Test 3 Flashcards
Second most common infection in children?
UTI
How can long term UTI’s effect the kidneys?
may cause renal scarring leading to long term kidney damage and eventual failure.
Symptoms of a lower(bladder) UTI?
- Frequency, urgent urination
- Painful urination
- Increased bed wetting
- Strong smelling urine
Symptoms of a Upper (kidneys)
UTI ?
- High fever
- Abdominal and flank pain
- Vomiting
- Chills
- Dehydration
What labs are performed in an expected UTI?
Culture and sensitivity using sterile or clean catch urine
Diagnosis of UTI is confirmed by detection of
- detection of bacteria in urine culture
What is the most common cause of renal scarring?
Vesicoureteral Reflux VCUG
What is Vesicoureteral Reflux?
Abnormal retrograde flow of urine from the bladder into the ureters
Re: vesicoureteral reflux, Primary reflux results from ____________? While Secondary reflux occurs as a result of _____________?
- Congenitally abnormal insertion of ureters into the bladder
- an acquired condition
At what age are the kidney’’s fully developed?
3 years of age
____ number of uti’s normal
1-2
uti symptoms in infancy
- poor feeding
- vomiting
- failure to gain weight
- excessive thirst
- frequent urination
- fever
- persistent diaper rash
therapeutic management of a uti
- eliminate current infection (antibiotics)
- identify contributing factors to reduce the risk of recurrence
- prevent systemic spread of the infection (check cbc, follow HR and O2)
- preserve renal function (repeated UTI will cause chronic kidney damage)
- clean catch urine culture (or another type of clean to sterile culture based on child’s age)
nursing care for uti’s
- parental education-prevention (hygiene, do not spend a lot of time bathtubs)
- infants-sterile catheterization or suprapubic aspiration
- prepare for procedures-dolls to drawing
Sudden increase in wet diapers that are not very wet are a sign of infection?
UTI
What lab values would you expect in a patient with a UTI
- RBC
- WBC
- Increased Protein
- increased Specific gravity
What would you assess in a kid with and expected UTI ?
- Temperature
- flank pain
- Urine - color, odor, consistency
- Check for signs of
- vitals
- Clean catch urine culture
Manifestations of Nephrotic syndrome
- Severe edema (Weight gain)
- puffy face
- Low blood pressure
- Abdominal sweilling
- Pleural effusion
- Fluid in the lungs
- Irritability
- Easily fatigued
- Susceptibility to infection
- Urine alterations (decreased volume, frothy)
Which sex is twice as likely to have nephrotic syndrome?
boys
signs of AGN (acute glomerulonephritis):
- presence of blood and protein in urine
- increase in BUN
- ASO (+)
- periorbital edema
_______________ refers to the retrograde flow of urine from the bladder into the upper urinary tract.
Vesicoureteral Reflux
Primary reflux results from ____________ insertion of ureters into the bladder; secondary reflux occurs as a result of an ___________________
congenitally abnormal
acquired condition.
What is a ultrasonography, voiding cystourethrogram?
Using a contrast die to watch the flow of urine from the kidney to see where the obstruction is
vesicoureteral reflux is diagnosed by___
VCUG (voiding system urethrogram)
what is structural or functional abnormalities of the urinary system that obstruct the normal flow of urine that can result in renal dysfunction?
obstructive uropathy
obstructive uropathy could be ___
- congenital or acquired
- unilateral or bilateral
- complete or incomplete
- acute or chronic manifestations
What is Nephrotic syndrome?
Nephrotic syndrome is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
** membrane of the glomeruli to become increasingly permeable to protein, but the cause and mechanisms are only speculative.
Manifestations of Nephrotic syndrome
- Severe edema (Weight gain)
- puffy face
- Low blood pressure
- Abdominal sweilling
- Pleural effusion
- Fluid in the lungs
- Irritability
- Easily fatigued
- Susceptibility to infection
- Urine alterations
complications to high dose steroids
- water retention
- immune suppression
- hyperglycemia
- hypertension
- hirsutism
- growth retardation
- cataracts
- gastrointestinal bleeding
- bone demineralization
signs of AGN (acute glomerulonephritis):
- presence of blood and protein in urine
- increase in BUN
- ASO (+)
- periorbital edema
Nursing care for acute glomerulonephritis:
- vitals signs (frequent bp &, daily weights)
- volume and character of urine
- may need IV access
- watch for seizures if edema, HTN, and gross hematuria
- collaboration with parents and dietician is necessary (poor appetite in acute phase)
- follow-up care; see provider every month for awhile
Number treatment of nephrotic syndrome
High dose steriods
Therapeutic management Acute Glomerulonephritis
If normal B/P and good urine output, may be treated at home.
Hospitalization for: edema+, hypertension, gross hematuria, significant oliguria
Diet for Acute Glomerulonephritis?
- Diet: moderate sodium restriction and fluid restriction
- Potassium restriction during oliguria
What is Hemolytic Uremic Syndrome
A heymolytic response to toxins left by e. coli bacteria in the body that can cause kidney failure
What clinical manifestation is often reported to physicians in patients with Wilms Tumor ?
The most common presenting sign is painless swelling or mass within the abdomen.
What is the parent teaching for Uremic Syndrome?
Teach parents if kids aren’t recovering as fast as they should to bring them back in.
The Endocrine System is mainly comprised of what 3 components?
(1) the cell that sends a chemical message using a hormone;
(2) the target cells or organs, which receive the chemical message
(3) the environment through which the chemical is transported from the site of synthesis to the site of cellular action (e.g., blood, lymph, extracellular fluids).
The controlling gland of the endocrine system is the _________ which is regulated by the ___________
Anterior pituitary
hypothalamus
Panhypopituitarism is defined clinically as
the loss of all anterior pituitary hormones, leaving only posterior function intact
What is the most common cause of Hypopituitarism of the anterior lobe
Tumor - Craniopharyngiomas
________ is the diminished secretion of one or more pituitary hormones.
Hypopituitarism
Manifestations of HYPOPITUITARISM?
- Dry skin
- Puffiness around eyes
- Sparse hair
- Constipation
- Sleepiness
- Mental decline
When parents are concerned with their childrens height, WHAT NEEDS TO BE RULED OUT?
- Malnutrition
- Is short stature common in the family
- Constitutional growth - delay refers to individuals (usually boys) with delayed linear growth, generally beginning as a toddler, and skeletal and sexual maturation that is behind that of age mates
- What does the growth chart show?
- Dental exams - dentition is delayed in children with HYPOPITUITARISM. - Teeth can be crowed b/c jaw isn’t growing the way it should
- Family history
- headache and vision changes = signs of possible tumor
Neonates with congenital HYPOPITUITARISM may have symptoms of __________ & _________
hypoglycemia and seizure activity
Therapeutic Management of HYPOPITUITARISM
- Surgery/ radiation due to tumor
- Biosynthetic GH
- Preparation for diagnostic test
- Home administration of GH-family education
NURSING CARE MANAGEMENT OF HYPOPITUITARISM
- Identification of child at risk
- Family history
- Preparation for diagnostic tests
- Home administration of GH (Pt Education)
PITUITARY HYPERFUNCTION - DIAGNOSIS
- Excess GH before closure of the epiphyseal shafts results in proportional overgrowth of the long bones until the individual reaches a height of 2.4 m (8 ft) or more.
- Vertical growth is accompanied by rapid and increased development of muscles and viscera. Weight is increased but is usually in proportion to height.
- Children with a pituitary-secreting tumor may also demonstrate signs of increasing intracranial pressure, especially headache.
- If over secretion of GH continues after epiphyseal closure (growth plate), growth occurs in the transverse direction, producing a condition known as acromegaly.
-
Precocious Puberty occurs when sexual development begins before the age of ___ in males.
___ in white girls
___ in African American girls.
9
7
6
What sequence of events is known as the Hypothalamic– pituitary– gonadal axis.
Normally, the hypothalamic-releasing factors stimulate secretion of the gonadotropic hormones from the anterior pituitary at the time of puberty. In boys, interstitial cell– stimulating hormone stimulates Leydig cells of the testes to secrete testosterone; in girls, FSH and LH stimulate the ovarian follicles to secrete estrogens
Approximately 80% of children with precocious puberty have __________________, in which pubertal development is activated by the hypothalamic gonadotropin-releasing hormone (GnRH). This produces early maturation and development of the gonads with secretion of sex hormones, development of secondary sex characteristics, and sometimes production of mature sperm and ova
Central Precocious Puberty
How is Peripheral precocious puberty (PPP) different from Central Precocious Puberty ?
includes early puberty resulting from hormone stimulation other than the hypothalamic GnRH– stimulated pituitary gonadotropin release.
Treatment of precocious puberty is directed toward the specific cause when known. In __% of cases, precocious pubertal development regresses or stops advancing without any treatment.
50
Central Precocious Puberty is managed with monthly injections of ___________
CPP is managed with monthly injections of a synthetic analog of luteinizing hormone– releasing hormone.
- The available preparation, leuprolide acetate (Lupron Depot), is given once every 4 to 12 weeks depending on the preparation.
- Effects of Med - With the initiation of treatment, breast development regresses or does not advance, and growth rates return to normal.
- Adverse effects Studies suggest that not all patients attain adult targeted heights, and the addition of GH therapy may be warranted.
** Treatment is discontinued at a chronologically appropriate time, allowing pubertal changes to resume.
Primary causes of Diabetes Insipidus are
__________ or __________ and secondary causes can be __________, ________, & ___________.
familial or idiopathic
Tumors, infections and Vascular anomalies
The principal disorder of posterior pituitary hypofunction is _____________ which is an under secretion of antidiuretic hormone (ADH), or vasopressin (Pitressin), and producing a state of uncontrolled diuresis
diabetes insipidus
Cardinal signs of Diabetes insipidus are _________ & ____________. In older children, signs such as excessive urination accompanied by a compensatory insatiable thirst may be so intense that the child does little more than go to the toilet and drink fluids.
Polyuria
Polydipsia (thirsty)
Simplest test used to diagnose Diabetes Insipidus
- restriction of oral fluids and observation of consequent changes in urine volume and concentration.
** LIMITING FLUIDS WILL NOT CONCENTRATE URINE
Why is AQUEOUS VASOPRESSIN given to a child suspected to have Diabetes Insipidus?
- The administration of injected aqueous vasopressin should alleviate the polyuria and polydipsia. ****Unresponsiveness to exogenous vasopressin usually indicates nephrogenic DI.
Therapeutic Management Treatment for Diabetes Insipidus?
- requires hormone replacement using vasopressin.
- Vasopressin is administered by intramuscular or subcutaneous injection or using a nasal spray of aqueous lysine vasopressin
- The injectable form has the advantage of lasting 48 to 72 hours; however, it has the disadvantage of requiring frequent injections and proper preparation of the drug.
** Medical alert bracelet
Nursing administration considerations for Vasopressin?
- Vial must be held under warm water for 10-15 min and shaken vigorously before being given
- Small brown particles, which indicate drug dispersion, must be seen in the suspension.
Assessment of Patient with Diabetes Insipidus
Daily weight, electrolytes and BUN, hematocrit, urine specific gravity and I&O
Syndrome of Inappropriate Antidiuretic Hormone Secretion
The disorder that results from hypersecretion of ADH from the posterior pituitary hormone
Fluid restriction is the first management of SIADH. Fluids continue to be restricted to ____- ____maintenance.
1/4 - 1/2
Manifestations of Syndrome of Inappropriate Antidiuretic Hormone Secretion are directly related to __________ & _____________
- fluid retention and hypotonicity.
When serum sodium levels are diminished to 120 mEq/ L, affected children may display ………
- anorexia, nausea (and sometimes vomiting)
- stomach cramps
- irritability
- personality changes.
- stupor & convulsions
The main physiological action of the Thyroid is to __________and thereby control the processes of growth and tissue differentiation.
Regulate the basal metabolic rate
____________ inhibits skeletal demineralization and promotes calcium deposition in the bone.
Calcitonin
What can cause short stature
- Genetics
- Hypothyroidism
- Malnutrition
- lack of sleep
- Illness
Signs of delayed growth
- Delayed secondary sex characteristics
- Over crowding teeth
- dropping off growth chart
Hyperthyroidism
- Graves disease is the most common cause of hyperthyroidism in children.
Clinical Manifestations of Hyperthyroidism (Graves Disease)
- Emotional lability
- Physical restlessness, characteristically at rest
- Decelerated school performance
- Voracious appetite with weight loss in 50% of cases
- Fatigue
Therapy for hyperthyroidism is controversial, but the end goal is the same— decrease the circulating __________. The three acceptable modes available are ________ drugs, subtotal _________ , and ablation with ________.
- Antithyroid drugs
- Thyroidectomy
- ablation with radioiodine
-
What is Cushing Syndrome
- Cushing syndrome is a characteristic group of manifestations caused by excessive circulating free cortisol (steroids)
Long-term therapy of steroids may lead to ________ is condition that includes hyperglycemia, fat redistribution to the shoulders and face, muscle weakness, bruising and bones that easily fraction
Cushing syndrome
Clinical Manifestations of Type 1 Diabetes Mellitus
-Polyphagia
-Polyuria
-Polydipsia
-Weight loss
-Enuresis or nocturia Irritability; “not himself” or “not herself”
-Shortened attention span
- Lowered frustration tolerance
- Dry skin Blurred vision -
- Poor wound healing -
- Fatigue
- Flushed skin Headache -
- Frequent infections -
Hyperglycemia
Ketoacidosis Treatment
- Administration of Bicarb - reduce acidosis and protect heart muscle
- Kusmal breaths to breathe off C02
- Hydration - (dehydrated b/c they are over saturated with sugar)
- ## Insulin (after hydration)
Diagnostic Evaluation for Diabetes
- Fasting glucose, if elevated repeat one week later.
Causes of hypoglycemia is diabetic kids
- Increased activity
- Decreased nutrition
- GI sickness
- Infection
What test results are diagnostic of Diabetes
(1) 8-hour fasting blood glucose level of 126 mg/ dl or more,
(2) a random blood glucose value of 200 mg/ dl or more accompanied by classic signs of diabetes,
(3) an oral glucose tolerance test (OGTT) finding of 200 mg/ dl or more in the 2-hour sample,
(4) hemoglobin A1C of 6.5% or more is almost certain to indicate diabetes
Nephrotic syndrome is a clinical state that includes _________, __________, __________, and ________.
massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
What disorder is characterized by increased glomerular permeability to plasma protein, which results in massive urinary protein loss.
Nephrotic syndrome
GLOMERULONEPHRITIS is sequelae of ________
Strep throat
Nephrotic Syndrome (Nephritis) treatment
1) Reducing excretion of urinary protein typically through the use of steroids
Pituitary
Tumor, trauma, infection, asphyxia (lack of oxygen to the brain
If left untreated, congenital hypothyroidism causes decreased ____________.
mental capacity
What are the three types of dehydration
- Isotonic
- Hypotonic:
- Hypertonic:
Treatment for Hypotonic dehydration
IV with sodium rich fluid
Hypertonic Dehydration
- Results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes.
- In hypertonic dehydration, fluid shifts from the lesser concentration of the ICF to the ECF.
- Plasma sodium concentration is greater than 150 mEq/ L.
_______dehydration is the Most dangerous type of dehydration
Hypertonic
Isotonic (isonatremic)
- most common inadequate intake
- primary form of dehydration occurring in children.
- occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportions.
- Shock is the greatest threat to life in isotonic dehydration, and the child with isotonic dehydration displays symptoms characteristic of hypovolemic shock.
- Plasma sodium remains within normal limits, between 130 and 150 mEq/ L.
Hypertonic (hypernatremic)
- Water loss exceeds electrolyte deficit
- Plasma sodium concentrations are typically less than 130 mEq/ L.
Signs and Symptoms of Hirschsprungs Disease
Newborn
- poor feeding
- failure to pass meconium
- Bile-stained vomitus
- abdominal distention
Infant
- Failure to thrive
- vomiting/diarrhea
Childhood
- constipation
- ribbonlike, foul-like stools
- abd. distention, fecal mass
- Sudden loss of bowel control (encopresis)
What is Hirschsprung’s Disease
- Congenital anomaly that occurs as the result of an absence of ganglion cells in the rectum and other areas of affected intestine
- Mechanical obstruction results b/c of inadequate motility in an intestinal segment
- Often seen in down syndrome
Surgery for Hirschsprungs
- Surgery to remove aganglionic portion of bowel
- A temporary colostomy is usually necessary post surgery
- Patient teaching - Stomal care, I&O, foley care, colostomy care, family support nutritional support
What is GERD?
Backflow of gastric contents into the esophagus
Complications of GERD
- Esophagitis
- Esophageal Strictures
- Aspirations of gastric contents
- Aspiration pneumonia
Symptoms of Acute Appendicitis
- Abdominal pain that is most intense at McBurney’s point
- Rebound tenderness and abdominal pain
- Elevated WBC
- Side-lying position w/ abdominal guarding (legs flexed) to releive pain
- Difficulty walking and pain in the right hip
- Low grade fever
What is Meckel Diverticulum
Congenital herniation of the small intestine that protrudes into the umbilicus
Therapeutic treatment of Meckel Diverticulum
- surgical procedure
- sometimes its an emergency- ie when the intestine protruding into umbilicus is becoming ischemic
Signs and Symptoms of Meckel Diverticulum
- Herniation is visible
- Abdominal pain
- Currant jelly stool (bright or dark red)
- Bleeding - severe anemia - (check hgb and hct
- Shock
Biliary Atresia
Congenital absence or obstruction of bile duct causing
- impaired drainage of bile and progre
- Progressive inflammation and cirrhosis
of liver
Signs and symptoms of Biliary Atresia
- Jaundice (starts earlier and last longer)
- dark urine
- clay colored stools
- Abdominal distention,
- Failure to Thrive
- Pruritus
Medical management for Biliary Atresia
Surgery
Nursing care management of Biliary Atresia
- Maintain fluid and electrolyte balance
- Support nutrition
- Promote Growth and Development
- Protect from infection
- Psychosocial support
Untreated Biliary Atresia can lead to
Liver cirrhosis and death by age of 2
Cleft Lip repair is usually performed at ___-___ months and repair for a Cleft palate at __ -__ months
2-3 montsh
6-12months
What his Esophageal Atresia & Tracheoesophageal Fistula
failure of the esophagus to develop as a continuous passage separate from the trachea
Pyloric Stenosis
- Narrowing between the stomach and duodenum
Classical signs of Esophageal Atresia & Tracheoesophageal Fistula known as the 3 C’s
- Cough
- Choke
- Cyanoisis
Signs and Symptoms of Pyloric Stenosis
- Hungery, happy , eat a lot!
- Dehydration
- Failure to Thrive
- projectile vomiting
- Visible peristalsis
- hard olive-like mass in epigastric area
Pyloric Stenosis is usually seen __-___ months of age
1-2
___________ is the most common cause of intestinal obstruction in children between 5 months old and 3 years
Intussusception
Intussusception occurs when _________________. It is more common in males than in females and is more common in children younger than 2 years old.
a proximal segment of the bowel telescopes into a more distal segment,
Treatment of Intussusception
Surgery or reduction or with an air or enema
Signs and Symptoms of Intussusception
- Abdominal pain - severe acute attacks cause kids to bring knees to chest
- NVD
- Irritability
Celiac Disease
- Diarrhea
- foul smelling stools
- Abdominal distention
- Failure to Thrive
- Behavioral changes
Hypotonic Dehydration
- Excessive electrolyte loss compared to water loss
Treatment for Isotonic dehydration
- Oral fluids, mild cases water
- IV with normal saline
Treatment for Hypotonic Dehydration
- Stop losses (diarrhea, vomiting)
- IV fluid with high levels of sodium
- Crystalloid and calloid replacements
Treatment for Hypertonic Dehydration
- Fluids with low sodium
- Glucose with low sodium
First Treatment of Dehydration
Fluids to make sure they have sufficient fluid in their blood vessels
Two disorders of motility most likely to see in kids
Diarrhea & Vomiting
_____________ is the most common virus that cause diarrhea and dehydration
Rotovirus
Causes of Hypotonic Dehydration
vomiting & diarrhea - large loss of sodium ions- can cause shock
Chronic pin worm infection can cause ________
Appendicitis
