renal infections exam 1 Flashcards
types of Pediatric Genitourinary DysfunctionUrinary Tract Infections?
Bladder = Cystitis
Kidney = Pyelonephritis
nursing care for Pediatric Genitourinary DysfunctionUrinary Tract Infections?
intake and output
blood pressure
teaching prep of child & family
pain control
UTI in kids?
Incidence and type of kidney or urinary tract dysfunction change with age and maturation
Identified with physical exam, family history, child’s history, lab studies, radiographic studies, biopsy, physical assessment
In newborns association between malformation of another system (low-set ears or ear tags)
Uncircumcised males under 3 mo. (20%)
Structure of short urethra = increased bacteremia in females
Stasis (normally sterile)
nursing care for UTI?
Fluid intake – flushing = lowered organisms (not prior to collection-dilutes sample)
Cranberry juice prevent attachment of E.Coli to tract walls
UTI in children under 2 yr, associated w/ renal malf. & reflux may have progressive renal injury
Prep family & child developmentally for tests
s/s of UTI?
Decreased appetite
Voiding often
Thirsty
Crying with painful void
Fever
Fatigue
Blood in urine
c/o abd pain
how to prevent UTI?
Girls should clean from front to back
No restrictive clothing-Cotton underwear only
Avoid bubble baths
Use bathroom when nature calls
Increase fluid intake
CM of Vesicoureteral Reflux?
Cystitis moves to pyelonephritis
Residual ureter urine in bladder until next void
High fevers, vomiting, chills
diagnosis of Vesicoureteral Reflux?
Cystoscopy or Voiding cystourethrogram
nursing care of Vesicoureteral Reflux?
Prevent bacteria reaching kidneys to reduce scarring chance
Low dose abx w/ cultures 2-3 months
Assess for high fevers, vomiting, chills
patho of Obstructive uropathy?
Structural or functional = hydronephrosis – acquired or congenital, unilateral or bilateral
With congenital defect consider malformation
Distal nephron damage (chronic uropathy) = urine concentration
nursing care of Obstructive uropathy?
Prepare family & child (consider development) {emotional}
Potential discharge home w/ devices
Equipment, fluids (urine flow), clotting, sediment
Possible dialysis or transplant in future
patho and nursing care for external defects?
Serious due to psychological impact
Activities & inquisitive nature impede recovery
Surgical repair prior to preschool: children may view procedures as punishment & obsession with genitals (differences and normalcy)
protrusion of abdominal contents into scrotum
inguinal hernia
fluid in scrotum
hydrocele
narrowing of opening in foreskin
phimosis
urethral opening on ventral surface of penis
hypospadias
ventral curvature
chordee
meatal opening on dorsal surface
epispadias
teste(s) undescended
cryptorchidism
bladder-open pubic arch-bladder exterior of abd wall
exstrophy of bladder
genitalia-sex undetermined by visualization (ultrasound to determine)
ambiguous genitalia
patho of nephrotic syndrome?
Predominately 2-7 yrs (rare under 6 mo, uncommon under 1 yr, unusual after 8 yrs)
May be metabolic, biochemical, physiochemical, or immune-mediated disturbance:
basement membrane increasingly permeable to protein - albumin leaks & is lost in urine (reduces serum albumin level), fluid accumulates in interstitial spaces (edema) and body cavities (ascites)
etiology of nephrotic syndrome?
Massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema
Primary: idiopathic nephrosis, childhood nephrosis, or minimal change nephrotic syndrome (MCNS=80%)
Secondary: after glomerular damage
Congenital: autosomal recessive
s/s of nephrotic syndrome?
Weight gain
Edema around eyes, scrotum, labia, ankles-especially in the morning
Ascites (massive swelling of abdomen, will look like they are pregnant)
Poor appetite
Elevated blood pressure
Tired
Urine is frothy and decreased in volume
therapy goals of nephrotic syndrome?
Reduce excretion of urinary protein & fluid retention in tissues
Prevent infection & minimize therapy complications
nephrotic syndrome treatment?
Low salt diet
Severe cases fluid restriction
Edema=diuretics
25% albumin
Corticosteriods
CMs of acute glomerulonephritis?
Latent period 10 days post pneumo or streptococcal & viral infections
Commonly – acute poststreptococcal glomerulonephritis (APSGN)
Proteinuria & hematuria 3-4+
acute glomerulonephritis nursing care?
Those with normal BP and urine output=home tx
Sodium restriction for those with edema and BP
Daily wt most useful means of assessing fluid balance
Pts w/ edema, HTN and gross hematuria may seize
acute glomerulonephritis etiology?
AGN – manifestation of systemic disorder
Peak age 6-7 yrs old, uncommon younger than 2 yrs
Occurs in boys 2:1
ASO indicates post strep infection
Reduced C3 –improvement of disease=risingC3
patho of Hemolytic Uremic Syndrome?
Primary site endothelial lining of the small glomerular arterioles-swell and occluded with deposits of platelets and fibrin clots.
Red blood cells are damaged moving through partially occluded blood vessels.
Damaged cells removed by spleen causing acute hemolytic anemia = thrombocytopenia
Hemolytic Uremic Syndrome triad?
anemia, thrombocytopenia, and renal failure
Hemolytic Uremic Syndrome CMs?
Primarily in infants 6 mos to 5 yr old
Acquired hemolytic anemia, thrombocytopenia, renal injury/failure, and CNS symptoms
Associated with e.coli (undercooked ground beef), unpasteurized milk or fruit juice (apple), sprouts, lettuce, salami or drinking-swimming in sewage-contaminated water
Begins with gastro or URI
Hemolytic Uremic Syndrome treatment?
Hemodialysis or peritoneal dialysis (for those anuric for 24 hrs, or oliguria w/uremia or HTN & seizures)
FFP and plasmapheresis, fresh/washed packed cells, remove plasma from blood and replace with FFP
Emergency support for family and child
Hemolytic Uremic Syndrome prognosis?
Prompt tx = 95% recovery
Residual renal impairment 10-50%
Complications: chronic renal failure, HTN, CNS disorders
wilms tumor patho?
Nephroblastoma-most common malignant renal & intra-abdominal tumor in childhood
Peak age 3 yrs
No method of identifying gene carriers at this time
Slightly favors left kidney-10% both kidneys
7/1 million Caucasian children, 3x more African-American than Asian
wilms tumor CMs?
Associated with aniridia (no iris in eyes), hemihypertrophy (1 side of body larger). Beckwith-Wiedemann syndrome (overgrowth syndrome)
Metastasis rare
Dx with radiographic studies, abd ultrasound, hematologic & biochemical studies, urinalysis
nursing care for wilms tumor?
Surgery asap removing tumor (keep encapsulated), affected kidney, and adjacent adrenal gland
Prognosis for localized (stage I-II) 90% success
May reoccur in lung
DO NOT PALPATE
Post op at risk for bowel obstruction
Family and child support
etiology for acute kidney injury (AKI)?
Inability to excrete waste, concentrate urine, conserve electrolytes
AKI in response to inadequate perfusion, kidney disease, UT obstruction
Chronic (CKI) long standing kidney disease or anomaly
Azotemia-accumulation of nitrogenous waste in blood
Uremia-retention of nitrogenous products - toxic
AKI patho?
Diminished urinary output and lethargy in a child who is dehydrated, is in shock, or has recently undergone surgery should be evaluated for possible AKI
Reduced glomerular filtration rate
Elevated BUN
Significant reductions in renal blood flow
AKI CMs?
Oliguria followed by diuresis
Water intoxication and hyponatremia risk
AKI treatment?
During oliguria: no Na++, CL, K+
Hyperkalemia: oral or rectal Kayexalate
HTN: meds, limit fluids and salt
Anemia: Hgb below 6g/dL w/PRBC
Seizure and cardiac failure precautions
AKI nursing care?
Accurate I&O, body wt, electrolyte measurement
Limit fluid intake
Nutrition (perhaps IV) tx nausea/vomiting
Tx anxiety, stress, discomfort
etiology of chronic kidney injury (CKI)?
Diseased kidneys maintain normal chemical structure of body fluids under normal conditions
Uremia
Caused by recurrent UTI, chronic pyelo/glomerulonephritis hereditary disorders, & glomerulonephropathy assoc. w/ anaphylactoid purpura and lupus erythematosus
CKI patho?
Asymptomatic w/ minimal biochemical abnormalities
Damaged nephrons=kidneys maintain fluid &electrolyte balance
s/s of CKI
Tired
Pallor (pale/gray skin)
Increased B/P (sometimes)
Headache
Nausea
Muscle cramps
Anorexia
Itching
Neurological involvement
diet management for CKI?
Most effective means besides dialysis for reducing quantity of waste requiring renal excretion
Low in protein, potassium, sodium, phosphorous
High in carbohydrates
Unrestricted amount of fat
Limit fresh fruit and veggies hyperkalemic
High in calcium
supplements for CKI?
Rich in folic acid and iron
Water soluble vitamin supplements & D
Phosphorus can be controlled by giving phosphorus-binding agents, e.g., calcium carbonate (most common) & aluminum hydroxide
complications of CKI?
Anemia-HTN-Infections
Dialysis and transplant only tx for ESRD
Dialysis for CKI physical and emotional challenges?
Physical challenges:
Implanting graft, fistula or peritoneal catheter
Accessing with needle each time – goal pain free
Emotions challenges:
Denial-fear-sadness
Adolescent independence
Body changes
Relentless need for tx comes before all else
