renal infections exam 1

Question 1

types of Pediatric Genitourinary DysfunctionUrinary Tract Infections?

Answer 1

Bladder = Cystitis
Kidney = Pyelonephritis

Question 2

nursing care for Pediatric Genitourinary DysfunctionUrinary Tract Infections?

Answer 2

intake and output
blood pressure
teaching prep of child & family
pain control

Question 3

UTI in kids?

Answer 3

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)

Question 4

nursing care for UTI?

Answer 4

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

Question 5

s/s of UTI?

Answer 5

Decreased appetite
Voiding often
Thirsty
Crying with painful void
Fever
Fatigue
Blood in urine
c/o abd pain

Question 6

how to prevent UTI?

Answer 6

Girls should clean from front to back
No restrictive clothing-Cotton underwear only
Avoid bubble baths
Use bathroom when nature calls
Increase fluid intake

Question 7

CM of Vesicoureteral Reflux?

Answer 7

Cystitis moves to pyelonephritis
Residual ureter urine in bladder until next void
High fevers, vomiting, chills

Question 8

diagnosis of Vesicoureteral Reflux?

Answer 8

Cystoscopy or Voiding cystourethrogram

Question 9

nursing care of Vesicoureteral Reflux?

Answer 9

Prevent bacteria reaching kidneys to reduce scarring chance
Low dose abx w/ cultures 2-3 months
Assess for high fevers, vomiting, chills

Question 10

patho of Obstructive uropathy?

Answer 10

Structural or functional = hydronephrosis – acquired or congenital, unilateral or bilateral
With congenital defect consider malformation
Distal nephron damage (chronic uropathy) = urine concentration

Question 11

nursing care of Obstructive uropathy?

Answer 11

Prepare family & child (consider development) {emotional}
Potential discharge home w/ devices
Equipment, fluids (urine flow), clotting, sediment
Possible dialysis or transplant in future

Question 12

patho and nursing care for external defects?

Answer 12

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)

Question 13

protrusion of abdominal contents into scrotum

Answer 13

inguinal hernia

Question 14

fluid in scrotum

Answer 14

hydrocele

Question 15

narrowing of opening in foreskin

Answer 15

phimosis

Question 16

urethral opening on ventral surface of penis

Answer 16

hypospadias

Question 17

ventral curvature

Answer 17

chordee

Question 18

meatal opening on dorsal surface

Answer 18

epispadias

Question 19

teste(s) undescended

Answer 19

cryptorchidism

Question 20

bladder-open pubic arch-bladder exterior of abd wall

Answer 20

exstrophy of bladder

Question 21

genitalia-sex undetermined by visualization (ultrasound to determine)

Answer 21

ambiguous genitalia

Question 22

patho of nephrotic syndrome?

Answer 22

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)

Question 23

etiology of nephrotic syndrome?

Answer 23

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

Question 24

s/s of nephrotic syndrome?

Answer 24

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

Question 25

therapy goals of nephrotic syndrome?

Answer 25

Reduce excretion of urinary protein & fluid retention in tissues Prevent infection & minimize therapy complications

Question 26

nephrotic syndrome treatment?

Answer 26

Low salt diet Severe cases fluid restriction Edema=diuretics 25% albumin Corticosteriods

Question 27

CMs of acute glomerulonephritis?

Answer 27

Latent period 10 days post pneumo or streptococcal & viral infections Commonly – acute poststreptococcal glomerulonephritis (APSGN) Proteinuria & hematuria 3-4+

Question 28

acute glomerulonephritis nursing care?

Answer 28

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

Question 29

acute glomerulonephritis etiology?

Answer 29

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

Question 30

patho of Hemolytic Uremic Syndrome?

Answer 30

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

Question 31

Hemolytic Uremic Syndrome triad?

Answer 31

anemia, thrombocytopenia, and renal failure

Question 32

Hemolytic Uremic Syndrome CMs?

Answer 32

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

Question 33

Hemolytic Uremic Syndrome treatment?

Answer 33

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

Question 34

Hemolytic Uremic Syndrome prognosis?

Answer 34

Prompt tx = 95% recovery Residual renal impairment 10-50% Complications: chronic renal failure, HTN, CNS disorders

Question 35

wilms tumor patho?

Answer 35

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

Question 36

wilms tumor CMs?

Answer 36

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

Question 37

nursing care for wilms tumor?

Answer 37

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

Question 38

etiology for acute kidney injury (AKI)?

Answer 38

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

Question 39

AKI patho?

Answer 39

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

Question 40

AKI CMs?

Answer 40

Oliguria followed by diuresis Water intoxication and hyponatremia risk

Question 41

AKI treatment?

Answer 41

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

Question 42

AKI nursing care?

Answer 42

Accurate I&O, body wt, electrolyte measurement Limit fluid intake Nutrition (perhaps IV) tx nausea/vomiting Tx anxiety, stress, discomfort

Question 43

etiology of chronic kidney injury (CKI)?

Answer 43

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

Question 44

CKI patho?

Answer 44

Asymptomatic w/ minimal biochemical abnormalities Damaged nephrons=kidneys maintain fluid &electrolyte balance

Question 45

s/s of CKI

Answer 45

Tired Pallor (pale/gray skin) Increased B/P (sometimes) Headache Nausea Muscle cramps Anorexia Itching Neurological involvement

Question 46

diet management for CKI?

Answer 46

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

Question 47

supplements for CKI?

Answer 47

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

Question 48

complications of CKI?

Answer 48

Anemia-HTN-Infections Dialysis and transplant only tx for ESRD

Question 49

Dialysis for CKI physical and emotional challenges?

Answer 49

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