Renal Disorders

Question 1

Bladder Capacity- Newborn

Answer 1

1 to 2 oz

1 oz = 30cc

Question 2

Bladder Capacity- Child

Answer 2

Age (in years) + 2 = oz

Question 3

Phimosis

Answer 3

Narrowing or stenosis of the opening of the foreskin
Normal in infants and young boys
Can obstruct flow

Question 4

Phimosis Nursing Care

Answer 4

Thorough and consistent hygiene
DO NOT forcibly retract foreskin– PARAPHIMOSIS
Worry about infection

Question 5

Phimosis Treatment

Answer 5

Circumcision

Question 6

Hydrocele

Answer 6

Fluid filled sac around a testicle, scrotal swelling
Non-communicating - Common in newborns, resolves on own
Communicating - Surgical repair

Question 7

Hydrocele Nursing Care

Answer 7

Instruct parents that most resolve spontaneously

Continue to watch

Question 8

Hypospadias

Answer 8

Urethral opening is located below the glans penis or anywhere on the ventral surface

Question 9

Hypospadias Nursing Care

Answer 9

Inspect all male newborns
Teach parents post operative care - indwelling catheters, stents, irrigation
I/O’s

Question 10

Hypospadias Goals

Answer 10

Enable normal voiding

Preserve sexual functioning

Question 11

Ambiguous Genitalia

Answer 11

Disturbance of normal events of gender determination
Abnormal gender determination, differentiation of gonads, differentiation of ductal systems, abnormal secretion of androgen or tissue insensitivity to hormone

Question 12

Ambiguous Genitalia Nursing Care

Answer 12

Support parents in participation with health care team to make a gender assignment
Assist parents in understanding the process and importance of careful assignment
Assignment does not need to happen immediately

Question 13

Vesicoureteral Reflux

Answer 13

Retrograde flow of urine from the bladder into the ureter
Most common cause: pyelonephritis
Girls > Boys
HIGH RISK FOR INFECTION

Question 14

Vesicoureteral Reflux- Primary

Answer 14

Congenital
Abnormal tunneling of urethral segment or defects in ureter orifice
More common amount siblings

Question 15

Vesicoureteral Reflux- Secondary

Answer 15

Acquired
UTI or trauma can produce temporary reflux
Multiple infections before 3- be suspicious

Question 16

Vesicoureteral Reflux Grades

Answer 16

Full bladder – refluxes back up in ureter
Grade 1 &2 – Can resolve on its own
Grade 4&5 – Surgical Interventions

Question 17

Vesicoureteral Reflux Nursing Care

Answer 17

Goal is to prevent infection and scarring
Support parents in adherence to medication
Chronic antibiotics
Frequent evaluation of urine

Question 18

Obstruction of Uropathy Symptoms

Answer 18

UTI
Hematuria
Nausea
Flank pain
Dysfunctional voiding patterns
Can happen anywhere in the tract
Urinary stasis is the biggest risk

Question 19

Upper Tract Urinary Infection

Answer 19

Ureter
Renal Pelvis
Calyces
Renal parenchyma

Question 20

Lower Tract Urinary Infection

Answer 20

Urethra

Bladder

Question 21

Risk Factors for UTI

Answer 21

Urinary stasis - biggest risk
Children 2-6 – potty training age!
Girls

Question 22

Recurrent UTI

Answer 22

Repeated episodes of bacteriuria

Question 23

Persistent UTI

Answer 23

Despite antibiotics treatment, bacteria persits

Question 24

Febrile UTI

Answer 24

Bacteria with fever, implies pyelonephritis

Infants- common UTI with fever

Question 25

Urethritis

Answer 25

Inflammation of the urethra

Question 26

Urosepsis

Answer 26

Systemic signs of bacterial illness with UTI

Question 27

Pyelonephritis

Answer 27

Inflammation of the UPPER urinary tract AND kidney

Question 28

Cystitis

Answer 28

Inflammation of the bladder

Question 29

UTI Nursing Care

Answer 29

PREVENTION Proper voiding technique, avoid tight clothing and diapers, encourage generous fluid intake, avoid constipation, avoid "holding" urine

Question 30

UTI Symptoms

Answer 30

Educate parents! Signs: incontinence in a toilet trained child, strong smelling urine, frequency and urgency, pain

Question 31

Acute Glomerulonephritis (AGN)

Answer 31

A post- infection, immune complex condition associated with a combination of symptoms SECONDARY Glomerular capillaries are injured = decrease GFR

Question 32

AGN Symptoms

Answer 32

OLIGURIA EDEMA HTN Circulatory congestion - puffy eyes, hematuria, proteinura, loss of appetite, cola colored urine, irritable, lethargic

Question 33

AGN Timeline

Answer 33

``` Staph infection 10days - 2 weeks Then symptomatic Edema resolves- AGN starting to resolve 10 days - 3 weeks acute phase followed by DIURESIS phase ```

Question 34

AGN Complications

Answer 34

Hypertensive encephalopathy and cerebral edema Acute cardiac de-compensation- from HTN Acute renal failure Na and Water retention issues

Question 35

AGN Nursing Care

Answer 35

Closely monitor VS, fluid balance, and childs appearance Daily weight is best! Assess irritability, change in LOC, HTN Assess early renal failure -- hyperkalemia, uremia, excessive BUN, elevated creatinine, metabolic acidosis

Question 36

Nephrotic Syndrome

Answer 36

A number of distinct glomerular diseases with increased glomerular permeability = massive proteinuria, hypoalbuminemia, hyperlipidemia and EDEMA MASSIVE PROTEIN IN URINE- "Dumping" Leak fluid into tissues- vascular protein decreases

Question 37

Types of Nephrotic Syndrome

Answer 37

Minimal changes - 80%, biposy looks normal. Resolves Secondary -- result of AGN Congenital -- Autosomal recessive genetic disorder

Question 38

Nephrotic Syndrome Nursing Care

Answer 38

``` Strict daily weights, VS, I/O's Measure abdominal girth, urine output, color and appearance of protein Meticulous skin care- look at folds! Preventive measures to avoid infections Monitor for spontaneous peritonitis Good nutrition and meal planning! Developmental and family support ```

Question 39

Acute Renal Failure

Answer 39

Sudden inability of the kidneys to regulate volume and composition of urine Oliguria, azotemia, acidosis, diverse electrolyte imbalances DEHYDRATION! Secondary to vomiting or diarrhea TX: Dialysis, Na balance

Question 40

Enuresis

Answer 40

Intentional or involuntary passage of urine into the bed during sleep or into clothing during daytime hours at least twice a week for 3 months in children at least 5 years of age Usually resolves between ages 6 and 8

Question 41

Enuresis: Primary

Answer 41

Never achieved continence

Question 42

Enuresis: Secondary

Answer 42

Onset of wetting after having achieved continence | Infection, physiologic reason, psychological , a significant event

Question 43

Enuresis: Causes

Answer 43

Urinary tract infection that is undetected Genetic predisposition Familial tendency Emotional or behavioral factors

Question 44

Enuresis: Nursing Care

Answer 44

Assess for physiologic cause Support and respect the child and parents Support treatment plans (audible alarms, medications, behavioral therapies) Help child manage treatment expectations and provide consistency in the process Provide reassurance to parents Medication to decrease bladder spasms

Question 45

Encopresis

Answer 45

Repeated voluntary or involuntary passage of feces of normal or near normal consistency in inappropriate places at least once per month for 3 months after the age of 4 years CONSTIPATION

Question 46

Encopresis: Primary

Answer 46

Never achieved continence

Question 47

Encopresis: Secondary

Answer 47

Happens after established fecal continence | Painful to have a BM-- further avoidance

Question 48

Encopresis: Etiology

Answer 48

Constipation due to stressors in the environment and withholding stool Chronic and severe constipation resulting in fecal obstruction Abnormalities of the digestive tract (rectal prolapse) Medical conditions [CP, MD, irritable bowel syndrome (IBS)] Fear-panic disorders leading to learned abnormal defecation patterns

Question 49

Encopresis: Nursing Care

Answer 49

``` Thorough history and care is directed toward cause of soiling Education about normal digestive patterns and defecation Bowel retraining Correction of impaction Positive reinforcement Family plan and follow-up Support and non-judgmental attitude At 5 -- suppose to be continent! ```