Renal Flashcards
(44 cards)
1
Q
what is often the first sign of any type of illness in neonates?
A
- poor feeding
2
Q
3 parameters most significant to assess in children with renal conditions:
A
- weight
- I & O
- blood pressure
3
Q
other components of the physical exam of the renal system
A
- abnormal rate and depth of respirations
- HTN
- fever
- FTT
- signs of circulatory congestion
- abdominal distention
- early signs of uremic encephalopathy
- signs of congenital abnormalities
4
Q
lab studies and diagnostics for the renal system
A
- urinalysis
- urine culture and sensitivity
- ultrasonography
- voiding cystourethrogram (VCUG): uses constrast to evaluate their voiding
- intravenous pyelogram (IVP)
- cystoscopy
5
Q
when can we use a urine bag to collect urine?
A
for a urinalysis–don’t need sterile
6
Q
if you want to do a urine culture, how will you collect it?
A
sterile catheterization
7
Q
how to get a urine sample for a child <1 yo?
A
- often use a catheter
- if can’t obtain with a catheter, then do a suprapubic bladder tap
8
Q
names of UTIs based on where infection is:
A
- urethra–>urethritis
- bladder–>cystitis
- ureters–>ureteritis
- kidneys–>pyelonephritis
9
Q
4 goals of tx for UTIs
A
- eliminate current infection
- identify controlling factors
- prevent systemic spread–>urosepsis
- preserve renal function
10
Q
what type of organisms cause UTIs?
A
- most commonly E. coli and gram negative organisms
11
Q
contributing factors for UTIs
A
- urinary stasis
- urinary reflux
- poor perineal hygiene
- constipation–may not allow for full emptying of the bladder
- pregnancy
- noncircumcision
- indwelling catheter placement
- antimicrobial agents that alter flora of urinary tract
- tight clothes/diapers
- bubble baths
- local inflammation–vaginitis
- sexual intercourse
12
Q
peak ages for UTIs
A
- 2-6 yo and sexually active adolescents
- higher incidence in females
- only higher incidence in males when they are newborns
13
Q
clinical manifestations of UTI
A
- fever
- weight loss
- vomiting, diarrhea
- frequency
- urgency
- chills
14
Q
in a potty trained child, what would be a sign that they may have a UTI?
A
- daytime incontinence
15
Q
diagnostic findings with a UTI
A
- UA: may reveal hematuria, proteinuria, pyuria
- urine may be foul smelling and is cloudy with possible strands of mucus
- culture: reveals growth of bacteria
16
Q
how to avoid UTIs
A
- wipe front to back
- good hydration
- void right before and right after sexual intercourse
- avoid bladder irritants: caffeine
- wear cotton underwear that are not tight, should be well fitting
- get out of wet underwear/swimsuits quickly
17
Q
drug therapy for UTIs
A
- uncomplicated cystitis: short term course of abx
- complicated UTIs: long term tx
- TMP-SMX
- cephalexin
- gentamycin
- may beed antispasmodics
- pyridium: analgesic–>turns urine orange
18
Q
repeated UTIs
A
- prophylactic or suppressive abx
- TMP-SMX administered every day to prevent recurrence or single dose before events likely to cause UTI
19
Q
vesicoureteral reflux (VUR)
A
- congenital anomalies can cause primary reflux - ureters not inserted normally into bladder
- secondary reflux is caused by infection and ureterovesicular junction incompetency r/t edema
- may also be r/t neurogenic bladder and NTDs
- runs in families
- graded 1-5:
- 5 is worst
20
Q
clinical manifestations of VUR
A
- dysuria
- urinary frequency, urgency, hesitancy
- urinary retention
- cloudy, dark, blood tinged urine
- recurrent UTIs
21
Q
diagnostic findings with VUR
A
- RBCs or pyuria noted in UA
- IVP, VCUG, or cystoscopy may reveal structural abnormalities
22
Q
tx for VUR
A
- nonsurgical:
- deflux injection - gel used in endoscopic injections
- gel is injected around the ureter opening to create a valve and to make the backflow of urine into the kidneys more difficult
- requires anesthesia
- deflux injection - gel used in endoscopic injections
- surgical:
- detach ureter and reinsert at correct angle
- use a stent
- need 24 hr hospital stay
- detach ureter and reinsert at correct angle
23
Q
nephrotic syndrome
A
- complex of symptoms characterized by:
- proteinuria
- hypoalbuminemia
- hyperlipidemia
- altered immunity and edema
- etiology unknown
- but minimal change nephrotic syndrome is most common
- can also be secondary to SLE, DM, sickle cell anemia
24
Q
pathology of nephrotic syndrome
A
- somehow there is inc permeability to protein usually due to some damage to the glomerulus, so the protein leaks out and albumin comes out in the urine
- what causes fluid shift from intravascular space to interstitial space?
- hypoalbuminemia decreases the colloid osmotic pressure in the capillaries, as a result the hydrostatic pressure exceeds the colloid osmotic pressure and fluid accumulates in the interstitial spaces and the body cavities–>3rd spacing occurs
- what does the change in intravascular vol stimulate?
- RAAS system and secretion of ADH and aldosterone–>body tries to retain fluid
- tubular reabsorption of sodium and water inc in an attempt to inc intravascular volume
25
clinical manifestations of nephrotic syndrome
* periorbital, pedal, and scrotal edema that progresses to generalized edema
* generalized edema may progress to resp distress
* weight inc--\>b/c retaining fluids
* dec urine output
* possible pleural effusion--\>fluid has to go somewhere
* pallor anorexia
* fatigue
* abdominal pain
* diarrhea
* _BP may be normal or even slightly dec_--\>b/c intravascular volume is depleted
* high urine SG
26
diagnostic findings of nephrotic syndrome
* UA:
* marked proteinuria,
* hyaline casts,
* few RBCs,
* inc specific gravity
* serum protein level is markedly decreased
* esp the albumin level
27
tx for nephrotic syndrome
* during edema phase--child limited to quiet activity
* during remission--activity is not restricted
* acute and recurrent infections are treated with appropriate abx and efforts are made to minimize the risk of injury
* corticosteroid--started as soon as the diagnosis has been established
* 2 mg/kg in divided BID doses
* 3 mos of therapy
* course of therapy: usually not immediate change, but know they are improving when pt starts to diurese
* remember to never d/c steroids abruptly
* children with nephrotic syndrome often relpase 1-3 times/year
28
diet for nephrotic syndrome
* salt restriction necessary when massive edema and when taking corticosteroids
* is water restricted?
* seldom but may be necessary when have severe edema
* protein?
* not necessarily beneficial to inc protein in diet
* should restrict protein if have azotemia and renal failure
29
acute glomerulonephritis (GN)
* most are post streptococcal
* may be distinct entity or manifestation of SLE, sickle cell
30
clinical manifestations of acute GN
* _HTN_: due to inc ECF
* pallor
* irritability
* fatigue
* lethargy
* periorbital and generalized edema--not as obvious as nephrotic syndrome
* weight gain
* electrolyte imbalance
* oliguria and hematuria--cola colored urine
* CVA tenderness
* anorexia
31
diagnostic findings with GN
* UA: RBCs, casts, WBCs, and protein
* (inc amt of protein = inc severity of renal dz)
* serum chemistry:
* elevated BUN, Cr, ESR, and anti streptolysin O titer (ASO--shows if current or post strep infection)
* serum complement level (CS) is dec initially but returns to normal 8-10 weeks after onset GN
32
acute post streptococcal GN (APSG)
* noninfectious renal dz (autoimmune)
* onset 5-12 days after another infection
* often group A beta hemolytic strep
* most common in children 6-7 yo
* older kids than nephrotic syndrome
* uncommon in children under 2
33
nursing mgmt of APSG
* manage edema: daily weights, accurate I/O, daily abdominal girth
* nutrition:
* low sodium: moderate restriction with HTN or edema
* low to moderate protein
* potassium containing foods restricted during the period of oliguria
* susceptibility to infections
* bed rest is not necessary--although most kids will restrict activity b/c of malaise
34
hypospadias
* urethral opening below the glans penis or anywhere along ventral surface of penile shaft
* can be assoc with undescended testes and inguinal hernias
* pathology results from failure of the urethral folds to fuse completely over the ureteral groove
35
post op care for hypospadias or epispadias
* care of indwelling catheter
* no baths until catheter removed
* instruct to gently cleanse around tip of penis and catheter
* encourage liquids
* analgesia as needed
36
acute renal failure (ARF)
* kidneys suddenly unable to regulate the volume and composition of urine
* esp if dehydrated
* not common in children
* principle feature is oliguria
* assoc with azotemia, metabolic acidosis, and electrolyte disturbances
* most common cause is transient renal failure resulting from severe dehydration
* usually reversible
* mgmt: aimed at minimizing complications
* assess for changes in V/S, U/O
37
complications of ARF
* hyperkalemia: restrict potassium
* HTN
* anemia
* sz
* hypovolemia
* cardiac failure w/ pulmonary edema
38
chronic renal failure (CRF)
* begins when diseased kidneys cannot maintain normal chemical structure of body fluids
* clinical syndrome called uremia
39
potential causes of CRF
* congenital renal and urinary tract malformations
* VUR assoc with recurrent UTIs
* chronic pyelonephritis
* chronic GN
40
what are the 3 types of dialysis?
* hemodialysis
* peritoneal dialysis
* hemofiltration
41
hemodialysis
* very time consuming
* requires creation of a vascular access and special dialysis equipment
* best suited for kids who can be brought to facility 3 times per week for 4-6 hrs
* achieves rapid correction of fluid and electrolyte abnormalities
* assess AV fistual: auscultate for bruit and palpate for thrill
42
peritoneal dialysis
* abdominal cavity acts as semipermeable membrane for filtration
* can be managed at home in some cases
* warmed solution enters peritoneal cavity by gravity
* remains for period of time before removal
* weigh client before and after procedure to see how much fluid taken off
43
continuous venovenous hemofiltration
* uses technique for ultrafiltration of blood continuously at a very slow rate
* works with the fluid overload in portop period
* successful alternative for critically ill children who might not survive rapid volume changes of hemodialysis of PD
* best type of dialysis if client is hemodynamically unstable
* done in ICU
44
transplantation
* have to match HLA antigens
* 7 HLAs--more that match, the better the chance to prevent rejection
* cna be from living or cadaver donor
* primary goal: long term survival of grafted tissue
* will be on immunosuppresant therapy
