Pediatric Nursing: Renal and Genitourinary Problems Flashcards
Urinary Tract Infection (UTI)
- bacterial invasion of the urinary tract from flora from the skin or GI tract.
- uncircumcised infants are more likely to develop a UTI than a circumcised infant.
- hygiene is important to prevent.
- children may experience asymptomatic bacteuria, so if there is a suspicion of infection, they should be screened and treated.
Glomerulonephritis: description
- refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus, most of which are caused by an immunological reaction.
- the disorder results in proliferative and inflammatory changes within the glomerular structure.
- destruction, inflammation, and sclerosis of the glomeruli of the kidneys occur.
- inflammation of the glomeruli results from an antigen-antibody reaction produced by an infection elsewhere in the body.
- loss of kidney function develops.
Glomerulonephritis: causes, types, and complications
Causes:
- immunological diseases, autoimmune diseases, antecedent group A B-hemolytic streptococcal infection of the pharynx or skin, history of pharyngitis or tonsillitis 2-3 weeks before symptoms.
Types:
- acute: occurs 2-3 weeks after a streptococcal infection.
- chronic: may occur after the acute phase or slowly over time.
Complications:
- kidney failure, hypertensive encephalopathy, pulmonary edema, heart failure, seizures.
Glomerulonephritis: assessment
- periorbital and facial edema
- anorexia
- decreased urinary output
- cloudy, smoky, brown-colored urine (hematuria)
- pallor, irritability, lethargy
- older child: headaches, abd or flank pain, dysuria
- hypertension
- proteinuria
- azotemia
- increased urea and creatinine levels
- increased anti-streptolysin O titer (used to diagnose streptococcal infection)
Glomerulonephritis: interventions
- monitor VS, intake and output, and characteristics of urine.
- measure daily weights (same time, scale and clothing).
- limit activity and provide safety measures.
- diet restrictions of sodium as prescribed
- monitor for complications (kidney failure, hypertensive encephalopathy, seizures, pulmonary edema, heart failure).
- adm diuretics, antihypertensives, and ATB as prescribed.
- initiate seizure precautions and adm anticonvulsants as prescribed.
- instruct parents on signs to report.
Nephrotic Syndrome: description and assessment
- a kidney disorder characterized by massive proteinuria, hypoalbuminemia, and edema.
- primary objectives of management are to reduce the excretion of urinary protein, edema, and prevent infection, and minimize complications.
Assessment: - child gains weight
- preorbital and facial edema
- leg, ankle, labial, or scrotal edema.
- urine output decreases; dark and frothy.
- ascites
- BP normal or slightly decreased
- lethargy, anorexia, and pallor
- massive proteinuria
- decreased serum protein and elevated serum lipid levels
Nephrotic Syndrome: Interventions
- monitor VS, intake and output, daily weight, urine specific gravity and protein, edema.
- a regular diet without added salt may be prescribed if the child is in remission; sodium is restricted during periods of massive edema (fluids may also be restricted).
- corticosteroid therapyis prescribed as soon as the diagnosis has been determined (monitor for signs of infection and adverse effects).
- immunosuppressant therapy may be prescribed to reduce the relapse rate and induce long-term remission, or if the child is unresponsive to corticosteroid therapy alone.
- diuretics may be prescribed to reduce edema.
- plasma expanders such as salt-poor human albumin may be prescribed for a severely edematous child.
Hemolytic-Uremic Syndrome
- thought to be associated with bacterial toxins, chemicals, and viruses that cause acute kidney injury in children.
- occurs primarily in infants and small children 6m to 5y
- clinical features include acquired hemolytic anemia, thrombocytopenia, kidney injury, and CNS symptoms.
Assessment: - triad of anemia, thrombocytopenia, and kidney failure.
- proteinuria, hematuria, and presence of urinary casts.
- urea and creatinine levels elevated; Hb and Ht levels decreased.
- vomiting, irritability, lethargy, marked pallor, bruising, petechiae, jaundice, bloody diarrhea, oliguria or anuria, seizures, stupor, coma.
Interventions: - hemodialysis or peritoneal dialysis if anuric. Strict monitoring of fluid balance, prevent infection, and adequate nutrition.
- meds to treat manifestations and adm of blood products to treat anemia.
Enuresis: description and types
Condition in which a child is unable to control bladder function.
- Primary enuresis: wetting that occurs in a child that has not fully mastered toilet training.
- Nighttime (nocturnal) enuresis: bedwetting in a child who has never been dry for extended periods. Common in children, and most eventually outgrow without therapeutic intervention. Child is unable to sense a full bladder and does not awaken to void. May have delayed maturation of the CNS and should be evaluated for any pathological causes before diagnosis.
- Daytime (diurnal) enuresis: wetting that occurs during the day.
- Secondary enuresis: onset of wetting occurs after a period of established continence. If child complains of dysuria, urgency, or frequency; should be assessed for UTI.
Enuresis: assessment and intervention
Assessment:
- child older than 5 years wets their bed or their clothes 2 times a week or more, for at least 3 months.
Interventions:
- perform urinary analysis and urine culture to rule out infection (as prescribed)
- limit fluid intake at night, and encourage the child to void just before going to bed.
- involve the child in caring for the wet sheets and changing the bed to assist in taking ownership of the problem. Provide reward systems as appropriate.
- desmopressin may reduce urine production at night; anticholinergics may reduce bladder contractions and increase bladder capacity.
- encourage follow-up.
Cryptorchidism
- a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac.
Assessment: - testes are not palpable or easily guided into the scrotum.
Interventions: - monitor during the first 6m of life to determine whether spontaneous descent occurs.
- surgical correction is commonly done at 6-12m.
- monitor for bleeding and infection postop.
- instruct parents on postop home care.
Epispadias and Hypospadias
- are congenital defects involving abnormal placement of the urethral orifice of the penis.
- can lead to the easy entry of bacteria.
Assessment: - epispadias: orifice is on the dorsal surface (often associated with exstrophy of the bladder).
- hypospadias: orifice is below the glans penis along the ventral surface.
Surgical Intervention: - done before the age of toilet training, between 6-12m
Postop: - child has a pressure dressing and may have some type of urinary diversion or a urinary stent while the meatus is healing.
- monitor VS, intake and output, and urine for cloudiness or a foul odor. Encourage fluid intake to maintain adequate urine output and patency of the stent.
- notify surgeon if there is no urinary output for 1h.
- Adm pain meds or anticholinergics (relieve bladder spasms), ATB.
- instruct parents to avoid tub bath, home care, and the need for follow-up for dressing removal.
Bladder Exstrophy: description
- a congenital anomaly characterized by extrusion of the urinary bladder to the outside of the body through a defect in the lower abd wall.
- cause is unknown; possibly a combination of genetic and environmental risk factors during pregnancy.
- condition can include specific defects of the abd wall, bladder, genitals, pelvic bones, rectum, and anus.
- children with bladder exstrophy will also experience vesicoureteral reflux; epispadias is also noted.
- treated through surgical procedures, initial surgery for closure of the abd defect should occur within the first few day of life.
- the goal of subsequent surgeries is to reconstruct the bladder and genitalia and enable the child to achieve urinary continence.
Bladder Exstrophy: assessment and interventions
Assessment:
- exposed bladder mucosa and epispadius in males.
- defects of the abd wall, vesicoureteral reflux, and defects of the rectum and anus.
Interventions:
- monitor urinary output, sings of urinary tract or wound infection.
- maintain the integrity of the exposed bladder mucosa, prevent tissue from drying, while allowing the drainage of urine, until surgery. Immediately after birth, exposed bladder is covered with sterile, nonadherent dressing to protect it.
- monitor lab values and urinalysis to assess renal function.
- adm ATB.
