Renal Disorders Flashcards
Bladder Capacity- Newborn
1 to 2 oz
1 oz = 30cc
Bladder Capacity- Child
Age (in years) + 2 = oz
Phimosis
Narrowing or stenosis of the opening of the foreskin
Normal in infants and young boys
Can obstruct flow
Phimosis Nursing Care
Thorough and consistent hygiene
DO NOT forcibly retract foreskin– PARAPHIMOSIS
Worry about infection
Phimosis Treatment
Circumcision
Hydrocele
Fluid filled sac around a testicle, scrotal swelling
Non-communicating - Common in newborns, resolves on own
Communicating - Surgical repair
Hydrocele Nursing Care
Instruct parents that most resolve spontaneously
Continue to watch
Hypospadias
Urethral opening is located below the glans penis or anywhere on the ventral surface
Hypospadias Nursing Care
Inspect all male newborns
Teach parents post operative care - indwelling catheters, stents, irrigation
I/O’s
Hypospadias Goals
Enable normal voiding
Preserve sexual functioning
Ambiguous Genitalia
Disturbance of normal events of gender determination
Abnormal gender determination, differentiation of gonads, differentiation of ductal systems, abnormal secretion of androgen or tissue insensitivity to hormone
Ambiguous Genitalia Nursing Care
Support parents in participation with health care team to make a gender assignment
Assist parents in understanding the process and importance of careful assignment
Assignment does not need to happen immediately
Vesicoureteral Reflux
Retrograde flow of urine from the bladder into the ureter
Most common cause: pyelonephritis
Girls > Boys
HIGH RISK FOR INFECTION
Vesicoureteral Reflux- Primary
Congenital
Abnormal tunneling of urethral segment or defects in ureter orifice
More common amount siblings
Vesicoureteral Reflux- Secondary
Acquired
UTI or trauma can produce temporary reflux
Multiple infections before 3- be suspicious
Vesicoureteral Reflux Grades
Full bladder – refluxes back up in ureter
Grade 1 &2 – Can resolve on its own
Grade 4&5 – Surgical Interventions
Vesicoureteral Reflux Nursing Care
Goal is to prevent infection and scarring
Support parents in adherence to medication
Chronic antibiotics
Frequent evaluation of urine
Obstruction of Uropathy Symptoms
UTI Hematuria Nausea Flank pain Dysfunctional voiding patterns Can happen anywhere in the tract Urinary stasis is the biggest risk
Upper Tract Urinary Infection
Ureter
Renal Pelvis
Calyces
Renal parenchyma
Lower Tract Urinary Infection
Urethra
Bladder
Risk Factors for UTI
Urinary stasis - biggest risk
Children 2-6 – potty training age!
Girls
Recurrent UTI
Repeated episodes of bacteriuria
Persistent UTI
Despite antibiotics treatment, bacteria persits
Febrile UTI
Bacteria with fever, implies pyelonephritis
Infants- common UTI with fever
Urethritis
Inflammation of the urethra
Urosepsis
Systemic signs of bacterial illness with UTI
Pyelonephritis
Inflammation of the UPPER urinary tract AND kidney
Cystitis
Inflammation of the bladder
UTI Nursing Care
PREVENTION
Proper voiding technique, avoid tight clothing and diapers, encourage generous fluid intake, avoid constipation, avoid “holding” urine
UTI Symptoms
Educate parents! Signs: incontinence in a toilet trained child, strong smelling urine, frequency and urgency, pain
Acute Glomerulonephritis (AGN)
A post- infection, immune complex condition associated with a combination of symptoms
SECONDARY
Glomerular capillaries are injured = decrease GFR
AGN Symptoms
OLIGURIA
EDEMA
HTN
Circulatory congestion - puffy eyes, hematuria, proteinura, loss of appetite, cola colored urine, irritable, lethargic
AGN Timeline
Staph infection 10days - 2 weeks Then symptomatic Edema resolves- AGN starting to resolve 10 days - 3 weeks acute phase followed by DIURESIS phase
AGN Complications
Hypertensive encephalopathy and cerebral edema
Acute cardiac de-compensation- from HTN
Acute renal failure
Na and Water retention issues
AGN Nursing Care
Closely monitor VS, fluid balance, and childs appearance
Daily weight is best!
Assess irritability, change in LOC, HTN
Assess early renal failure – hyperkalemia, uremia, excessive BUN, elevated creatinine, metabolic acidosis
Nephrotic Syndrome
A number of distinct glomerular diseases with increased glomerular permeability = massive proteinuria, hypoalbuminemia, hyperlipidemia and EDEMA
MASSIVE PROTEIN IN URINE- “Dumping”
Leak fluid into tissues- vascular protein decreases
Types of Nephrotic Syndrome
Minimal changes - 80%, biposy looks normal. Resolves
Secondary – result of AGN
Congenital – Autosomal recessive genetic disorder
Nephrotic Syndrome Nursing Care
Strict daily weights, VS, I/O's Measure abdominal girth, urine output, color and appearance of protein Meticulous skin care- look at folds! Preventive measures to avoid infections Monitor for spontaneous peritonitis Good nutrition and meal planning! Developmental and family support
Acute Renal Failure
Sudden inability of the kidneys to regulate volume and composition of urine
Oliguria, azotemia, acidosis, diverse electrolyte imbalances
DEHYDRATION! Secondary to vomiting or diarrhea
TX: Dialysis, Na balance
Enuresis
Intentional or involuntary passage of urine into the bed during sleep or into clothing during daytime hours at least twice a week for 3 months in children at least 5 years of age
Usually resolves between ages 6 and 8
Enuresis: Primary
Never achieved continence
Enuresis: Secondary
Onset of wetting after having achieved continence
Infection, physiologic reason, psychological , a significant event
Enuresis: Causes
Urinary tract infection that is undetected
Genetic predisposition
Familial tendency
Emotional or behavioral factors
Enuresis: Nursing Care
Assess for physiologic cause
Support and respect the child and parents
Support treatment plans (audible alarms, medications, behavioral therapies)
Help child manage treatment expectations and provide consistency in the process
Provide reassurance to parents
Medication to decrease bladder spasms
Encopresis
Repeated voluntary or involuntary passage of feces of normal or near normal consistency in inappropriate places at least once per month for 3 months after the age of 4 years
CONSTIPATION
Encopresis: Primary
Never achieved continence
Encopresis: Secondary
Happens after established fecal continence
Painful to have a BM– further avoidance
Encopresis: Etiology
Constipation due to stressors in the environment and withholding stool
Chronic and severe constipation resulting in fecal obstruction
Abnormalities of the digestive tract (rectal prolapse)
Medical conditions [CP, MD, irritable bowel syndrome (IBS)]
Fear-panic disorders leading to learned abnormal defecation patterns
Encopresis: Nursing Care
Thorough history and care is directed toward cause of soiling Education about normal digestive patterns and defecation Bowel retraining Correction of impaction Positive reinforcement Family plan and follow-up Support and non-judgmental attitude At 5 -- suppose to be continent!
