Renal system

Question 1

What is acute poststreptococcal glomerulonephritis?

Answer 1

Inflammatory injury to the glomerulus in reaction to a by-product of an antecedent streptococcal infection

Question 2

Clinical manifestations of acute poststreptococcal glomerulonephritis?

Answer 2

• Oliguria - urine looks cloudy, smoky brown resembling cola or tea
• Edema - primarily periorbital
• Hypertension
• Pallor, irritability, lethargy
• Circulatory congestion
• Hematuria
• Proteinuria
• Increased BUN and creatinine levels

Question 3

Interventions for acute poststreptococcal glomerulonephritis?

Answer 3

1. Monitor vital signs, intake and output, and characteristics of urine
2. Daily weight
3. Limit activity
4. Sodium restrictions and potassium restrictions during periods of oliguria
5. Monitor for complications e.g., kidney failure
6. Administer diuretics if significant edema and fluid overload present

Question 4

What is nephrotic syndrome?

Answer 4

Defined as massive proteinuria, hypoalbuminemia, hyperlipidemia and edema

Primarily preschoolers

Question 5

Clinical manifestations of nephrotic syndrome

Answer 5

• Child gains weight
• Periorbital and facial edema most prominent in the morning
• Ascites
• Urine output decreases, dark and frothy
• Massive proteinuria
• Decreased serum protein (Hypoproteinemia)

Question 6

Interventions for nephrotic syndrome

Answer 6

• Monitor vital signs, intake and output and daily weights
• Routine abdominal girth measurement
• Monitor urine for specific gravity and protein
• Monitor for edema - location, pitting (vulnerable to infection)
• Ensure regular diet without added salt, sodium restriction during periods of massive edema
• Administration of corticosteroids (vulnerable to infection)
• Administration of diuretics to reduce edema

Question 7

What is epispadias?

Answer 7

Urethral opening on dorsal surface of penis

Question 8

What is hypospadias?

Answer 8

Urethral opening on ventral surface of penis

Question 9

Important family education after repair of epispadias and hypospadias

Answer 9

• Use double diapering to protect the operative site
• Do not bathe child in a tub until stent is removed
• Restrict activities that put pressure on surgical site.
• Encourage infant/toddler to drink fluids to ensure adequate hydration
• Administer full course of prescribed antibiotics to prevent infection
• Observe for skins of infection - fever, swelling, redness, pain

Question 10

Nursing interventions for epispadias and hypospadias

Answer 10

• Monitor intake and output

*Encourage fluid intake

• Ensure protection of the surgical site and stent
• Administer analgesia, anticholinergics and antibiotics

Question 11

What is congenital adrenal hyperplasia?

Answer 11

An autosomal recessive disorder caused by decreased enzyme activity required for cortisol production in the adrenal cortex

Two classic forms which are:
* 75% salt losing cause aldosterone deficiency and overproduction of androgen
*25% are non-salt losing with production of masculine secondary sexual characteristics in females

Question 12

What enzyme is deficient in congenital adrenal hyperplasia?

Answer 12

21-hydroxylase

Question 13

Treatment of congenital adrenal hyperplasia?

Answer 13

Administration of glucocorticoids to suppress high secretions of ACTH and adrenal androgens