T3 U7 RENAL Flashcards
Main symptom when the kidneys are off balance
HTN
A child is admitted with AKI post severe dehydration, what common complication of AKI in pedi?
HTN
what common finding is often related to AKI in symptom presentation?
HA (r/t dehydration & kidney filtration)
What is the most important intervention with AKI?
Monitoring I&O’s
what happens to calcium in AKI?
HYPOcalcemia
what is the best test to run to assess kidney function in children with AKI?
Serum creatinine
what diet should AKI patients follow?
Low in K
Low in salt
Low in phosporus
High in Ca
examples of food to avoid in AKI?
Oranges
Beans
Dairy
Lunch meat
Dark Soda
when receiving hemodialysis for AKI, what should the nurse do during the procedure?
Assess for s/sx of infection at access site
what is most likely to be present in a child’s medical Hx that has hemolytic uremic syndrome?
Recent Gastrointestinal infection with bloody diarrhea (E. Coli)
what lab finding(S) would be expected in a child with hemolytic uremic syndrome?
elevated BUN & creatinine
hyperkalemia
what would be the priority intervention for a child diagnosed with hemolytic uremic syndrome?
administering IV fluids
what would the nurse assess on a patient at risk for fluid overload that has hemolytic uremic syndrome?
crackles heard on lung ausculation
why do children the HUS sometimes receive a blood transfusion?
needed to replace red blood cells that have been destroyed
what would be characteristic of nephrotic syndrome?
proteinuria
(foamy urine)
what should the diet of a PT with nephrotic syndrome look like?
Low sodium
a child with nephrotic syndrome is on corticosteroids, which side effect is most important to monitor & why?
increased susceptibility to infection
bc longterm steroids = decreased immune system
how can a childs abdomen present with nephrotic syndrome?
Ascites, distended
when assess a PT with nephrotic syndrome, what would indicate theyre responding to treatment well?
Decreased abdominal girth
what med would be appropriate for treating enuresis
Oxybutynin Chloride (Ditropan) - 5mg/day
normal serum albumin level?
4.5-9
4 main complications associated with hemodialysis?
HypoT
bleeding
febrile reaction
infection
why do we prescribe Tums (Ca carbonate) to AKI patients?
Gets rid of high levels of phosphrous
if a cross country runner has a urinalysis during school physical & presents with proteinuria, which action is most appropiate?
redo test in 48 hr
s/sx of kidney transplant rejection?
Pain over kidney
Fever
decreased urinary output
edema
what test/sign being positive for a child with stomach pain require immediate intervention?
Positive heel drop jarring test (APPDX)
a PT with glomerulonephritis was prescribed corticosteroids, what should the nurse monitor?
Blood glucose
regarding exercise & glomerulonephritis, what would be an incorrect statement?
Can resume normal exercise routine without any restrictions
what lab level would be priority in a PT with end stage renal disease thats receiving hemodialysis? & why
serum potassium level
High can cause cardiac arrest = kill you faster
what food choice would adhere to a low phosph diet?
whole wheat bread
A renal disease PT on a loop diurertic (Furosemide) should be have what monitored?
BP
& Vit K
why shouldnt a PT with chronic renal failure take OTC pain meds
likely on corticosteroids & NSAIDS interferre
what would the nurse associated with primary enuresis?
bedwetting that has been present since early childhood w/o periods of dryness
s/sx of UTI
Fever
Malodorus urine
dribbling urine
dysuria
flank pain
what would be present in a urine analysis for a UTI?
Nitrates (PINK)
prevention edu for UTI?
handwashing
wipe front to back
cotton underwear & loosefitting clothes
Avoid bubblebaths & sitting in swimswear for long periods
diff btwn primary & secondary VUR?
P: Congenital
S: Infection/obstruction
s/sx of VUR
UTI s/sx
Enuresis
Fever
Enlarged kidneys on imaging
is VUR r/t hematuria?
NO
s/sx of pyelonephritis
high fever
painful/frequent urination
cloudy/foul smelling urine
pathology of acute glomerulonephritis?
occlusion of glomerular capillaries = decreased urine filtration
water & Na retention –> circulatory congestion & HTN
what infection does acute glomerulonephritis often follow?
Strep or impetigo
s/sx of acute glomerulonephritis
gross hematuria (bloody urine)
periorbital edema
HTN
HA
what is the diagnosis for acute glomerulonephritis
ASO titer (detect prior strep)
management for acute glomerulonephritis
strict I&O (same scale/time)
ABX
Diuretics (monitor BP)
Low sodium
Hemolytic Uremic Syndrome (HUS)
Acute renal failure r/t ingesting E.Coli (undercooked beef)
staple symptoms of HUS
Bloody diarrhea (Gastroenteritis)
s/sx of HUS
Bloody diarrhea
Hematuria & proteinuria
Pallor
Altered LOC
prevention HUS
fully cook beef
wash fruits/veggies
use pasteurized products
lab diagnosis for HUS
Elevated BUN + Creatinine
High K
High Phos
Low Ca
what to monitor for with HUS
Potential for dialysis
LOC/ICP
I&O (CHF)
Nephrotic syndrome can lead to what? (4)
HYPOalbuminemia
Proteinuria
Hyperlipidemia
Hypercholesterolemia
Edema
s/sx of Nephrotic syndrome?
severe edema (periorbital)
Anorexia
massive proteinuria
AKI leads to what being imbalance?
A/B balance
Fluid balance
Electrolyte
what are the 3 main causes (general) of AKI?
Pre-renal
Intrarenal
Postrenal
examples of pre-renal causes of AKI?
Effect profusion
Hypovolemia
Cardiac failure
Dehydration
ex of intrarenal causes of AKI?
Infection
Glomerulonephritis
NSAIDS
Ex of post renal causes of AKI
Obstructions
Stones
Tumor
Clots
what labs would be indicative of AKI
HYPErphos
HYPOcal
HYPERkal
what physiolgical changes can happen with hyperkalemia
weird EKG
TachyC, Kussmals breathing
what counseling is recommended for Chronic kidney disease PT?
genetic
chronic kidney disease diet?
low/mod protein
low sodium
low potassium
low phosp
ex what cant be of CKD diet
NO
bananas
dairy
red meat
salty
what facial feature assessment can indicate potential kidney issues?
ears
ask about hearing impairment
what is peritoneal dialysis?
Dialysis + ABD cath + osmotic process + drain
what finding should the nurse immediately report with Continuous cycling dialysis?
Cloudy dialysate
2 major complications from peritoneal dialysis?
Peritonitis
Pulmonary complications
how to treat Peritonitis
Cephalosporins/vanco
what would be the next step if a peritoneal pt reported pain?
Slow down rate
what does the nurse check to ensure P.Dialysis is safe to start?
I&O
Labs
V/S
frequency of hemodialysis
3/4x week for 3-4 hr
what is used for hemodialysis for access?
AV fistula
after AV Fistula is placed, what is the next step for hemodialysis?
wait 2-6wk for AVF to become stronger
what should the nurse note about the AVF?
Bruit is heard over AVF @ incision
complications of hemodialysis
HYPOT
HYPOvolemia
Anemia
muscle cramps
what electrolyes should be monitored with hemodialysis
K (!!)
Na
what foods should a hemodialysis pt avoid?
bananas/spinach
lunch meat/dark soda
how might a pt with enuresis present?
urgency - jiggling/crossing legs
foul smelling urine
Polyuria (Diabetes)
med management of enuresis
DDVAP (Desmopressin)
Nasal Spray
Considerations for DDVAP?
Not used for under 6Y
Risk of low Na
If HTN = use PO
interventions for enuresis
voiding all fluids
bed/bladder alarm
edu for bed/bladder alarm?
stop all liquids before bed
go pee again after in bed for 20 min
what is hypospadias?
urethral opening located on underside of penis
manifestations for hypospadias?
incomplete foreskin
curve during erection
abnormal scrotal position
why dont you preform circumcision on a hypospadias PT?
the skin is used to fix defect in surgery
what to report immediately if found in Post op with hypospadias?
Blood in foley bag
