Peds Alteration in Urinary/Genitourinary Disorders

Glomerulonephritis

Acute post-streptococcal glomerulonephritis (APSGN)-when immune processes injure the glomeruli Injury of glomeruli, causes inflammation which alter glomerular structure and function to both kidneys Follows an infection, upper respiratory or skin Treatment Hydration and HTN management Nursing Assessment Common signs and symptoms: general edema, fever, lethargy, headache, decreased urine output, abdominal pain, vomiting, anorexia Assess blood pressure, auscultate heart and lungs (may hear crackle in lungs and gallop in heart due to fluid overload), inspect urine (protein-cola/tea color) Nursing Management Administer hypertensives, maintain sodium/fluid restrictions, weight child daily (same scale, same clothing, same time ), neurological evaluation Education on home regimen (monitor BP/diet, urine samples, no activity/contact sports) No NSAIDs!!

A 4-year old girl presents with recurrent UTI. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? A. Obtain a sterile urine sample after completion of antibiotics B. Teach appropriate toileting hygiene C. Prepare child for surgery to reimplant the ureters D. Administer antibiotics intramuscularly

B Inappropriate toileting hygiene is the cause of most UTI's in preschool girls. Although obtaining a urine specimen to ensure eradication of bacteria after completion of the antibiotic course is important, the priority is patient teaching. Infected urine may cause reflux and that reflux may scar the kidneys leading to hypertension later in life.

When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? A. Test urine for specific gravity B. Weigh the child daily C. Weigh the wet diapers D. Measure abdominal girth daily

B The most accurate measure for determining fluid retention (or loss) is daily weight measured on the same scale, at the same time, in similar clothing or naked

Renal Failure

Condition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products (often reversible) May be acute or chronic When acute renal failure continues to progress, it becomes chronic (ESRD) Medication commonly used that can reduce renal function: Cephalosporins - may see increase in BUN & creatinine Nephrotic drugs - aminoglycosides, sulfonamides, vancomycin, NSAIDs Nursing management (acute) Treat the underlying cause Managing hypertension Restoring fluid and electrolyte balance -Administer polystyrene sulfonate to decrease potassium Providing family education Complications of Acute Renal Failure Water intoxication and hyponatremia Hyperkalemia Hypertension Anemia Seizures Cardiac failure with pulmonary edema End-stage renal disease (ESRD) (chronic) Chronic renal failure requiring long-term dialysis or kidney transplantation Often results from structural defects Complications -Uremia toxins deplete erythrocytes and kidneys cannot make erythropoietin = severe anemia -Hypertension, heart failure Assessment of ERSD Physical examination Peritoneal catheter (PD) -look at site for absence of drainage, bleeding, or redness Fistula (HD) -If under hemodyalisis -Looking for breuie (rumbling sound) and feel for thrill (vibration) Lab and diagnostics Low hemoglobin and hematocrit Increased uric acid and creatinine Nursing management Growth and development Daily protein 0.9 to 1.5 g for adequate growth Sodium and potassium restrictions Goals for ESRD Promoting growth and development Remove waste products and maintaining fluid balance via dialysis Encourage psychosocial well-being -Often suffer from depression and anxiety -Referring children and families to the social worker, counselor or other resources as needed for any noted depression or anxiety issues Support and educate the family

A nurse is caring for a 12-year old girl recently diagnosed with ESRD. The nurse is discussing dietary restrictions with the girl's mother. Which of the following responses indicates a need for further teaching? A. "My daughter can eat what she wants when she is hooked to the machine." B. "My daughter must avoid a high sodium diet." C. "She needs to restrict her potassium intake." D. "She can eat whatever she wants on dialysis days."

D She can't eat whatever she wants on dialysis days, but she can eat whatever she wants on those days while actively undergoing treatment. Others are correct.

Variations in pediatric anatomy and physiology

Kidney: large in relation to the stomach; prone to injury Urethra: shorter; risk for bacteria into bladder (UTI) Glomerular filtration rate: slower in infant; risk for dehydration Bladder capacity: 30 mL in newborn; increases to adult size by 1 year Reproductive organs: immature at birth until adolescence

Resorting Fluid and electrolyte balance

Monitor vital signs frequently and assess urine-specific gravity. Maintain strict records of intake and output. Administer diuretics as ordered. When urine output is restored, diuresis may be significant. Monitor for signs of hyperkalemia and hypocalcemia. Administer polystyrene sulfonate (Kayexalate) as ordered. Administer packed red blood cell transfusions as ordered. Dialysis may become necessary.

Dialysis

Peritoneal (preferred for kids) Uses patient's abdomen as a semipermeable membrane to help remove excess fluid and waste products Advantages (can be done at home) Improved growth Increased independence Steadier state of electrolyte balance If abdomen is distended, make sure all fluid put in is coming out clear not cloudy Hemodialysis (Done 3 times a week with specialized equipment) Removes toxins and excess fluid from blood by pumping the blood through a dialysis machine and then reinfusing back to the body Disadvantages Missing school and other activities Access site may become infected Stricter diet between treatments If dialysis fails, kidney transplant. Familial match increases positive outcome.

Nursing care laboratory and diagnostic testing

The expected urine output in the infant and child is 0.5 to 2 mL/kg/hr. Obtaining a clean or sterile urine specimen is necessary for accurate urine culture results Suprapubic aspiration for obtaining a sterile urine specimen from the neonate or young child A urinary catheter must be inserted just prior to the voiding cystourethrogram Close monitoring of serum blood counts and electrolytes is a critical component of nursing care related to renal disorders

Laboratory and diagnostic tests for UTI

Urinalysis (clean catch, suprapubic, or catheterization): most common; may be positive for blood, nitrites, leukocyte esterase, white blood cells, or bacteria (bacteriuria) Urine culture: will be positive for infecting organisms Renal ultrasound: may show hydronephrosis if child also has a structural defect VCUG: not usually performed until the child has been treated with antibiotics for at least 48 hours, as infected urine tends to reflux up the ureters anyway. VCUG performed once the urine has regained sterility may be positive for VUR