lecture 6 [adolescent + renal] Flashcards
what kind of changes are to be expected in the postpubescent period?
- complete skeletal growth
- well-established reproductive functions
ages
early adolescence
11-14
ages
middle adolescence
15-17
ages
late adolescence
18-20
which gland is responsible for the development of secondary sex characteristics?
anterior pituitary gland
which part of the brain stimulates the anterior pituitary gland?
hypothalamus
what stage of Erikson’s are adolescents in?
group identity vs. alienation
Stage 5
what is the nurse’s role regarding parents & adolescents?
facilitator between their discussions without taking any sides
what stage of Piaget’s developmental thought processes are adolescents in?
formal operational (abstract & hypothetical thinking)
stage 4
what are the characteristics of thought processes that adolescents have developed?
(4)
- mental manipulation of 2 or more variables simultaneously
- hypothetical thinking
- scientific & formal logic
- higher ability to “stand in someone’s shoes”
how does an adolescent’s relationship with their parents change?
mutual affection & equality
adolescents begin to develop sexual orientation & identification during this stage
true
what are the nursing implications for an adolescent’s developing sexuality?
present sex-ed in a straightforward manner
caloric needs & protein requirements are higher at this stage than others
true
what is the most common nutritional disturbance & challenging health problem of adolescents?
obesity
what is the likelihood of obese adolescents to become obese adults?
70-80%
most adolescents who have disturbed sleeping patterns tend to describe themselves negatively
true
what are common sleep disturbances among adolescents?
(4)
- difficulty waking
- sleepiness during the day
- frequent periods of wakefulness in the middle of the night
- difficulty going to sleep
at what age do girls start getting the HPV vaccine?
9 yrs old
how many weeks apart are Varicella doses for children younger than 13 yrs old?
3 months
how many weeks apart are Varicella doses for children older than 13 yrs old?
4 weeks
what are the various external defects of the genitourinary system among adolescents?
(9)
- inguinal hernia
- hydrocele
- phimosis
- hypospadias
- chordee
- epispadias
- cryptorchidism
- bladder exstrophy
- ambiguous genitalia
when does surgery happen for GU defects?
before preschool
nurses need to be conscious of how children view genital surgery–it may be a “punishment” & become obsessed with what is “normal”
true
definition
inguinal hernia
protrusion of ABD contents into scrotum
definition
phimosis
narrowed opening of foreskin
definition
chordee
ventral curvature
definition
cryptorchidism
undscended testes
definition
bladder exstrophy
bladder develops outside of exterior ABD wall
what is the pathophysiology of obstructive uropathy?
hydronephrosis causing distal nephron damage leading to urine concentration
what is the nursing care for obstructive uropathy?
(4)
- potential discharge w/ equipment (urostomy, kidney drains)
- present options for dialysis or transplant
- increase fluid
- monitor for sediments
what are some GU dysfunctions commonly seen among children?
(9)
- UTI
- vesicoureteral reflux
- obstructive uropathy
- nephrotic syndrome
- acute glomerulonephritis
- hemolytic uremic syndrome
- Wilms Tumor
- AKI
- CKD
what are the types of UTI?
(2)
- cystitis (bladder)
- pyelonephritis (kidney)
what are the risk factors for UTI?
(5)
- uncircumcised males under 3 months
- short urethera in females
- urine stasis
- malformation of another system (i.e. low-set ears or ear tags)
- renal reflux or malformation
why are ear malformations considered a risk factor for UTI?
the ears & kidneys were developing simultaneously in-utero
what is the nursing care for UTI?
- increase fluid intake (for flushing)
- cranberry juice (sugar-free)
what are the s/s of UTI?
- decreased appetite
- back pain
- polyuria
- polydipsia
- pain w/ voiding
- hematuria
- fatigue
- abd pain
pathophysiology of vesicoureteral reflux
cytitis moves to pyelonephritis
what are the s/s of vesicoureteral reflux?
(4)
- residual urine in ureters
- high fevers
- emesis
- chills
what are the diagnostic test for vesicoureteral reflux?
(2)
- cytoscopy
- voiding cystourethrogram
what is the nursing care for vesicoureteral reflux?
(3)
- prevent bacteria travelling up to kidneys from bladder
- low-dose ABX
- cultures every 2-3 months
what is the pathophysiology of nephrotic syndrome?
increasing permeability of basement membrane in kidneys leading to albumin leaks & accumulation of fluid in interstitial spaces
what is the etiology of nephrotic syndrome?
- proteinuria
- hypoalbuminemia
- nephrosis
- glomerular damage
- autosomal recessive
what are the manifestations of nephrotic syndrome?
(7)
- weight gain
- edema
- ascites
- poor appetite
- HTN
- tired
- proteinuria
what is the treatment for nephrotic syndrome?
- low Na+ diet
- severe fluid restriction
- diuretics (due to edema)
- 25% albumin
- steroids
what is the goal for treating nephrotic syndrome?
- reduce excretion of urinary protein
- reduce fluid retention in tissues
- prevent infection
which conditions does glomerulonephritis usually precede?
- pneumococcal infections
- streptococcal infections
how long is the latent period for glomerulonephritis preceding certain viral & bacterial infections?
10 days
what is the nursing care for glumerulonephritis with BP WNL?
teach home management
what is the nursing care glomerulonephritis in the hospital?
- strict Na+ restriction
- daily wt
- seizure precautions (indicated for pt w/ edema & hematuria)
what is an indication for improving glomerulonephritis?
increasing C3 levels
what is the role of C3 factors in the immune system?
activates the complement system in which antibodies are more effective in eliminating microbes
what is the pathophysiology of hemolytic uremic syndrome?
endothelial lining of glomerular arterioles swell & are occluded due to plt & clot deposits causing damage to RBCs and their elimination by the spleen
what is the triad for HUS?
- anemia
- thrombocytopenia
- renal failure
what are the manifestations of HUS?
- acuired hemolytic anemia
- thrombocytopenia
- renal injury
- CNS changes
- E. coli infection
what is the treatment for HUS?
(3)
- hemodialysis
- FFP (fresh frozen plasma)
- plasmapheresis
complications of HUS
(3)
- chronic renal failure
- HTN
- CNS disorders
another name for Wilms Tumor
nephroblastoma
Wilms tumor typically affects the left kidney
true
Wilms tumor predominantly affects black children
true
manifestations of Wilms tumor
- aniridia
- hemihypertrophy
- overgrowth syndrome (Beckwith-Wiedemann)
diagnostic procedures for Wilms tumor
- radiographic studies (x-ray)
- ABD U/S
- hematologic & biochem studies
- UA
why should nurses not palpate the protrusion in Wilms tumor?
to avoid rupturing the tumor
what is the treatment for Wilms tumor?
surgical removal of tumor, affected kidney, & adjacent adrenal gland
what is the etiology of AKI?
- decreased perfusion
- kidney disease
what are the implications for AKI?
- azotemia
- uremia
- inability to excrete waste, concentrate urine, & conserve electrolytes
definition
azotemia
accumulation of nitrogenous waste in blood
definition
uremia
retention of nitrogenous products in the blood
diagnostic results for AKI
- elevated BUN
- reduced GFR
- elevated creatinine
manifestations for AKI
- oliguria
- diuresis
what type of precautions need to be considered for AKI?
- seizure
- cardiac failure
treatment for oliguric AKI
avoid Na+, Cl, K+
treatment for hyperkalemic AKI
Kayexalate
treatment for hypertensive AKI
- anti-HTN
- limit fluids
- limit salt
treatment for anemic AKI
PRBC
if Hgb is < 6g/dL
pathophysiology of chronic kidney injury
damaged nephrons leading to inability to maintain fluid & electrolyte balance
common s/s of CKI
- fatigue
- pallor
- HA
- HTN
- nausea
- cramps
- CNS changes
diet management for CKD
- high carbs
- high Ca
- limit fresh produce & fruits
- low protein
- low K+, Na+, P
- unrestricted fat intake
supplements for CKD
(5)
- folate
- iron
- water-soluble vitamins (Vit B & C)
- Vit D
- phosphorus binding agents (Ca carbonate & aluminum hydroxide)
complications of CKD
- anemia
- HTN
- infection
which condition is dialysis only indicated for?
ESRD
