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Flashcards in Peds Final Review - Renal Deck (22)
1

ACUTE GLOMERULONEPHRITIS

Description: Immune complex response to an antecedent beta-hemolytic streptococcal infection of skin or pharynx.

Antigen-antibody complexes become trapped in the membrane of the glomeruli, causing inflammation and decreased glomerular filtration.

2

ACUTE GLOMERULONEPHRITIS

Nursing Assessment:

A. Recent streptococcal infection

B. Mild to moderate edema (often confined to face)

C. Irritability, lethargy

D. Hypertension

E. Dark-colored urine (hematuria)

F. Slight to moderate proteinuria

G. Elevated antistreptolysin (ASO) titer, elevated BUN and creatinine

3

ACUTE GLOMERULONEPHRITIS


Nursing Diagnosis:

Fluid volume: Excess R/T decreased glomerular filtration and increased sodium retention

Skin Integrity, Risk for Impaired R/T tissue edema

Nutrition, Imbalanced: less than body requirements R/T loss of appetite

Activity Intolerance R/T fluid and electrolyte imbalance, infectious process, and altered nutrition

4

ACUTE GLOMERULONEPHRITIS

Nursing Interventions:

--Intake and output every shift

--Daily weights

--Monitor cardiopulmonary status every shift

--Monitor BP frequently

Administer antihypertensives as prescribed

Fluid restrictions as ordered

Low-salt diet

Cluster care to promote rest

Bed rest during acute phase (usually 4 – 10 days)

Frequent position changes to decrease pressure on bony prominences (every 2 hours)

Monitor for seizures (hypertensive encephalophathy)

5

NEPHROTIC SYNDROME

Description: A disorder in which the basement membrane of the glomeruli becomes permeable to plasma proteins; most often idiopathic in nature.

Usually occurs between the ages of 2 and 3 years.

Its course may involve exacerbations and remissions for several years.

6

NEPHROTIC SYNDROME

Nursing Assessment:

A. Edema that begins insidiously, becomes severe and generalized

B. Lethargy

C. Anorexia

D. Pallor

E. Frothy-appearing urine

F. Massive proteinuria

G. Decreased serum protein (hypoproteinemia)

H. Elevated serum lipids

7

NEPHROTIC SYNDROME

Nursing Diagnosis:

Fluid volume: Excess R/T nephrotic syndrome

Nutrition, Imbalanced: less than body requirements R/T loss of appetite

8

NEPHROTIC SYNDROME

Nursing Interventions:

--Position changes every 2 hours

--Good daily hygiene and skin care

--Support and elevate edematous body parts with pillows

--Maintain bed rest during edematous phase

--Physical activity as tolerated

--Monitor I&O

Measure abdominal girth daily

Provide small, frequent feedings of a normal protein, low-salt diet. Client is commonly prescribed IV albumin followed by diuretic

Administer steroids as prescribed

Administer cholinergics as
prescribed

Monitor temperature and assess for signs of infection

Protect from persons with
infections

Antibiotics as ordered

Vital signs every shift

Intake and output every shift

9

URINARY TRACT INFECTION

Description: Bacterial infection anywhere along the urinary tract. (Most ascend)

10

URINARY TRACT INFECTION

Nursing Assessment:

Infants:

1. Vague symptoms

2. Fever

3. Irritability

4. Poor food intake

5. Diarrhea, vomiting, jaundice

6. Strong-smelling urine

7. Abdominal pain

Escherichia coli in urine cultures

11

URINARY TRACT INFECTION

Nursing Assessment:

In older children

1. Urinary frequency
2. Hematuria
3. Enuresis
4. Dysuria
5. Fever
6. Flank pain

Escherichia coli in urine cultures

12

URINARY TRACT INFECTION

Nursing Diagnoses:

Impaired Urinary Elimination patterns R/T

Deficient knowledge of medications R/t

13

URINARY TRACT INFECTION

Nursing Interventions:

--Suspect and assess for UTI in infants who are ill.

--Assess for recurrent urinary tract infections. In infants and young boys, UTI may indicate structural abnormalities of the urinary system

--Collect clean voided or catheterized specimen, as prescribed

--Administer antibiotics as prescribed

Teach home program:
--Instruct to finish all prescribed medication

--Note that follow-up specimens are needed

--Teach to avoid bubble baths
Teach to increase oral fluids (apple juice, cranberry juice)

--Instruct to void frequently

--Teach to clean genital area from front to back

--Note symptoms of recurrence

14

VESICOURETERAL REFLUX

Description: Result of valvular malfunction and backflow of urine into the ureters (and higher) from the bladder (severe cases are associated with hydronephrosis)

15

VESICOURETERAL REFLUX

Nursing Assessment:

Recurrent UTI

Reflux noted on voiding cystourethrogram (VCUG)

16

VESICOURETERAL REFLUX

Nursing Diagnosis:

Risk for infection

Risk for trauma

17

VESICOURETERAL REFLUX

Nursing Interventions:

--Teach home program for prevention of UTI

--Teach family the importance of medication compliance, which usually leads to resolution of mild cases

--Provide support for children and families requiring surgery. Siblings of clients with VUR should also be evaluated for reflux.

--Explain the goal of ureteral re-implantation: to stop reflux and prevent kidney damage

Monitor postoperative urinary drainage (may be suprapubic or urethral)
--Measure output from both
catheters
--Assess dressing and incision
for drainage
--Restrain child’s hands as
necessary

Maintain hydration with IV or oral fluids

Manage pain relief postoperatively
--Surgical pain
--Bladder spasms

18

HYPOSPADIAS

Description: congenital defect of urethral meatus in males; urethra opens on ventral side of penis behind the glans

19

HYPOSPADIAS

NCLEX Hint: surgical correction for hypospadias is usually done before preschool years to allow for the achievement of sexual identity, to avoid castration anxiety, and to facilitate toilet training.

20

HYPOSPADIAS

Nursing Assessment:

Abnormal placement of meatus

Altered voiding stream

Presence of chordee

Undescended testes and inguinal hernia (may occur concurrently)

21

HYPOSPADIAS

Nursing Diagnosis:

Impaired urinary elimination R/T

Disturbed body image R/T

22

HYPOSPADIAS

Nursing Interventions:

--Prepare child and family for surgery (no circumcision prior to surgery).

--Assess circulation to tip of penis postoperatively.

--Monitor urinary drainage after urethroplasty
a. Foley catheter
b. Suprapubic tube
c. Urethral stent

Restrain child’s arms and legs as necessary

Maintain hydration (IV and oral fluids)

Teach home care:
--Teach care of catheters

--Teach how to empty drainage bag

--Teach prevention of catheter displacement or blockage

--Instruct to increase oral fluids

--Describe signs of infection