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Peds Final Exam > Renal and Endocrine (WEDNESDAY) > Flashcards

Renal and Endocrine (WEDNESDAY) Flashcards

1
Q

Most common pathogen of UTI?

Symptoms of UTI in a child? 5

A

Escherichia coli most common pathogen (80% of cases)

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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2
Q

UTI Diagnostic Studies

preferred method?
What method is not used?
Whats used for older child?

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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3
Q

UTI TREATMENT—Antibiotics

Tx guided by ?
Treatment?
SNAP

A

Tx guided by clinical features, age, local resistance patterns and C&S

TREATMENT
-3rd generation Cephalosporin

Septra-Trimethoprim-sulfamethoxazole (Bactrim)
-Sulfa allergy contraindication
-Steven’s- Johnson Syndrome

-Nitrofurantoin (Macrobid)

-Amoxicillin

-Pyridium (OTC and prescribed)
-Relieves symptoms of UTI
-Stains urine reddish-orange (mistaken for blood)

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4
Q

Calculate normal urine output for a child.

A

Normal urine output: 1-2cc/kg/hour

Minimum urine output = 1 cc/kg/hour

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5
Q

Acute Poststreptococcal Glomerulonephritis

Caused by?
Onset?

Sudden onset of?
(PHOGE)

A

Caused by group A β-hemolytic streptococci (strep throat)

Onset 14 days after infection

antibody complexes collect in the glomeruli causing inflammation

Leukocytes occlude capillary

Proteinuria
HYPERTENSION
Oliguria (decreased urinary output)
Gross hematuria
EDEMA

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6
Q

Acute Poststeptococcal Glomerulonephritis lab tests

Four
Most important blood test?

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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7
Q

Acute Poststeptococcal Glomerulonephritis Management

A

Diuretics (Furosemide-Lasix)

Daily weights

Strict I&O

**Sodium restriction if hypertension or edema

Monitor vital signs

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8
Q

NEPHROTIC SYNDROME

What is lost in the urine?
Fluid shifts where and causes what?

A

Nephrotic syndrome is the most common chronic glomerular injury in children

Etiology is not completely understood: 70-80% cases from “minimal change disease”

Glomerular membrane becomes permeable to large proteins, especially albumin.

Albumin (Protein) is lost in the urine (Hyperalbuminuria)

Albumin in the blood decreases (Hypoalbuminemia) due to loss of albumin in the urine.

Due to the low albumin in the blood, fluid shifts to interstitial spaces resulting in edema.

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9
Q

Nephrotic Syndrome continued

three things happen?
Most common presentation?
BP is what?
at risk for what?

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

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10
Q

Nursing Alert nephrotic syndrome

Edema where?
3 other things

A

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

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11
Q

Nephrotic Syndrome Management

Whats restricted?
whats the therapy?

A

-Protein restricted if azotemia or renal failure

Sodium restrictions

Steroids (Prednisone)
-2 mg/kg divided into BID doses
-4-6 weeks of therapy then weaned (steroid duration of 3 months)

Immunosuppressant therapy (Cytoxan)
-more susceptible to infection

Diuretics (Lasix-Furosemide)

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12
Q

Nephrotic Syndrome (chart)

A

Damage to the glomerular increases permeability of the membrane to *protein (albumin)

*Massive proteinuria (3+-4+)
Hypovolemia (shift of fluid to interstitial space)
*Decreased urine output
Hyperlipidemia
Hypoalbuminemia
Normal or low B/P
*Edema r/t hypoalbuminemia
*Hematuria
Steroids, diuretics, immunosuppressants (Cytoxan)

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13
Q

acute glomerulonephritis chart

A

Immune complex disease following Group A β-hemolytic streptococci infection
*Mild proteinuria
Total body volume overload
*Decreased urine output
Normal(lipids)
Normal(albumin)
Hypertension
*Edema r/t decreased glomerular filtration rate (sodium and water retention)
Antistreptolysin O (ASO) titer: positive
*Hematuria
Antihypertensives, diuretics

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14
Q

What do nephrotic syndrome and APGN have in common?

A

Proteinuria
Decreased urine output
Edema
Hematuria

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15
Q

Acute Kidney Injury (AKI)

Principal feature?
Most common cause of AKI?
Usually what?
what may be needed?

A

-Definition—kidneys suddenly unable to regulate the volume and composition of urine

-Principal feature is oliguria: URINE OUTPUT< 1ml/kg/hr

severe dehydration

USUALLY REVERSIBLE

-Dialysis may be needed temporarily

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16
Q

Chronic Renal Failure (CRF)

Begins when?
progressive what?
Reversible?
Treatement?

A

Begins when diseased kidneys cannot maintain normal chemical structure of body fluids

Progressive deterioration over months to years

Final stage (End Stage Renal Disease) is irreversible

Treatment with dialysis and medication

Transplant if a candidate

17
Q

Potential Causes of Chronic Renal Failure

A

Congenital renal and urinary tract malformations

VUR (Vesicoureteral Reflux) associated with recurrent UTIs

Chronic pyelonephritis

Chronic glomerulonephritis

18
Q

Chronic Renal Failure: Signs and Symptoms

A

Uremia- vague ill-health, lassitude, anorexia and vomiting.
-Urea increases with renal failure.

Growth Failure
Osteodystrophy
Anemia

Convulsions (Seizure)
-Hypertension, hypocalcemia or uremia

19
Q

Nursing consideration CRF
monitor what?
Administer what?
Diet?

A

Monitor BP, labs (BUN/creatinine), 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

20
Q

Hemodialysis

Requires creation of?
Preferred for who?
Best suited for children who?
Achieves what?

A

Requires creation of a vascular access and special dialysis equipment

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

Achieves rapid correction of fluid and electrolyte abnormalities

21
Q

Child Receiving Hemodialysis?
no what?

A

NO BPs in the arm AV fistula

22
Q

PERITONEAL DIALYSIS

primary osmotic agent to remove water

A

-Fluid instilled into the peritoneal cavity and left for prescribed time

-Glucose is primary osmotic agent to remove water

-Fluid is allowed to drain thus removing waste products and excess water

-Tidal continuous cycling PD

-Dialysate absorbs or pulls waste and fluids from blood vessels in the abdominal lining.

-Can be managed at home-child can receive treatment while sleeping.

-Slower and gentle compared to hemodialysis

-Indicated for neonates, children.

23
Q

Nursing Management Peritoneal Dialysis

A

-Assess peritoneal insertion site for redness, edema, discharge

-Assess peritoneal fluid (if cloudy contact provider)- R/O peritonitis

-Daily weight

-Measure abdominal girth

24
Q

Type 1 diabetes

What is it?
Onset?
Symptoms? 3 ps and what?
Labs?

A

Autoimmune destruction of pancreatic beta cells

Absolute insulin deficiency

Onset: Abrupt

Polyuria (new onset bedwetting)
polydipsia
polyphagia
Rapid weight loss

Insulin (injections or pump)
Balance diet and activity

Labs: Monitor glucose level multiple times a day (goal 80-120 mg/dl)

Hemoglobin A1C- average blood sugar over the past 3 months.

Urine testing for ketones done during illness and Diabetic Ketoacidosis

25
Q

Type I diabetes Management

What should be monitered?
Postive ketones indicate?
encourage what?
Insulin should never be?
Children require what?

A

Parents should monitor blood glucose levels and urinary ketones every 3 hours. Positive ketones indicate acidosis and DKA.

Encourage fluids to prevent dehydration

Dont stop insulin during illness

Children require more insulin when they are sick r/t hyperglycemia

26
Q

Hypoglycemia

(definition and causes)

A

Blood sugar < 70 mg/dl

Causes
-Too much medications (i.e., insulin)

-Medication mistakes (i.e., accidental too much insulin administered)

-Missed meals

-Too little food eaten after insulin

-Excessive exercise - sports

27
Q

hypoglycemia management

3

A

-Hold insulin

-Have child eat or drink something that has sugar in it (ie.g., Orange juice, cake icing, hard candy, milk)

-Administer Glucagon IM or SQ

28
Q

Diabetic Ketoacidosis (DKA)

DKA results in? 3

A

Life-threatening situation

Newly diagnosed diabetic, insulin omission in known diabetics, acute gastroenteritis with persistent vomiting

DKA results in:
**Metabolic acidosis (ph < 7.30 or Bicarb (HCO3) < 15 mmol/L)

**Hyperglycemia (Serum glucose > 250 mg/dL)

**Fluid and electrolyte shifts

Hypokalemia
Hyponatremia

29
Q

DKA-Clinical Manifestations

what is a complication of DKA treatment?
Monitor what?
5 other signs?

A

**Cerebral edema is a complication of DKA treatment.

**Monitor neurological status (Glasgow Coma Scale)

Vomiting

Signs of dehydration-Hypotension, tachycardia

Kussmaul respirations- deep rapid breathing (metabolic acidosis)

Acetone odor on breath

Decreased level of consciousness

30
Q

Management of DKA

Avoid what?
Do not push what?

A

Iv fluid therapy

insulin therapy

potassium

**Avoid rapid bolus of fluids or insulin

**DO NOT PUSH K+

31
Q

IV Fluid Therapy

Corrects what?

A

Correct dehydration
0.9 Normal Saline

Then D10NS (balances insulin to avoid hypoglycemia and decreases cerebral edema due to fluid shift)

32
Q

insulin therapy

Corrects what?

A

Corrects Ketoacidosis

Continuous infusion
Regular Insulin 0.1 units/kg
per hour

Begin IV insulin after Initial IV hydration and urine

33
Q

potassium

A

Electrolyte Shifts

IV Potassium after IV fluid and urinating (Never give Potassium absence of urine).

Potassium is mixed in IV fluids - not given in a syringe IV push.

Peds Final Exam (14 decks)

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