chpater 21 peds final
The nurse is educating the parents of a child requiring renal replacement. The parents express concern because they live in a remote, rural area with no access to pediatric specialty dialysis units. Which would the nurse recommend to the parents? Hemodialysis Peritoneal dialysis In-home hemodialysis Renal transplant
Peritoneal dialysis Explanation: Peritoneal dialysis is performed in the home setting after proper training. Hemodialysis is completed several times a week at a dialysis center. Renal transplant would be a discussion if the child needed a kidney transplant.
Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant? Deficient fluid volume related to fluid intake restrictions postoperatively Risk for infection related to immunocompromised state Constipation related to effects of administered drugs Pain related to tissue rejection
Risk for infection related to immunocompromised state Explanation: Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection. The child may have pain from the surgical procedure but it does not occur from the rejection of the organ. Constipation may occur from the opioids used for pain management but it is not the priority nursing diagnosis. The fluid volume should return to normal once the transplanted kidney is functioning properly.
The nurse is caring for a child who is undergoing peritoneal dialysis. Immediately after draining the dialysate, which action should the nurse should take immediately? Empty the old dialysate. Weigh the old dialysate. Weigh the new dialysate. Start the process over with a fresh bag
Weigh the old dialysate. Explanation: The nurse should weigh the old dialysate to determine the amount of fluid removed from the child. The fluid must be weighed prior to emptying it. The nurse should weigh the new fluid prior to starting the next fill phase. Typically, the exchanges are 3 to 6 hours apart so the nurse would not immediately start the next fill phase.
The nurse is caring for a child who receives dialysis via an AV fistula. Which finding indicates an immediate need to notify the physician? presence of a bruit presence of a thrill dialysate without fibrin or cloudiness absence of a thrill
absence of a thrill Explanation: The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill. Dialysate without fibrin or cloudiness is normal and is used with peritoneal dialysis, not hemodialysis.
The nurse is caring for a 6-year-old client diagnosed with acute renal failure. During assessment, the nurse notes: temperature 99.0°F (37.2°C), urine output less than 0.4 mL/kg/hr, blood pressure 130/88 mm Hg, periorbital edema, and respirations 28 breaths/minute. Which prescriptions will the nurse anticipate from the primary health care provider? Select all that apply. furosemide dialysis serum electrolyte levels urinalysis labetalol
furosemide dialysis serum electrolyte levels urinalysis labetalol Explanation: The child is experiencing complications of the acute renal failure including oliguria, interstitial fluid shifting, and hypertension. Oliguria is defined as a urine output that is less than 0.5 mL/kg/h in children. The nurse would prepare to administer furosemide to assist with the edema and labetalol to lower the blood pressure. Dialysis may be needed due to the severe oliguria. The client is at risk for electrolyte disturbances and should be monitored closely. A urinalysis may reveal proteinuria or hematuria, which could indicate additional complications.
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder? hypertension hypotension hypothermia tachycardia
hypertension Explanation: Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.
The nurse is caring for a child who has been admitted to the acute care facility with manifestations consistent with hydronephrosis. Which tests will confirm the diagnosis? Select all that apply. intravenous pyelogram (IVP) urinalysis voiding cystourethrogram (VCUG) complete blood cell count (CBC) renal ultrasound
intravenous pyelogram (IVP) voiding cystourethrogram (VCUG) renal ultrasound Explanation: A VCUG will be performed to determine the presence of a structural defect that may be causing the hydronephrosis. Other diagnostic tests, such as a renal ultrasound or an intravenous pyelogram, may also be performed to clarify the diagnosis. A urinalysis may be performed to assess the quality and characteristics of the urine but the test will not confirm a diagnosis of hydronephrosis. A CBC may be used to assess the level of a genitourinary infection but it will not confirm the diagnosis of hydronephrosis.
A nurse is caring for a 12-year-old girl recently diagnosed with end-stage kidney disease. The nurse is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching? "My daughter can eat what she wants when she is hooked to the machine." "My daughter must avoid high sodium foods." "She needs to restrict her potassium intake." "She can eat whatever she wants on dialysis days."
"She can eat whatever she wants on dialysis days." Explanation: The girl cannot eat whatever she wants on dialysis days. She can eat what she wants during the few hours she is actively undergoing treatment in the hemodialysis unit. The other statements regarding a high sodium diet and potassium intake are correct.
The nurse is caring for an infant with grade II vesicoureteral reflux (VUR). The parent is very fearful that the infant will have progressive renal damage. Which response by the nurse would be appropriate? "This condition usually resolves spontaneously with no symptoms." "This problem must be carefully managed to avoid permanent damage." "You can expect recurrent urinary tract infections along with progressive renal damage." "Your infant will most likely need surgical intervention."
"This condition usually resolves spontaneously with no symptoms." Explanation: Grades I and II VUR usually resolves spontaneously. Grades III to V are generally associated with recurrent urinary tract infections, hydronephrosis, and renal damage. Typically, only grades III to V need surgical intervention.
A 10-year-old child in renal failure is on continuous ambulatory peritoneal dialysis (CAPD). What would be important to teach the parents? Dialysis solution must be infused over a period of 30 minutes. Slight bleeding from the exchange catheter is to be expected. The return solution will be cloudy because of urea in it. Cramping should not occur with an infusion.
Cramping should not occur with an infusion. Explanation: Continuous ambulatory peritoneal dialysis is a method which allows mobility for the child. The child should be assessed for toleration of the fluid volume instilled into the peritoneum. The abdomen will remain distended while the fluid is indwelling. The child may be slightly uncomfortable from the pressure but should not experience cramping or pain. The dwell time for this type of dialysis is from 3 to 6 hours. The return flow should be clear. A cloudy return flow suggests infection. The dialysate solution will fill from gravity so there is no specified time frame for instillation and will also be affected by the amount of dialysate solution to be instilled.
A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? Urinalysis Creatinine clearance rate Kidneys, ureter, and bladder x-ray Computed tomography scan
Creatinine clearance rate Explanation: The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.
When examining the musculoskeletal system of the child, which would be indicative of a potential kidney problem? Walking with a limp A clunk felt in abduction of the hip Muscle weakness Hypertonia
Muscle weakness Explanation: Muscle weakness occurs in many renal conditions. Walking with a limp, a hip clunk, and hypertonia are indicative of musculoskeletal problems, but not necessarily renal problems as well.
The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis: The child can live a more normal lifestyle. There are strict diet and fluid restrictions. Therapy is only 3 to 4 days per week. The child must go into a facility to get peritoneal dialysis.
The child can live a more normal lifestyle. Explanation: The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.
A child needs to undergo peritoneal dialysis. What type of education would the nurse provide to the family about this process? The peritoneal dialysis should help the child with his or her growth and blood pressure. The child will need to have increased fluid restrictions with this. Infection risk is low. This is performed for 24 hours a day.
The peritoneal dialysis should help the child with his or her growth and blood pressure. Explanation: The advantages of peritoneal dialysis over hemodialysis include improved growth as a result of more dietary freedom, increased independence in daily activities, and a steadier state of electrolyte balance. However, the risk for infection (peritonitis and sepsis) is a continual concern with peritoneal dialysis.
While assessing a child with end-stage kidney disease, the nurse notes that the child has fallen into a coma. The nurse interprets this finding as resulting from which complication? Uremia Metabolic acidosis Immunosuppression Hypocalcemia
Uremia Explanation: Uremia may result in depression of the central nervous system leading to symptoms such as headache or coma or gastrointestinal or neuromuscular disturbances. Metabolic acidosis causes lethargy, dull headache, and confusion. Immunosuppression is not involved with end-stage kidney disease. Hypocalcemia is manifested by muscle twitching, or tetany.
A nurse is caring for a 13-year-old boy with end-stage kidney disease who is preparing to have his hemodialysis treatment in the dialysis unit. Which nursing action is appropriate? Administer his routine medications as scheduled. Take his blood pressure measurement in the extremity with the AV fistula. Withhold his routine medication until after dialysis is completed. Assess the Tenckhoff catheter site.
Withhold his routine medication until after dialysis is completed. Explanation: The nurse should withhold routine medications on the morning that hemodialysis is scheduled since they would be filtered out through the dialysis process. His medications should be administered after he returns from the dialysis unit. A Tenckhoff catheter is used for peritoneal dialysis, not hemodialysis. The nurse should avoid blood pressure measurement in the extremity with the AV fistula as it may cause occlusion.
The nurse is caring for a child on a pediatric unit who has hemodialysis three times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child? cheeseburger, french fries, and lemonade grilled chicken, apple slices, and flavored water three-egg omelet, bacon, and orange juice tomato soup, crackers, and diet soda
grilled chicken, apple slices, and flavored water Explanation: Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium and potassium should be limited.
The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which characteristics of this condition should the nurse expect to assess or glean from chart review? hemolytic anemia, acute renal failure, and hypotension dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level hemolytic anemia, thrombocytopenia, and acute renal failure thrombocytopenia, hemolytic anemia, and nocturia several times each night
hemolytic anemia, thrombocytopenia, and acute renal failure Explanation: Hemolytic uremic syndrome is defined by all three particular features—hemolytic anemia, thrombocytopenia, and acute renal failure. Dirty green-colored urine, elevated erythrocyte sedimentation, and depressed serum complement level are indicative of acute glomerulonephritis. Hypertension, not hypotension, would be seen and the child would have decreased urinary output, which would not cause nocturia.
When assessing a child with hydronephrosis, what would the nurse expect to find? Select all that apply. intermittent hematuria abdominal mass foul-smelling urine flank pain proteinuria
intermittent hematuria abdominal mass Explanation: Intermittent hematuria is a common symptom of hydronephrosis. An abdominal mass may be palpated with hydronephrosis. Foul-smelling urine is associated with obstructive uropathy. Flank pain is associated with obstructive uropathy and vesicoureteral reflux. Proteinuria is associated with nephritic syndrome.
The nurse is providing care to a child with acute renal failure. What assessment would be a priority for the nurse to determine if this child is developing hyperkalemia? pulse rate and rhythm muscle tone blood pressure abdominal pain
pulse rate and rhythm Explanation: Hyperkalemia occurs when the potassium levels rise above normal laboratory values. Although it varies among laboratories, a normal potassium range is generally between 3.5 and 5 mEq/l (3.5 and 5 mmol/l). When the potassium levels rise, the child will develop symptoms such as a weak, irregular pulse, muscle weakness and abdominal cramping. The priority assessment is the pulse rate and rhythm, because potassium is directly linked to heart functioning. Increased muscle tone would be associated with hypocalcemia. The blood pressure is not directly affected by the potassium levels. It could be altered indirectly if arrhythmia occurs or the heart starts to fail.
