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.
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
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
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)
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.
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
NEPHROTIC SYNDROME
Nursing Diagnosis:
Fluid volume: Excess R/T nephrotic syndrome
Nutrition, Imbalanced: less than body requirements R/T loss of appetite
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
URINARY TRACT INFECTION
Description: Bacterial infection anywhere along the urinary tract. (Most ascend)
URINARY TRACT INFECTION
Nursing Assessment:
Infants:
- Vague symptoms
- Fever
- Irritability
- Poor food intake
- Diarrhea, vomiting, jaundice
- Strong-smelling urine
- Abdominal pain
Escherichia coli in urine cultures
URINARY TRACT INFECTION
Nursing Assessment:
In older children
- Urinary frequency
- Hematuria
- Enuresis
- Dysuria
- Fever
- Flank pain
Escherichia coli in urine cultures
URINARY TRACT INFECTION
Nursing Diagnoses:
Impaired Urinary Elimination patterns R/T
Deficient knowledge of medications R/t
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
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)
VESICOURETERAL REFLUX
Nursing Assessment:
Recurrent UTI
Reflux noted on voiding cystourethrogram (VCUG)
VESICOURETERAL REFLUX
Nursing Diagnosis:
Risk for infection
Risk for trauma
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
HYPOSPADIAS
Description: congenital defect of urethral meatus in males; urethra opens on ventral side of penis behind the glans
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.
HYPOSPADIAS
Nursing Assessment:
Abnormal placement of meatus
Altered voiding stream
Presence of chordee
Undescended testes and inguinal hernia (may occur concurrently)
HYPOSPADIAS
Nursing Diagnosis:
Impaired urinary elimination R/T
Disturbed body image R/T
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
