Renal & Urological Blueprint Flashcards
What is the cardinal sx of Post-Streptococcal Glomerulonephritis?
hematuria
List the sx of Post-Streptococcal Glomerulonephritis (hint: 17)
- Edema (pitting & dependent)
- Decreased weight
- Decreased urine output
- lethargy
- Irritability
- Pallor
- Febrile
- Headaches
- Dysuria
- Abd pain
- Elevated BP
- Foamy urine
- Frequent hiccups
- Generalized itching
- Nosebleeds
- Increased bruising
- Seizures
What is a life threatening complication of Post-Streptococcal Glomerulonephritis?
pulmonary embolism
What causes Post-Streptococcal Glomerulonephritis?
Group A beta-hemolytic streptococcal infection
List the nursing diagnoses for Glomerulonephritis (hint: 6)
- Ineffective breathing pattern related to the inflammatory process.
- Altered urinary elimination related to decreased bladder capacity or irritation secondary to infection.
- Excess Fluid volume related to a decrease in regulatory mechanisms with the potential of water.
- Risk for infection related to a decrease in the immunological defense.
- Imbalanced nutrition less than body requirements related to decreased appetite, nauses, or vomiting.
- Hyperthermia related to the ineffectiveness of thermoregulation secondary to infection.
List the tx for Post-Streptococcal Glomerulonephritis (hint: 6)
Penicillin G
Penicillin V
Supportive care
Manage HTN
Dietary modifications
Bed rest
What dietary modifications are used for Glomerulonephritis and why?
Na and fluid restriction should be advised for treatment of S&S of fluid retention (eg, edema, pulmonary edema)
Why is bed rest recommended for Glomerulonephritis?
until signs of glomerular inflammation and circulatory congestion subside as prolonged inactivity is of no benefit in the patient recovery process.
List the nursing interventions for Glomerulonephritis (hint: 5)
- Obtain complete physical assessment
- Monitor daily weight to have a measurable account on the fluid elimination.
- Monitor I&O every 4 hours to know progressing condition via glomerular filtration.
- Monitor BP and HR every hour to know progression of HTN and basis of further interventions mostly BP for HTN
- Assess for adventitious breath sounds to know for possible progression in the lungs
what is bladder exstrophy?
Congenital defect where the bladder is open and exposed to the outside of the abdomen.
What is the highest priority in bladder exstrophy?
skin disruption related to the exposed bladder mucosa
How can bladder exstrophy be corrected? (hint: 4 ways)
- Bladder closure (moving it inside the body)
- Epispadias repair with reconstruction of the genitalia.
- Bladder neck reconstruction (reconstruction of the urinary sphincter muscles)
- Pelvic osteotomy (closing the pelvic bones)
What imaging is involved in bladder exstrophy?
Imaging will include renal ultrasounds and pelvic X-rays. Prior to surgery, low-dose CT scan to assess pubic diastasis and potential hip issues.
Before bladder exstrophy correction surgery, what is sometimes given to males and when?
In some males, pre-operative testosterone is administered six weeks before the operation and then again three weeks before the operation.
What is the ideal age for bladder exstrophy correction surgery?
between 4 weeks and 16 weeks of age
Post-op considerations for bladder exstrophy correction surgery include management of what?
Management of their many tubes (ureteral stents, bladder suprapubic tube, urethral stent, and drain)
Is epispadias common?
No, it is rare
What is epispadias?
a birth defect where the urethra (the tube that carries urine from the bladder) does not develop into a full tube, and the urine exits the body from an abnormal location
mild to severe
severe epispadias is associated with what?
exstrophy of the bladder
what is important to note about epispadias and circumcision?
Male infant should not be circumcised until corrective surgery for epispadias is done
What is the cause of nephrotic syndrome?
Pathogenesis not understood → may be metabolic, physiochemical, biochemical, or immune-mediated disturbance that causes the basement membrane of the glomeruli to become permeable to protein
List the secondary systemic causes of nephrotic syndrome (hint: 4)
Lupus Erythematosus
Cancer
Heavy Metal Poisoning
Hepatitis
List the sx of nephrotic syndrome (hint: 15)
- Edema
- Proteinuria
- Anorexia
- Abd pain
- Fatigue
- Weight gain
- BP normal or slightly decrease**
- Susceptible to infection
- Hyperlipidemia
- Increased risk of thrombosis
- Bad kidney can give secondary HTN or renal HTN
- hyperalbuminurea**
- hypoalbuminemia**
- hypovolemia**
- Overall reduced volume
What is the tx options for nephrotic syndrome? (hint: 6)
Diuretics
Antibiotics
Corticosteroids
ACE inhibitors
Blood thinners
Low-sodium diet with moderate amounts of protein
Why are ACE inhibitors given for someone with nephrotic syndrome?
They reduce BP and the amount of protein released in the urine
Why are diuretics given to someone with nephrotic syndrome?
they decrease overall swelling and increase kidney output
Why are blood thinners given to someone with nephrotic syndrome?
to manage possible increase in coagulation
Why are steroids given to someone with nephrotic syndrome?
to control inflammation
List the reasons toddlers & preschoolers get UTIs (hint: 4)
- Potty Training
- In children who are not toilet trained, bacteria stay in the diaper, which makes travel to the urethra easier
- Structure of the urinary tract accounts for increased incidence in females
- Urinary stasis is the most important host factor
What is the most common cause of UTI?
Other causes? (hint: 5)
Common: E. coli (common)
Gram negative; anaerobic; rod-shaped; normal lower intestinal microbiome (faece)
Other causes:
- Klebsiella penumoniae
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
List the clinical manifestations of UTIs in infants (hint: 10)
- nonspecific sx
- fever (may be only manifestation)
- irritability
- abdominal fullness
- foul-smelling urine
- poor growth
- poor feeding
- vomiting
-diarrhea - weight loss
List the clinical manifestations of UTIs in toddlers (hint: 7)
- fever
- chills
- poor appetite
- vomiting
- urinary hesitancy
- incontinence after toilet training
- rubs back (flank pain)
List the clinical manifestations of UTIs in children and adolescents 4-20 y/o (hint: 9)
- dysuria
- urge to urinate
- frequent urination
- abdominal or flank pain
- urinary burning
- fever
- constipation
- incontinence in a previously continent child
- chills
What are antibiotic tx considerations for UTIs? (hint: 5)
- knowledge of the common UTI-causing organisms
- client age
- client weight
- ability to take oral medications (liquid vs. pill)
- recent antibiotic use
What are the common antibiotics used to tx children with UTIs?
penicillins, cephalosporins, sulfonamides, and nitrofurantoin
What supportive care is given to a child w UTI?
Supportive care → antipyretics and fluids
Fluids are typically given orally and increased from the expected intake
What client education is given for UTIs? (hint: 8)
- encourage child to use toilet multiple times per day
- increase their fluid intake
- keep genital area clean
- teach child to wipe from front to back
- change diapers frequently
- encourage the child to wear loose-fitting clothes and underpants
- buy the child cotton underpants
- avoid bubble baths
What is Vesicoureteral Reflux?
Abnormal retrograde flow of bladder urine into the ureters
What can Vesicoureteral Reflux cause? (hint: 3)
- Causes frequent UTIs in infants and children
- Kidney scarring can occur
- kidney failure can occur
what is the tx for vesicoureteral reflux? (hint: 2)
Surgery to fix structural issues occurring
Prophylactic abx
A child’s urinary output should be what?
1-2ml/kg/hour
The four-year old patient, who weighs 30kg, has voided 300ml in 6 hours. Is her urinary output adequate?
UOP/hours → 300/6= 50
AVG UOP/WT → 50/30= 1.7
The patient’s urinary output is adequate.
If a child has one kidney, how can you protect it from damage? (hint: 3)
- No contact sports
- Prevent any type of infection: early management if any infection does occur
- NSAIDs should be avoided / other medications → that can cause kidney impairment
What are the big three sx for Wilms tumor?
What are the other sx? (hint: 3)
Big three:
- hematuria
- HTN
- Fever
Other:
- fatigue/malaise
- weight loss
- abdominal swelling or mass
What are the characteristics of an abdominal mass caused by Wilms tumor?
Firm, nontender, confined to one side
What should you NEVER do in a pt with Wilms tumor and why?
DO NOT PALPATE ABDOMEN!!! It increases risk of rupturing tumor and can spread the tumor to other parts of the body
Secondary metabolic alterations from tumor or metastasis can occur from Wilm’s tumor. What sx can occur? (hint: 4)
Dyspnea
Cough
SOB
Chest pain
What are the tx options for Wilms tumor? (hint: 4)
- Surgery
- Other kidney inspected & biopsied later
- B/L kidney chemo or radiation
- Possible partial nephrectomy on one side & total nephrectomy on the other side
How is surgery done for Wilms tumor?
Surgery within 24-48 hr of admission → removing the tumor, affected kidney, & adjacent adrenal gland
What agents are used for B/L chemo or radiation for Wilm’s tumor?
Agents → actinomycin D (dactinomycin, vincristine & adriamycin)
Cyclophosphamide can be added for unfavorable histologic characteristic or advance in disease progress of tumor
What findings suggest a UTI on urinalysis?
+nitrates
+leukocytes
hematuria
What is the gold standard for UTIs on urinalysis?
+nitrates
What must happen for +leukocytes to indicate UTI in a urinalysis?
+leukocytes → need rapid rise - can be there without bacterial infection
Need to know normal leukocyte to know if there is a rapid rise
What pH values may be indication of UTI on urinalysis?
pH of 4.6 to 8
