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328 Pediatrics Final Exam > Renal > Flashcards

Renal Flashcards

1
Q

Etiology of UTI?

A

Escherichia coli most common pathogen (80% of cases)

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2
Q

UTI manifestations in an Infant?

A
  • Nonspecific symptoms
  • Poor feeding
  • Vomiting
  • Irritability
  • Failure to Thrive
  • Fever in some cases- may be afebrile
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3
Q

UTI manifestations in a Child?

A
  • Dysuria (e.g., crying on urination or vocalized pain)
  • Frequent urination (>q 2 h)
  • Urgency
  • Suprapubic discomfort or pressure “Tummy/belly aches”
  • New onset bedwetting or incontinence
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4
Q

UTI diagnostic tests?

A
  • Catherization is the preferred sample in child not potty-trained
  • U-bag– not used to diagnose UTIs-easily contaminated
  • Clean-catch outpatient older child
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5
Q

UTI treatment?

A
  • 3rd generation Cephalosporin
  • Septra-Trimethoprim-sulfamethoxazole (Bactrim)
    • Sulfa allergy contraindication
  • Nitrofurantoin (Macrobid)
  • Amoxicillin
  • Pyridium (OTC and prescribed)
    • Stains urine reddish-orange (mistaken for blood)
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6
Q

What is Normal and Minimum Urine Output?

A
  • Normal urine output: 1-2cc/kg/hour
  • Minimum urine output = 1cc/kg/hour
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7
Q

What is Normal and Minimum Urine Output for a child who weighs 10kg?

A
  • Normal urine output: 10cc-20cc per hour
  • Minimal urine output per hour 10cc per hour
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8
Q

Etiology of Acute Poststreptococcal Glomerulonephritis?

A
  • Caused by group A β-hemolytic streptococci (strep throat)
  • Onset 14 days after infection
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9
Q

Pathophysiology of Acute Poststreptococcal Glomerulonephritis?

A
  • Immune response to infection –antigen- antibody complexes collect in the glomeruli causing inflammation
  • Leukocytes occlude capillary
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10
Q

Acute Poststreptococcal Glomerulonephritis manifestations?

A

Sudden onset of:

- Gross hematuria
- Proteinuria
- Oliguria (decreased urinary output)
- Edema
- Hypertension

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11
Q

Acute Poststreptococcal Glomerulonephritis laboratory tests?

A
  • Urinalysis: Proteinuria and Hematuria
  • Renal function: Elevated BUN and creatinine (renal insufficiency)
  • C-Reactive Protein (CRP) increased indicating inflammation
  • Erythrocyte Sedimentation Rate (ESR)
  • Antistreptolysin O (ASO) blood test: circulating antibodies in the body in response to streptococcal infection. (4-6 weeks)
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12
Q

Acute Poststreptococcal Glomerulonephritis treatment?

A
  • Diuretics (Furosemide-Lasix)
  • Daily weights
  • Strict I&O
  • Sodium restriction if hypertension or edema present
  • Monitor vital signs
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13
Q

Etiology of Nephrotic Syndrome?

A
  • Nephrotic syndrome is the most common chronic glomerular injury in children
  • Etiology is not completely understood: 70-80% cases from “minimal change disease” or MCD
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14
Q

Pathophysiology of Nephrotic Syndrome?

A

glomerular membrane becomes permeable to large proteins → albumin lost in urine → due to low albumin in blood, fluid shifts to interstitial spaces resulting in edema.

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15
Q

Nephrotic Syndrome manifesations?

A
  • Massive proteinuria
  • Hypoalbuminemia
  • Hyperlipidemia
    Edema: most common presentation
  • BP is usually normal or slightly decreased
  • At risk of chronic kidney disease and end stage renal disease
  • 10-20% of children will have Steroid Resistant Nephrotic Syndrome
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16
Q

Nephrotic Syndrome nursing considerations?

A

Evaluate a child who exhibits the following symptoms for the possibility of nephrotic syndrome:

  • Periorbital, abdominal, gonadal, or lower extremity edema
  • Weight gain greater than expected based on previous pattern
  • Decreased urinary output (Fluid goes to interstitial space)
  • Pallor, fatigue
17
Q

Nephrotic Syndrome treatment?

A
  • Diet
    • Protein restricted if azotemia (excess nitrogen in the blood) or renal failure
      - Sodium restrictions
  • Steroids (Prednisone)
  • Immunosuppressant therapy (Cytoxan)
  • Diuretics (Lasix-Furosemide)
18
Q

Acute Kidney Injury (AKI) manifesations?

A
  • **Principal feature is oliguria: urine output < 1ml/kg/hr **
  • Most common cause of AKI results from severe dehydration
  • Usually reversible
  • Dialysis may be needed temporarily
19
Q

Describe Chronic Renal Failure (CRF).

A
  • Progressive deterioration over months to years
  • Final stage (End Stage Renal Disease) is irreversible
  • Treatment with dialysis and medication
  • Transplant if a candidate
20
Q

Chronic Renal Failure (CRF) manifestations?

A
  • Uremia (anorexia, vomiting)
  • Growth Failure
  • Osteodystrophy
    • bone pain, deformity (knock knees) or waddling gate, rickets
  • Convulsions (Seizure)
  • Hypertension, hypocalcemia
  • Anemia
21
Q

Renal Failure nursing considerations?

A
  • Monitor BP
  • Monitor labs (BUN/creatinine)
  • Monitor growth
  • Administer diuretics
  • Regulation of diet most effective means 2nd to dialysis
    • Low sodium, fluid restrictions initially
    • Recommended Dietary Allowance (RDA) protein
    • Potassium limitations if increased creatinine
22
Q

Who would be a better candidate for Hemodialysis?

A
  • Preferred dialysis method for children over 20 kg
  • Best suited for children who live close to dialysis center (requires 3 visits per week for 3-5hrs
  • Requires creation of a vascular access and special dialysis equipment
  • Achieves rapid correction of fluid and electrolyte abnormalities
23
Q

Who would be a better candidate for Peritoneal Dialysis?

A
  • Can be managed at home-child can receive treatment while sleeping.
  • Slower and gentle compared to hemodialysis
    Indicated for neonates, children.
  • Dialysate absorbs or pulls waste and fluids from blood vessels in the abdominal lining.
24
Q

Peritoneal Dialysis nursing considerations?

A
  • Assess peritoneal insertion site for redness, edema, discharge
  • Assess peritoneal fluid (if cloudy contact provider)- R/O peritonitis
  • Daily weight
  • Measure abdominal girth

328 Pediatrics Final Exam (5 decks)

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