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Peds Exam 2 > Renal > Flashcards

Renal Flashcards

1
Q

Organs involved in lower urinary tract

A

Urethra & Bladder

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2
Q

Organs involved in upper urinary tract What do we worry about here?

A

Ureters, Renal Pelvis, Calyces, Renal Parenchyma We worry about the inflammation and scarring that is damaging to tissues. Long term wise, it can affect the kidney function.

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3
Q

Do infant and elderly UTI symptoms present like adult symptoms?

A

No they present differently. But sometimes they don’t present symptoms at all.

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4
Q

What is Pyelonephritis ? What is the main mechanism that causes this?

A

Upper tract infection that leads to organs & is huge concern for renal function An obstruction causing reflux of urine back into upper urinary tract.

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5
Q

Is urine sterile? Is this important?

A

We used to think it was. But now, we know it has some organisms in it. It was never an issue though bc the constant flow of urine flushes them out. Now, when there’s a block and stasis of urine, the organisms can accumulate and grow inside urinary tract.

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6
Q

(What is hydronephrosis?)

A

When the renal pelvis enlarges due to an obstruction of some sort . So in short, Pyelonephritis (upper uti) can cause hydronephrosis.

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7
Q

Who is more likely to have a uti? Do men have protection? What about when you consider circumcision?

A

Females due to shorter urethra The prostate secretions actually protect males from harmful organisms. Uncircumcised infant boys actually become more at risk due to the foreskin trapping organisms.

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8
Q

Contributing factors for uti?

A

Stasis of urine Low fluid intake alkaline ph Reflux - so when someone constricts their bladder muscles and don’t get a steady stream which flushes organisms away

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9
Q

How can you avoid urine stasis habits?

A

Don’t make your child hold their pee! Or make sure child is ok to pee at school.

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10
Q

How can you make sure your child gets enough water?

A

Small frequent sips or popsicles

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11
Q

Most common organism to cause uti

A

E. Coli due to proximity to anus and is already within GI tract BUT it can be other organisms. Need to do culture to determine organism and then base treatment off of it.

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12
Q

Neonate symptoms of uti

A

Not eating Breathing is distressed Temp goes up and down Jaundice

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13
Q

Infant to 2 yr old symptoms of uti

A

Fever, Irritability, Exhaustion Vomiting and diarrhea now Diaper rash & Crying when peeing Enlarged kidneys or bladder Frequent urination that smells Seizures

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14
Q

Older child uti symptoms

A

Very classic.. Frequent peeing that smells Incontinence even Fever and vomiting Flank pain Hematuria or blood Pain on urination Accidents at night and day (despite being potty trained by now)

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15
Q

If an infant comes in with a fever ands shows abnormal signs, how soon do we check for uti?

A

Pretty soon. The baby is wearing a diaper and so that can increase odds.

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16
Q

Best way to diagnose uti? Gold standard? How do you collect?

A

UA but understand that infants aren’t just going to pee in a cup. Gold standard is catheter but that isn’t always necessary. Get midstream - so get rid of first few CC of urine and then collect the urine that comes after.

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17
Q

What is a bagged UA?

A

Can essentially tape a bag to infant genitals to get the lab. But, you won’t be able to get the ideal midstream from this. Also have to make sure to remove it before urine sits too long due to test accuracy. Check frequently.

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18
Q

What is suprapubic aspiration?

A

Take needle to aspirate urine from the bladder on the suprapubic surface for UA. Very sterile. Probably second gold standard.

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19
Q

What is Leukocyte Esterase? What about Nitrites?

A

Product of WBC breakdown in the urine. If it is present, there’s a good change that you have a uti. It’s more of a less invasive marker option. Nitrites kinda work the same way. BUT just know these only are reliable if you get a positive result. If you get a negative result it doesn’t rule out infection. Need to get a culture to know for sure.

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20
Q

What will repeat UTI’s make us concerned about?

A

Are there structural abnormalities that are causing the uti? To find out we will do imaging like sonogram, ultrasound, IVP, VCUG, cystocopy, etc. All these check for obstruction or narrowing that cau cause reflux.

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21
Q

Does AAP recommend about treating infants with antibiotics?

A

Recommend urine specimen and culture dont to confirm uti

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22
Q

Main goals for managing uti?

A

Treat infection, Determine anatomy issues, Preserve kidneys, prevent sepsis or spreading to bloodstream

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23
Q

What should we educate parents o?

A

Hygiene such as diaper changes, wiping, etc. And don’t stop meds !

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24
Q

Antibiotics used for uti treatment?

A

Penicillins - most common Sulfonamide Cephalosporins Nitrofurantoin You know which one to use based off culture.

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25
Q

What is VUR?

A

Stands for Vesicoureteral Reflux When ureter valves don’t close due to anatomical placement on the bladder. This allows for urine reflux and leads to upper uti (pyelonephritis)

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26
Q

How can VUR effect ureters long term?

A

The ureters become backed up and then end up stretched and distorted but also just general scarring of the kidneys occur.

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27
Q

VUR grade 1 (I)

A

Reflux to ureter only

28
Q

VUR grade 2 (II)

A

Reflux into ureter and renal pelvis. No distention

29
Q

VUR grade 3 (III)

A

Reflux into ureter and renal pelvis with mild hydronephrosis or distention

30
Q

VUR grade 4 (IV)

A

Now how moderate hydronephrosis or distention

31
Q

VUR grade 5 (V)

A

Severe hydronephrosis now. Ureters end up twisted

32
Q

How is VUR diagnosed?

A

VCUG if it doesn’t go away on its own as a mild case. Ureter, kidneys, and bladder will have to have dye put in them.

33
Q

How will they treat mild VUR? How will they treat severe VUR? Describe it. Antibiotics? And toilet training?

A

May do some watching and waiting. If they see it improving on its own they might allow it to play out. If too severe they’ll just ahead and do surgical interventions bc they don’t wanna risk the kidneys. Surgery includes re-implanting ureter into proper position so the valves work. Both cases may receive low dose antibiotics. Just depends on whether they will do a watch and wait scenario. And if child is able to become toilet trained they may stop antibiotics.

34
Q

When taking care of a suprapubic catheter (catheter inserted through suprapubic site), what will care be like?

A

A combination of foley-like care but also taking care of the stoma. Check for bleeding, drainage, and clots. Flushing with saline is appropriate.

35
Q

After surgery, what is the bladder at risk for?

A

Infection of course but also bladder spasms! Give B&O or a Ditropam for anti-spasmotics.

36
Q

What are the hydration needs after surgical intervention for VUR?

A

Hydrate more often since they will need 1.5-2 x than the maintenance amount

37
Q

What is acute glomerulonephritis?

A

An acute onset of infection that occurs following another infection of strep, pneumonia, or viral in nature

38
Q

Acute glomerulonephritis features?

A

Oliguria or not peeing Edema of face Hypertension Congestion Blood & Protein in urine (Hematuria/Proteinuria) They will overall just feel really unwell.

39
Q

Most common type of glomerulonephritis? What age?

A

Acute post strep glomerulonephritis (APSGN) which is common in kids that are school aged

40
Q

In Acute post strep glomerulonephritis , what is the patho?

A

Strep infection that was treated leaves behind the membrane of the organism allowing it get into the circulation and cause inflammation of the renal system.

41
Q

What does the acute post strep glomerulonephritis result in? How long does it last?

A
  • Will result in edema - which acts as an obstruction so fluid builds up. - HTN is next - sodium increase - third spacing All because of the old membrane causing inflammation and edema. Last anywhere from 7 days to 3 weeks.
42
Q

Now, if acute post strep glomerulonephritis is caused by something thats viral will we even know ?

A

No sometimes won’t even know the kid even had an infection to cause the issue.

43
Q

Acute post strep glomerulonephritis symptoms

A

The same facial swelling that may even spread to abdomen now. Hematuria & Proteinuria Hypertension (may need anti-hypertensives) Won’t want to eat Tea stained urine Oliguria or no peeing

44
Q

What are signs of improvement with acute post strep glomerulonephritis?

A

When urine output returns Hematuria improves Other symptoms go away. Proteinuria may linger even after tx tho.

45
Q

When treating acute post strep glomerulonephritis would you want to use a diuretic?

A

Probably not. A diuretic won’t help since it is an obstructional edema issue.

46
Q

With acute post strep glomerulonephritis, what is a neuro complication that can occur?

A

Hypertensive Encepholpathy which can have effect on the ANS system leading to - decreased LOC - seizures and vomiting - headache and dizziness

47
Q

What about a cardiac complication of acute post strep glomerulonephritis? Should we still try to protect kidneys from renal injury?

A

Cardiac Decompression from hypervolemic stage. Can show as - enlarged heart - pulmonary edema Yes! the kidneys are the main problem in the first place & we don’t want any other issue to pop up such as a renal injury

48
Q

How is acute post strep glomerulonephritis diagnosed?

A

Check symptoms and check titer - it can see if you had a past infection (a reg throat swab wouldn’t be able to do this if the infection had passed) Can also do a urinalysis to check and see how the urine is doing in terms of protein, wbc, nitrites and general appearance

49
Q

How to manage edema with acute post strep glomerulonephritis?

A

Edema - Take weight Check I & O Restrict fluids & Na - Diuretic use doesn’t help that much though. Only use if renal failure is not severe.

50
Q

How to manage BP in acute post strep glomerulonephritis?

A

BP - antihypertensives Monitor frequently

51
Q

How to manage seizures in acute post strep glomerulonephritis?

A

Anticonvulsants

52
Q

How to address diet in acute post strep glomerulonephritis?

A

If in renal failure restrict protein, K, & Na If not, then normal diet is ok. Just no adding extra salt.

53
Q

When do we use antibiotics in acute post strep glomerulonephritis?

A

Persistent infections. We try to allow it to run its course.

54
Q

In acute post strep glomerulonephritis, how often do we monitor vitals? How often do we check weight? What do we check for when assessing urine? How often do we pay attention to I&O? Other things to check?

A

Monitor vitals every 4-6 hrs. Check weight daily Assess the volume and appearance of urine. Check I&O as much as possible. Check signs of fluid status as well. Pay attention to behavior and general appearance

55
Q

If any patient is on a fluid restriction , what should you as the nurse do to prepare family?

A

Plan out how they are going to distribute fluids. You don’t want them to drink everything by 9 am essentially.

56
Q

What is chronic glomerulonephritis?

What age is this more common in?

A

This is a type of infection that comes from a response to other disease processes going on.

Ex: Lupus

Chronic is more common in older kids compared to infants bc it takes time for these diseases to run their course.

57
Q

How is chronic glomerulonephritis diagnosed?

A

Biopsy for changes in renal tissue

58
Q

Three treatment options for chronic glomerulonephritis?

A

1) gluccocorticoids or cytotoxic agents to reduce inflammation
2) Dialysis if it is very chronic
3) Renal transplant but only if the disease that caused this can somehow be managed so it doesn’t happen again.

59
Q

Types of Nephrotic Syndrome?

A

1) Idiopathic
2) Minimal Change

60
Q

What is the patho of Minimal Change Nephrotic syndrome?

What does this cause?

Which hormones are affected ?

A

A disturbance (metabolic, biochemical, or physio) in the basement of the glomeruli’s that changes it’s membrane permeability.

Large molecules of protein and lipids can now pass over - and water follows to cause third spacing.

ADH and aldoseterone secrete causing sodium retention.

61
Q

Symptoms of Nephrotic Syndrome

Type of edema? Which results in?

Labs?

BP?

Skin?

A

General Edema and weight gain

Microscopic or absent hematuria

Severe proteinuria in urine

Low protein in blood now

Normal or decreased BP (due to shock)

Skin breaksdown due to edema

Skin infection risk

62
Q

Diagnosing Nephrotic Syndrome

A

Urinalysis

Serum proteins

Serum cholesterol/triglycerides

Biopsy of renal membrane

63
Q

How is Nephrotic Syndrome treated?

Main goal?

A

Very supportive

Main goal is to reduce loss of protein from membrane.

64
Q

Type of med that can help w inflammation in nephrotic syndrome? For how long?

What’s the name of the med?

And what can these meds increase?

A

Corticosteroids.

Can reduce it near the site that altered permeability.

Can be given for 4-6 weeks. Then go onto 2-5 mo schedule.

Prednisone

65
Q

Nephrotic syndrome diet plan?

Why measure abdominal girth?

A

Depends if you have renal failure or not. If not, then encourage protein, no water restriction, no added salt.

For ascites tracking

66
Q

How common are relpases with nephrotic syndrome?

How do they reduce the relapse rate and increse remission time?

A

1-3x in a year is common

W Cytoxan

67
Q

Cytoxan side effects (nephrotic syndrome relapse)

A

Bone marrow depression of neutrophils, rbcs, and platelets.

Azoospermia - lack of sperm in semen

Malignancy - cancer

Hemorrhagic cystitis - to avoid, do high fluids to flush the bladder of the med .

Nephrotoxicity - so montior for renal function

Peds Exam 2 (7 decks)

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