renal alterations in children Flashcards
what are the kidneys function?
- elimination of liquid waste products
- production of hormone erythropoietin
- production of chemical renin
- stimulation of hormone aldosterone
- regulation of fluids and electrolytes
- regulation of acid-base balance
Renal development and function infancy:
glomerular filtration and absorption low in infancy until the age of 1-2 years. unable to concentrate urine effectively, unable to reabsorb sodium and water, produces very dilute urine.
Urinary Tract Infections in infants symptoms
vague symptoms, fever, irritability, poor food intake, diarrhea, committing, jaundice, strong-smelling urine
UTIs in children symptoms
urinary frequency, strong smelling urine, hematuria, enuresis, dysuria, fever, abdominal pain in <4 yr and flank pain in >4 yr
UTI indicators:
frequency, urgency and urination pain, foul urine odor, color and clarity of urine, specific gravity and pH of the urine will be skewed, abdominal, pelvic and flank pain
UTI prevention is the most important thing, how do we do it?
females: wipe front to back and cotton panties.
avoid ‘holding’ and empty bladder completely, avoid and treat constipation- high fiber diet, have them wake up early so they have time to go.
no bubble baths and teach parents to observe for signs of UTI.
increase clear liquid, avoid carbonated bevs. and caffeine, observe for signs of parasites and treat them. urinate as soon as possible after intercourse.
Clean-catch urine
first morning sample, female child can face the tank to obtain best sample; take to the lab immediately or refrigerate NO LONGER THAN 24 hours.
infants: in and out Cath is the more effective way.
Nursing care for UTIs in children
provide large quantities of Childs favorite oral fluids, start and maintain patent IV, encourage fluid consumption, and treat fever and discomfort.
Medication therapies for UTIs
1st in line: trimethoprim-sulfamethoxazole
uncomplicated: short term course of antibiotics
complication: long term course
Pyridium: reddish orange staining of urine-sooth effect on the urinary tract
nursing considerations for Sulfamethoxazole-trimethoprim
-give meds before sleep
-take with 8 oz water and ensure plenty of water intake during course
-causes photosensitivity
-SE: mainly GI- loss of appetite, N/V
-Serious SE: bruising, bleeding, aplastic anemia, jaundice, hepatic necrosis, mouth sores, joint aches, severe skin rashes, itching and sore throat, SJS
They need to notify the physician at the first sign of any skin rash- no matter how MILD!
what is pyelonephritis?
infection of the structures of the kidneys (upper tract), observed in infants and young children -where UTI ascended. treat promptly with antibiotics
what is cystitis?
lower tract infection
what is vesicoureteral reflux?
retrograde flow of bladder urine into the ureters, comes in grades; we suspect it after the 2nd UTI
-will be on prophylactic antibiotics- they have a genetic link-siblings should be testing before the age of 2
when should we do the voiding cystourethrography (VCUG)? and what is it?
we should do it on the 2nd UTI, and we should educate the child on exactly that’s happening.
contrast medium is injection into the bladder through the urinary catheter
