Unit III Flashcards
Compared to adults, children are at a greater risk for fluid and electrolyte imbalance. Why??
- A greater body surface area
- A higher percentage of total body water
- A greater potential for fluid loss via the gastrointestinal tract and skin
- Increased incidence of fever, URI, and AGE
- A greater metabolic rate
- Immature kidneys that are insufficient at excreting waste products
- Kidneys have a decreased ability to concentrate urine
- Inability to verbalize thirst
Signs of fluid and electrolyte balance deficit:
- Diaphoresis
- Vomiting
- Diarrhea
- Hemorrhage
Signs of fluid and electrolyte balance overload:
- Kidney disease
- CHF
- Over-administration of IV fluids
Fluid and Electrolyte Balance is measured by what?
daily weights and I/O
Most common type of dehydration, electrolyte and water deficits are equal, Serum Na = 130-150
Isotonic dehydration
Pateints in isotonic dehydration are at risk for:
hypovolemic shock
type of dehydration where electrolyte deficit is greater than water deficit, serum Na=<130, symptoms are more sever with small fluid losses
hypotonic dehydration
most dangerous type of dehydration, water loss is greater than electrolyte loss, serum Na=>150
Hypertonic dehydration
Patients in hypertonic dehydration are at risk for:
seizures
maintenance fluid requirement for 0-10 kg
100mL/kg of body weight
Maintenance fluid requirement for 11-20 kg
1000mL+50mL/kg for each kg > 10
Maintenance fluid requirement for >20 kg
1500mL + 20mL/kg for each kg >20
minimum urinary output should be what?
1mL/kg/hr
second most common bacterial infection in children
gender, age, race, renal tissue, poor hygeine, constipation, nutritional status, structural abnormalities, sexual activity
most common cause of UTI
e.coli
S&S of UTI in neonate:
failure to thrive, jaundice, fever
S&S of UTI in infant:
poor feeder, strong smelling urine, v/d
S&S of UTI in preschooler:
anorexia, sleepiness, v/d, abdominal pain, foul smelling urine, enuresis, dysuria, urgency/frequency
S&S of UTI in school age:
new enuresis, flank pain, dysuria, urgency/frequency, changes in personality
S&S of UTI in adolescents:
fatigue, flank pain
urine backflows from the bladder to the uterus and back to the kidney
Vesicoureteral Reflux (VUR)
does vesicoureteral reflux have grades?
yes 1-4 (5)
primary (congenital) vesicoureteral reflux
may resolve spontaneously
secondary vesicoureteral reflux
secondary to UTI
S&S of Vesicoureteral Reflux
- recurrent UTI
- flank pain
- abdominal pain
- enuresis
diagnosis for vesicoureteral reflux
VCUG
Vesicoureteral Reflux leaves the patient at risk for:
Acute pyelonephritis (renal scarring)
Group A strep 7-14 days prior
Antigen-antibody complexes form and deposit in the glomeruli
post-streptococcal glomerulonephritis
S&S of post-streptococcal glomerulonephritis
- gross hematuria, tea/cofee colored urine
- edema (periorbital)
- HTN, headache, proteinuria, ascites (more severe)
Diagnosis of Post Streptococcal Glomerulonephritis
ASO titer, serum complement (C3), BUN, Creatinine, urinalysis
Nursing care for post-streptococcal glomerulonephritis
- antibiotics
- I&O
- diuretics, antihypertensives, corticosteroids
- dialysis-severe
- Most common type of acute renal failure in children; Most common in children 6mo-3years
- Caused by E. Coli (undercooked beef)
- Bacteria in gut cause capillary wall destruction; endothelium of glomerulus becomes edematous and platelets cause a clot (no renal circulation); increased rennin production HTN and thrombocytopenia
Hemolytic Uremic Syndrome
1st S&S of Hemolyric Uremic Syndrome
gastoenteritis and possible URI
2nd S&S of Hemolyric Uremic Syndrome
Triad: thrombocytopenia, anemia, ARF
other S&S of Hemolytic Uremic Syndrome:
Pallor, lethargy, anorexia, irritability
Decreased UOP, abnormal BMP, HSM, dehydration, bloody diarrhea
Seizures, altered consciousness, dialysis, petechiae, purpura, ecchymosis
Diagnosis of Hemolytic Uremic Syndrome:
lab results
- elevated BUN
- creatinine
- potassium
- phosphorus
- decreased glucose
- calcium
Nursing care of Hemolytic Uremic Syndrome:
- strict I/O
- dialy weights
Hemolytic Uremic Syndrome
Vaculitis – component of inflammation in the arteries
Typically follows a URI
Typically ages 4y-10y
Glomerulonephritis component may not develop until 2 months after onset of symptoms
Henoch-Schonlein Purpura
S&S of Henoch-Schonlein Purpura
- hematuria
- HTN
- bloody diarrhea
- crampy abdominal pain
- rash
- RAISED PURPURA
- joint pain/swelling
- scrotal swelling
Diagnosis of Henoch-Schonlein Purpura
- rash
- GI complaints
- hematuria
- arthritis
Nursing care for Henoch-Schonlein Purpura
most recover spontaneously
damage to glomerular membrane causes permeability that permit passage of protein muscles, can be caused by HIV, SLE, nephrotoxins
Chronic Clomerulonephritis
S&S of chronic glomerulonephritis
- silent for years
- presents in adolescence
- decreased UOP
- HTN
- headaches
- periorbital edema
- icreased abdominal girth
- scrotal/labial swelling
Diagnosis of Chronic Glomerulonephritis:
- UA
- BMP
- pH
S&S of renal trauma
- hematuria
- flank tenderness
- palpable mass
any condition that reduces blood flow to the kidneys
Example-Dehydration, heart failure, burns
PreRenal
results in destruction to the renal filtering components
Example-Acute tubular necrosis, glomerulonephritis
IntraRenal
Obstruction of the outflow of urine
Example-Urethral obstruction, ureterocele
Post renal
Diagnosis of Acute Renal Failure
H/P, Labs (UA, BMP, pH), renal US, renal biopsy
Difference between chronic and acute renal failure? Chronic has:
- irreversible
- progressive deterioration
- 4stages
Dialysis solution remains in abdomen for several hours and then drained
CAPD - continuous dialysis ambulatory peritoneal dialysis
several cycles are performed during sleep
CCPD - continuous cycling peritoneal dialysis
Hemodialysis is dialysis through the blood
Children must be hemodialyzed three times a week at a dialysis center
AV fistula is preferred site
May also use AV graft or venous catheter
Nursing care
Keep fistula site clean
No BP on that arm
Fluid/dietary restrictions between sessions
renal transplants are received from donors
living or cadaveric
can a child receiving renal transplant be immunocompromised?
no, they are usually on dialysis until a kidney is available and are usually in end-stage renal disease
Abnormal emptying or storage in the bladder
Associated with bladder and bowel withholding and incontinence
Dysfunctional Elimination Syndrome/Voiding Dysfunction
S&S of dysfunctional elimination syndrome/voiding dysfunction
Frequency, urinary incontinence, and urgency
Nursing Care for children with Dysfunctional Elimination Syndrome/Voiding Dysfunction
- Ask child about voiding
- Maintain normal bowel regimen
- Assess for emotional or social problems
- Teach girls with an inflamed perineum that they can take baking soda sitz baths and use barrier creams
- Prophylactic antibiotics
Involuntary or unintentional urination at any age when voluntary control should be present
Nocturnal Enuresis
never gained continence
Many times constipation is a huge cause
Primary nocturnal enuresis (PNE)
incontinent after being dry 6-12 months
Secondary nocturnal enuresis (SNE)
**Social factors huge**
Nursing care for patients with nocturnal enuresis
- Bladder hygiene
- Bedwetting alarms
- Medications - DDAVP
bladder exposed out of the body
exstrophy of the bladder
Associated with other congenital anomalies
- episadias
- cleft scrotum
- rectal prolapse
Nursing Care for Exstrophy of the Bladder
surgery within first 48 hours of life
vulvovaginitis
yeast infection
vulvovaginitis; due to:
- poor hygeine (preschool age-can’t reach)
- antibiotic use or irritants
- STD (adolescent girls)
S&S of vulvovaginitis:
- vulvar itching
- vaginal candidiasis has thick curdy white discharge and is pruritic and foul-smelling
Nursing care:
- apply topical antifungal
- wite front to back
fusion of labia minora caused by inflammation, infection, trauma, and estrogen deficit
labial adhesions
what age group most commonly acquire labial adhesions
girls 3m-6y
Nursing care for Labial Adhesions:
Educate that it may spontaneously resolve; parents can do gentle stretching with diaper changes
May need Premarin cream
no menses by age 16years
primary amenorrhea
has had menses, but spontaneously stopped for 3months or more
secondary amenorrhea
abnormal dilation in the testicular veins
Most common cause of male infertility - correctable
15-20% of males have a varicocele
varicocele
S&S of variocele
bag of worms
Nursing care of Variocele:
surgery
absent, undescended, or ectopic testicles, most common congenital anomaly, major risk for testicular cancer
crytochidism, will need surgery
inability to retract foreskin
phimosis
inability to return foreskin back over glans after retraction
paraphimosis
Nursing care for phimosis/paraphimosis
never force, curcumcision may be necessary
urethreal meatus is inferior to usual position, can cause chordee - bending of penis
hypospadias
urethral meatus is superior to usual position
epispadias
nursing care for hypospadias/epispadias
surgery to correct
EMERGENCY!!
Twisted spermatic cord,
Sudden onset of testicular pain
Trauma or physical exertion may promote development but can occur with no etiology
Usually unilateral
testicular torsion
Nursing care for testicular torsion
surgery imperative within 4-8h to prevent orchiectomy
External reproductive organs not easily identified as male or female
ambiguous genitalia
