TLO 2.5 Renal/Urinary Child Flashcards
Anatomy of urinary system of child
Stress: reduced kidney function in infants Shorter urethras Complete bladder control by age 4-5 Most regain normal function following acute renal failure Output: Infants: 2mL/kg/hr Children: .5-1mL/kg/hr Adolescents: 40-60 mL/hr
Urinary diagnostic tests for children
Urinalysis, Culture and sensitivity often included
Serum studies: BUN (5-18 child), creatinine (0.3-0.7 child), osmolality
KUB (kidney, ureters, bladder)
Imaging: CT, VCUG (voiding crystal urethrogram), Renal US
Cystoscopy
UTI in children
Presence of bacteria in urine caused from outside the urethra getting into bladder and UT
- fecal bacteria causes most UTI’s
- bacteria in blood (seeds in kidney) can cause UTI in infants
Predisposed r/t
Urinary tract obstructions Urinary stasis r/t voiding dysfunction Anatomic differences Susceptibility to infection Reflux Toilet training females Sexually active adolescent girls
UTI manifestations INFANTS
vague/nonspecific fever irritability crying when voiding odorous urine feeding difficulties
UTI manifestation CHILDREN
ab pain frequency/urgency dysuria fever enuresis (involuntary urination, especially by children at night.)
What is pyelonephritis?
Inflammation of the pelvis (acute infection of kidney): high fever, chills back pain costovertebral angle tenderness N/V
UTI therapeutic management
oral antibiotics with non complicated UTI
pyelonephritis:
identifying contributing factors to prevent recurrence
prevent system spread of infection
preserve renal function
UTI interventions HOSPITALIZED CHILD
educate on reason for procedures
keep infant/child’s routine
encourage parents/child be part of care
monitor hydration: encourage fluids, monitor signs of dehydration, I/O, skin turgor
UTI interventions NOT HOSPITALIZED CHILD
ensure completion of antibiotic promote comfort good hydration keep following up appointments and diagnostic studies monitor for return of symptoms
Cryptorchidism
what is it?
Absence of at least one testicle descent from scrotum:
occurs when one or both testes fails to descent
affects about 1-5% of healthy boys at birth
most infants have spontaneous descent by age 6 months
Cryptorchidism manifestations
Testes no palpable
Testes not easily guided into the scrotum
Previously descended testis that ascends into extrascrotal position
**Children with undescended testes are at increased risk for malignancy and infertility
Cryptorchidism therapeutic management
Observation of infant up to 6 months
Assess for testicular presence at each well child exam
Persists >6 mo = orchidopexy (done before 12 mo of age reduces risk of adverse consequences
Cryptorchidism interventions
Educate parents
provide parents with information/resources
Provide post-op care
hypospadias
what is it?
Opening of urethral meatus is below the normal placement on the glans of the penis
Different degrees: some slightly ventral to glans or as far back as penoscrotal junction
One of the most common congenital anomaly
Epispadias
what is it?
Dorsal (on top) placement of urethral opening
Congenital anomaly
Less common, extremely rare
Hypospadias
Manifestations
Occurs from incomplete development in utero
Stenosis of the opening= partial obstruction of urine= altered urine stream
Might interfere with fertility in mature man if left uncorrected
Chordee: downward curvature of penile shaft
Hypospadias
Therapeutic management
Surgical correction, 6-12 mo before toilet training
Should not be circumcised, foreskin can be used to reconstruction
Urinary diversion
Restricted activity for few days, no hip straddling after surgery
Goal: urinary/sexual function normal and improved cosmetic
Epispadias
Manifestation and therapeutic management
Manifestation: Defect on topside of penis Often associated with bladder exstrophy (bladder outside the ab wall) Therapeutic: Surgical reconstruction
Misc. anomalies of GU tract 4 types (male)
Hydrocele
Phimosis (inability to retract the skin (foreskin or prepuce)
Testicular torsion
Bladder exstrophy (bladder outside of body)
Hydrocele
what is it?
Painless swelling of scrotum
Caused by collection of fluid
Usually resolves by 12 mo of age
Phimosis
what is it?
Inability to retract the foreskin at an age is should retractable
Mild cases: cleaning and gentle manual retraction
Severe cases: surgical enlargement of phimotic ring or circumcision
Testicular torsion
what is it?
Rotation of testicles causing interruption to blood supply
Most be corrected quickly to avoid damage
Sudden onset of severe scrotal pain, erythema, edema
Acute glomerulonephritis (AGN) what is it?
Inflammatory injury in the glomerulus
Acute post streptococcal glomerulonephritis is the most common type:
-an immune reaction to group A beta-hemolytic streptococcal infection of throat or skin
-damage is caused by antigen-antibody complex that lodges in glomeruli
-streptococcal infection needs to be verified for dx
Most common in preschool or early school age
AGN manifestations
Hematuria- cola colored urine
Proteinuria
Edema
HTN
AGN lab findings
RBC’s, casts, small amount of protein in urine
Decreased or normal Hgb and Hct
Altered electrolytes
Elevated BUN/creatinine
Elevated ASO titer or Streptozyme, decreased complement
AGN management
Supportive Antihypertensive Diuretics Antibiotics for active strep infection Low salt diet Possible fluid restrictions
AGN nursing care
Prevent fluid excess Provide adequate rest/quiet play Maintain skin integrity Maintain nutritional status Relieve anxiety
AGN patient outcomes
Child will remain normal fluid balance
The child will exhibit no signs of skin breakdown
The child will have adequate nutrition
Nephrotic Syndrome
what is it?
Kidney disorder characterized by proteinuria, hypoalbuminemia, edema
Can occur:
a primary disease known as minimal change nephrotic syndrome
a secondary disorder after glomerular damage
a congenital form that is inherited as an autosomal recessive disorder
Nephrotic syndrome
Occurs most frequently in?
Toddlers or preschool aged children
Nephrotic syndrome
Manifestations
Severe proteinuria Edema Normotensive Hypovolemia Pallor/fatigue Anorexia Ab pain Increased weight
Nephrotic syndrome
lab findings
Protein in urine
Possible microscopic hematuria
hypoalbuminemia <2.5 g/dL
Elevated cholesterol, triglycerides, Hgb, Hct, platelet levels
Nephrotic syndrome management
prednisone to initiate remission (remission= less than 1+ urine protein for 3-7 consecutive days) diuretics possible albumin admin prevent infection/skin breakdown no added salt diet
Nephrotic syndrome nursing care
Live virus vaccines are contraindicated in children receive steroid therapy Monitor for s/s infection Assess fluid status, daily weight, I/O Monitor labs, CBC, UA Observe for s/s of dehydration
Nephrotic syndrome patient outcomes
Child will be free from skin breakdown
Child will maintain adequate fluid volume
Child will not exhibit signs of fluid overload
Parents will be able to explain principles of home management
