by maintaining muscle contraction, heart rhythm, and brain function
>Sodium (130-150 mEq/L)
>Potassium (3.5 to 5.5 mEq/L)

Question 21

Calcium

Answer 21

8.8 to 10.8 mEq/L

Question 22

Fluid and Electrolyte Imbalance Nursing Interventions

Answer 22

-obtain daily weights (same scale, same time, wearing same clothing); infants weighed naked, often older children weighed in only underwear
-measure intake and output (weigh diapers)
-assess hydration status (presence of tears, skin turgor, anterior fontanelle (up to 18 months), sticky mucous membranes, sunken eyeballs, urine and stool output, weight loss, tachycardia, tachypnea, decreased BP, temperature, and thirst)
-obtain laboratory tests; specific gravity, hematocrit, blood urea nitrogen (BUN), creatinine, Na+, K+, and Ca++
-assess type of acid-base disturbance (metabolic acidosis, metabolic alkalosis, or respiratory acidosis)
-administer oral clear liquids as ordered (1-2 oz q hour)
-start an IV or fluid and electrolyte placement as ordered
-before administering IV potassium (K+), ensure child has voided to prevent tubular necrosis
-cleanse perineal area and apply protective topical ointment
>encourage parents to be involved in the care; S/S of dehydration, rehydration, when to call health-care provider; follow-up appointments

Question 23

Assessing Peripheral IV Infiltration

Answer 23

occurs when the IV catheter moves out of the vein and the administered fluid then enters the surrounding tissue
>Grade 0:
-no symptoms; flushed with ease
>Grade 1:
-localized swelling (1-10%); flushed with difficulty; pain at the site
>Grade 2:
-slight swelling at the site (1/4 to 1/2 of the extremity above or below site, or 25-50% of extremity above or below site); pain at site; skin cool to touch; blanching; diminished pulse below site
>Grade 4:
-severe swelling at the site (more than 50% of extremity above or below site); infiltration of blood products, irritants, and/or vesicants (any amount of swelling); skin cool to touch; skin breakdown/necrosis; blistering; diminished or absent pulse; pain at site; capillary refill greater than 4 seconds
>if infiltration occurs:
-stop the infusion immediately
-elevate extremity; apply warm packs; use a compression dressing
>for more advanced infiltrations: Bacitracin (Baciguent) is applied topically, and site is covered with dressing
-call health-care provider for medical orders in severe situations
-reassess the site frequently and document the site

Question 24

When does the Kidney Mature in the Child?

Answer 24

immature until 2 years

-before this, unable to conserve water an electrolytes or fully assist in acid-base balance