NCLEX/HESI Pediatric Renal and Genitourinary Problems
The nurse is reviewing a treatment plan with the parents of a newborn with hypospadias. Which statement by the parents indicates their understanding of the plan?
"Circumcision has been delayed to save tissue for surgical repair."
Which question would the nurse ask the parents of a child suspected of having glomerulonephritis?
"Has the child had a sore throat or a throat infection in the last few weeks?" *: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury. Usually URTI come first.
The nurse reviews the record of a child who is suspected to have glomerulonephritis. Which statement that relates to this diagnosis would the nurse expect to hear from the child's parents?
"I noticed the urine was the color of cola lately."
The nurse has provided discharge instructions to the parents of a 2-year-old child who underwent an orchiopexy to correct cryptorchidism. Which statement by the parents indicates a need for FURTHER instruction?
"I'll let my child decide when to return to play activities." *All vigorous activities need to be restricted for 2 weeks after surgery to promote healing and prevent injury
Hemolytic Uremic Syndrome (HUS)
6 months to 5 y/o. Acute kidney injury. -Thrombocytopnia. -CNS-seizures, stupor, coma. -Triad of anemia. -Hemorrhagic-bruising, petechiae, jaundice, bloody diarrhea. -Proteinuria. -Hematuria. -Urinary casts. -High BUN/Cr. -Vomiting. -Irritability. -Lethargy. -Oliguria.
Nephrotic syndrome
A kidney disorder characterized by massive proteinuria, hypoalbuminemia (hypoproteinemia), hyperlipidemia, and edema
The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When analyzing the results of the urinalysis, which would the nurse most likely expect to note?
Bacteriuria
The nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse would plan which intervention?
Cover the bladder with a nonadhering plastic wrap.
UTI
E. coli, Staphylococcus saprophyticus (young women). More likely when uncircumcised and not wiping front to back.
Bladder exstrophy
Extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. Vesicoureteral reflux-urine backflow. Use a sterile, nonadherent dressing. *Do NOT use petroleum jelly because it dries out eventually.
VUR interventions
Finish antibiotics. *Avoid juice and soft drinks. *Warm blanket or towel over the abdomen.
The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with nephrotic syndrome notes that which most common characteristic is associated with this syndrome?
Generalized edema
Glomerulonephritis causes
Immunological or autoimmune disease. Hemolytic strep infection. Pharyngitis or tonsillitis 2-3 weeks before.
Glomerulonephritis s/s
Kidney failure. Hypertensive encephalopathy. Pulmonary edema. Heart failure. Seizures. *Periorbital edema. *Cola urine. *Distended head and neck veins. Pallor. Irritable. Anorexia. Proteinuria. Azotemia. Increased BUN/Cr. Increased anti-streptolysin O titer.
Glomerulonephritis interventions
Monitor vitals and urine appearance. Limit activity. *Restrict sodium and potassium. Monitor complications. *Diuretics for edema and fluid overload. *Antihypertensives for hypertension. *Antibiotics for strep. Seizure percautions.
A 7-year-old child is seen in a clinic, and the pediatrician documents a diagnosis of nighttime (nocturnal) enuresis. The nurse would plan to provide which information to the parents?
Nighttime (nocturnal) enuresis is usually outgrown without therapeutic intervention
The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment findings would the nurse expect to observe? Select all that apply
Pallor Edema Anorexia Proteinuria *Also hypoalbuminemia and elevated lipids.
The nurse is planning care for a child with hemolyticuremic syndrome who has been anuric and will be receiving peritoneal dialysis treatment. The nurse would plan to implement which measure?
Restrict fluids as prescribed
Nephrotic syndrome interventions
Sodium restriction. Corticosteroids. Immunosuppressant therapy. Diuretics. Testing the urine for protein. Infection monitoring.
VUR s/s
UTI. Bloody/cloudy urine. Urgency. Abdominal mass/ swollen bladder. Anorexia and poor weight gain. Constipation.
Enuresis Interventions
Urinalysis to rule out infection or DM. Limit fluid intake at night. Void right before bed. Reward system. Behavioral conditioning. Desmopressin.
vesicoureteral reflux (VUR)
Urine flow is abnormal and flows from the bladder back up into the ureters and the kidneys. Found with abdominal ultrasound and urinalysis.
Nephrotic syndrome s/s
Weight gain. Periorbital edema. Leg/ankle edema. Oliguria. *Dark/frothy urine. Ascites-fluid in the abdomen. BP decreased. Lethargy, anorexia, pallor. Proteinuria. Hypoproteinemia. Elevated lipids.
Enuresis
a condition in which a child is unable to control bladder function, even though the child has reached an age at which control of voiding is expected. Kid > 5y/o for 2xweek, at least 3 months. Primary= wetting with no prior toilet training. Secondary=wetting after toilet training. Nocturnal=bedwetting at night. Diurnal=during day.
cryotochidism
a condition in which one or both testes fail to descend through the inguinal canal into the scrotal sac.
Glomerulonephritis
a group of kidney disorders characterized by inflammatory injury in the glomerulus, most of which are caused by an immunological reaction. Acute: Occurs 1 to 2 weeks after a strep infection or parent reports the child has a history of streptococcal infection of the skin 3 to 6 weeks before symptoms. Chronic: May occur after the acute phase or slowly over time.
Epispadias and Hypospadias
congenital defects involving abnormal placement of the urethral orifice of the penis. These anatomical defects can lead to the easy entry of bacteria into the urine. *NO circumcision allowed.
