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Pediatrics Test III > Renal > Flashcards

Renal Flashcards

1
Q

what is often the first sign of any type of illness in neonates?

A
  • poor feeding
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2
Q

3 parameters most significant to assess in children with renal conditions:

A
  • weight
  • I & O
  • blood pressure
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3
Q

other components of the physical exam of the renal system

A
  • abnormal rate and depth of respirations
  • HTN
  • fever
  • FTT
  • signs of circulatory congestion
  • abdominal distention
  • early signs of uremic encephalopathy
  • signs of congenital abnormalities
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4
Q

lab studies and diagnostics for the renal system

A
  • urinalysis
  • urine culture and sensitivity
  • ultrasonography
  • voiding cystourethrogram (VCUG): uses constrast to evaluate their voiding
  • intravenous pyelogram (IVP)
  • cystoscopy
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5
Q

when can we use a urine bag to collect urine?

A

for a urinalysis–don’t need sterile

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6
Q

if you want to do a urine culture, how will you collect it?

A

sterile catheterization

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7
Q

how to get a urine sample for a child <1 yo?

A
  • often use a catheter
    • if can’t obtain with a catheter, then do a suprapubic bladder tap
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8
Q

names of UTIs based on where infection is:

A
  • urethra–>urethritis
  • bladder–>cystitis
  • ureters–>ureteritis
  • kidneys–>pyelonephritis
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9
Q

4 goals of tx for UTIs

A
  • eliminate current infection
  • identify controlling factors
  • prevent systemic spread–>urosepsis
  • preserve renal function
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10
Q

what type of organisms cause UTIs?

A
  • most commonly E. coli and gram negative organisms
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11
Q

contributing factors for UTIs

A
  • urinary stasis
  • urinary reflux
  • poor perineal hygiene
  • constipation–may not allow for full emptying of the bladder
  • pregnancy
  • noncircumcision
  • indwelling catheter placement
  • antimicrobial agents that alter flora of urinary tract
  • tight clothes/diapers
  • bubble baths
  • local inflammation–vaginitis
  • sexual intercourse
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12
Q

peak ages for UTIs

A
  • 2-6 yo and sexually active adolescents
    • higher incidence in females
    • only higher incidence in males when they are newborns
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13
Q

clinical manifestations of UTI

A
  • fever
  • weight loss
  • vomiting, diarrhea
  • frequency
  • urgency
  • chills
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14
Q

in a potty trained child, what would be a sign that they may have a UTI?

A
  • daytime incontinence
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15
Q

diagnostic findings with a UTI

A
  • UA: may reveal hematuria, proteinuria, pyuria
    • urine may be foul smelling and is cloudy with possible strands of mucus
  • culture: reveals growth of bacteria
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16
Q

how to avoid UTIs

A
  • wipe front to back
  • good hydration
  • void right before and right after sexual intercourse
  • avoid bladder irritants: caffeine
  • wear cotton underwear that are not tight, should be well fitting
  • get out of wet underwear/swimsuits quickly
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17
Q

drug therapy for UTIs

A
  • uncomplicated cystitis: short term course of abx
  • complicated UTIs: long term tx
    • TMP-SMX
    • cephalexin
    • gentamycin
  • may beed antispasmodics
  • pyridium: analgesic–>turns urine orange
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18
Q

repeated UTIs

A
  • prophylactic or suppressive abx
  • TMP-SMX administered every day to prevent recurrence or single dose before events likely to cause UTI
19
Q

vesicoureteral reflux (VUR)

A
  • congenital anomalies can cause primary reflux - ureters not inserted normally into bladder
  • secondary reflux is caused by infection and ureterovesicular junction incompetency r/t edema
    • may also be r/t neurogenic bladder and NTDs
  • runs in families
  • graded 1-5:
    • 5 is worst
20
Q

clinical manifestations of VUR

A
  • dysuria
  • urinary frequency, urgency, hesitancy
  • urinary retention
  • cloudy, dark, blood tinged urine
  • recurrent UTIs
21
Q

diagnostic findings with VUR

A
  • RBCs or pyuria noted in UA
  • IVP, VCUG, or cystoscopy may reveal structural abnormalities
22
Q

tx for VUR

A
  • nonsurgical:
    • deflux injection - gel used in endoscopic injections
      • gel is injected around the ureter opening to create a valve and to make the backflow of urine into the kidneys more difficult
      • requires anesthesia
  • surgical:
    • detach ureter and reinsert at correct angle
      • use a stent
      • need 24 hr hospital stay
23
Q

nephrotic syndrome

A
  • complex of symptoms characterized by:
    • proteinuria
    • hypoalbuminemia
    • hyperlipidemia
    • altered immunity and edema
  • etiology unknown
    • but minimal change nephrotic syndrome is most common
    • can also be secondary to SLE, DM, sickle cell anemia
24
Q

pathology of nephrotic syndrome

A
  • somehow there is inc permeability to protein usually due to some damage to the glomerulus, so the protein leaks out and albumin comes out in the urine
  • what causes fluid shift from intravascular space to interstitial space?
    • hypoalbuminemia decreases the colloid osmotic pressure in the capillaries, as a result the hydrostatic pressure exceeds the colloid osmotic pressure and fluid accumulates in the interstitial spaces and the body cavities–>3rd spacing occurs
  • what does the change in intravascular vol stimulate?
    • RAAS system and secretion of ADH and aldosterone–>body tries to retain fluid
    • tubular reabsorption of sodium and water inc in an attempt to inc intravascular volume
25
Q

clinical manifestations of nephrotic syndrome

A
  • periorbital, pedal, and scrotal edema that progresses to generalized edema
    • generalized edema may progress to resp distress
  • weight inc–>b/c retaining fluids
  • dec urine output
  • possible pleural effusion–>fluid has to go somewhere
  • pallor anorexia
  • fatigue
  • abdominal pain
  • diarrhea
  • BP may be normal or even slightly dec–>b/c intravascular volume is depleted
  • high urine SG
26
Q

diagnostic findings of nephrotic syndrome

A
  • UA:
    • marked proteinuria,
    • hyaline casts,
    • few RBCs,
    • inc specific gravity
  • serum protein level is markedly decreased
    • esp the albumin level
27
Q

tx for nephrotic syndrome

A
  • during edema phase–child limited to quiet activity
  • during remission–activity is not restricted
  • acute and recurrent infections are treated with appropriate abx and efforts are made to minimize the risk of injury
  • corticosteroid–started as soon as the diagnosis has been established
    • 2 mg/kg in divided BID doses
    • 3 mos of therapy
    • course of therapy: usually not immediate change, but know they are improving when pt starts to diurese
    • remember to never d/c steroids abruptly
  • children with nephrotic syndrome often relpase 1-3 times/year
28
Q

diet for nephrotic syndrome

A
  • salt restriction necessary when massive edema and when taking corticosteroids
  • is water restricted?
    • seldom but may be necessary when have severe edema
  • protein?
    • not necessarily beneficial to inc protein in diet
    • should restrict protein if have azotemia and renal failure
29
Q

acute glomerulonephritis (GN)

A
  • most are post streptococcal
  • may be distinct entity or manifestation of SLE, sickle cell
30
Q

clinical manifestations of acute GN

A
  • HTN: due to inc ECF
  • pallor
  • irritability
  • fatigue
  • lethargy
  • periorbital and generalized edema–not as obvious as nephrotic syndrome
  • weight gain
  • electrolyte imbalance
  • oliguria and hematuria–cola colored urine
  • CVA tenderness
  • anorexia
31
Q

diagnostic findings with GN

A
  • UA: RBCs, casts, WBCs, and protein
    • (inc amt of protein = inc severity of renal dz)
  • serum chemistry:
    • elevated BUN, Cr, ESR, and anti streptolysin O titer (ASO–shows if current or post strep infection)
    • serum complement level (CS) is dec initially but returns to normal 8-10 weeks after onset GN
32
Q

acute post streptococcal GN (APSG)

A
  • noninfectious renal dz (autoimmune)
  • onset 5-12 days after another infection
  • often group A beta hemolytic strep
  • most common in children 6-7 yo
    • older kids than nephrotic syndrome
  • uncommon in children under 2
33
Q

nursing mgmt of APSG

A
  • manage edema: daily weights, accurate I/O, daily abdominal girth
  • nutrition:
    • low sodium: moderate restriction with HTN or edema
    • low to moderate protein
    • potassium containing foods restricted during the period of oliguria
  • susceptibility to infections
  • bed rest is not necessary–although most kids will restrict activity b/c of malaise
34
Q

hypospadias

A
  • urethral opening below the glans penis or anywhere along ventral surface of penile shaft
  • can be assoc with undescended testes and inguinal hernias
  • pathology results from failure of the urethral folds to fuse completely over the ureteral groove
35
Q

post op care for hypospadias or epispadias

A
  • care of indwelling catheter
    • no baths until catheter removed
    • instruct to gently cleanse around tip of penis and catheter
  • encourage liquids
  • analgesia as needed
36
Q

acute renal failure (ARF)

A
  • kidneys suddenly unable to regulate the volume and composition of urine
    • esp if dehydrated
  • not common in children
  • principle feature is oliguria
    • assoc with azotemia, metabolic acidosis, and electrolyte disturbances
  • most common cause is transient renal failure resulting from severe dehydration
    • usually reversible
  • mgmt: aimed at minimizing complications
    • assess for changes in V/S, U/O
37
Q

complications of ARF

A
  • hyperkalemia: restrict potassium
  • HTN
  • anemia
  • sz
  • hypovolemia
  • cardiac failure w/ pulmonary edema
38
Q

chronic renal failure (CRF)

A
  • begins when diseased kidneys cannot maintain normal chemical structure of body fluids
  • clinical syndrome called uremia
39
Q

potential causes of CRF

A
  • congenital renal and urinary tract malformations
  • VUR assoc with recurrent UTIs
  • chronic pyelonephritis
  • chronic GN
40
Q

what are the 3 types of dialysis?

A
  • hemodialysis
  • peritoneal dialysis
  • hemofiltration
41
Q

hemodialysis

A
  • very time consuming
  • requires creation of a vascular access and special dialysis equipment
  • best suited for kids who can be brought to facility 3 times per week for 4-6 hrs
  • achieves rapid correction of fluid and electrolyte abnormalities
  • assess AV fistual: auscultate for bruit and palpate for thrill
42
Q

peritoneal dialysis

A
  • abdominal cavity acts as semipermeable membrane for filtration
  • can be managed at home in some cases
  • warmed solution enters peritoneal cavity by gravity
    • remains for period of time before removal
  • weigh client before and after procedure to see how much fluid taken off
43
Q

continuous venovenous hemofiltration

A
  • uses technique for ultrafiltration of blood continuously at a very slow rate
  • works with the fluid overload in portop period
  • successful alternative for critically ill children who might not survive rapid volume changes of hemodialysis of PD
    • best type of dialysis if client is hemodynamically unstable
  • done in ICU
44
Q

transplantation

A
  • have to match HLA antigens
    • 7 HLAs–more that match, the better the chance to prevent rejection
  • cna be from living or cadaver donor
  • primary goal: long term survival of grafted tissue
  • will be on immunosuppresant therapy

Pediatrics Test III (6 decks)

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