week 3- peds GU
Pyelonephritis requires what kind of antibiotics?
IV antibiotics can lead to renal scarring
UTI prevention
Increase water intake (want light yellow urine) Urinate every 2-3 hours; double void to fully empty bladder NO bubble baths (can cause vulvar and urethral irritation) Wipe front to back after BM Wear cotton underwear Good hygiene (wash vulva daily to lower bacterial count on perineum)
Clinical Presentations of Wilm's Tumor
Increased abdominal girth Abdominal swelling/mass firm and non-tender to one side Hematuria Hypertension Fatigue Weight loss
Acute Post Streptococcal Glomerulonephritis- when does it occur?
Occurs 10-21 days after a strep infection in certain strains of strep that cause immune-complexes to deposit in the glomerular basement membrane causing the glomeruli to become edematous occluding the capillary lumen
Goal for treatment of nephrotic syndrome- Reduce 2 things:
Reduce excretion of urinary protein Reduce fluid retention
CM's of nephrotic syndrome
Weight gain (edema) Facial edema (especially when waking up) Abdominal swelling Diarrhea (edema in the intestinal mucosa) Anorexia Easily fatigued Decreased urine volume
The nurse is caring for a 12-year-old girl with nephrotic syndrome. The girl confides that she feels like a "freak" compared to her peers because of her weight, edema, and moon face. Which response by the nurse would be most appropriate? A) "Let's put you in touch with some other girls who are also having the same body changes." B) "Luckily, this is just a temporary, unfortunate part of your condition; you need to accept it." C) "Your real friends do not care about your appearance and just want you to get well." D) "You are beautiful in your own way; what matters is what is on the inside."
A) "Let's put you in touch with some other girls who are also having the same body changes"
Urinalysis of UTI will show?
Leukocytes Nitrates Blood
Survival rate for Wilm's Tumor? more common in what gender? peak diagnosis age is? associated with?
Most common renal malignancy in children: 500 new cases per year 90% survival rate Peak age of diagnosis is 3 years More frequent in males Associated with GU anomalies and syndromes
What should you never do with Wilm's Tumor?
NEVER PALPATE ABDOMEN Manipulation of tumor may cause spread of cancer cells to adjacent sites
Nephrotic Syndrome- occurs as a result of
Occurs as a result of increased glomerular basement membrane permeability resulting in the passage of larger plasma proteins
Hemolytic Uremic Syndrome (HUS)
Simultaneous occurrence of 1. hemolytic anemia 2. thrombocytopenia 3. & acute renal disease usually preceded by a diarrheal illness which is usually caused by strain of E. coli
When is Wilm's tumor operated on?
Surgery is performed 24-48 hours after diagnosis Chemotherapy is started immediately after surgery
Treatment of Wilm's Tumor
Surgical removal Chemotherapy +/- radiation 90% survival rate if detected early
What is it important to assess in a child receiving prednisone to treat nephrotic syndrome? a. Infection b. Urinary retention c. Easy bruising d. Hypoglycemia
a. Infection
Clinical Manifestations of UTI in infant
poor feeding vomiting failure to thrive frequent & foul urine pale fever persistent diaper rash
Almost all children diagnosed with acute post-streptococcal glomerulonephritis
recover completely
acute pyelonephritis can lead to 3 things:
renal scarring hypertension ESRD
May need to do what kind of testing for structural defect?
renal ultrasound and/or VCUG
The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to: a. neurologic manifestations that occur with dialysis. b. physiologic manifestations of renal disease. c. adolescents having few coping mechanisms. d. adolescents often resenting the control and enforced dependence imposed by dialysis.
d. adolescents often resenting the control and enforced dependence imposed by dialysis.
A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: a. blood pressure will stabilize. b. the child will have more energy. c. urine will be free of protein. d. urinary output will increase.
d. urinary output will increase.
Parent education for nephrotic syndrome?
2/3 of children will relapse. Early detection minimizes damage to kidneys!! Signs and symptoms of nephrotic syndrome Urine dipsticks at home
The nurse is measuring ouput on an infant on the pediatric unit. When weighing the diaper and subtracting the weight of the dry diaper, the nurse records 30 grams and documents this as _________ mL.
30 mL
Bladder capacity in newborn increases to adult size in?
30 mL adult size in 1 year
Peak age for Acute Post Streptococcal Glomerulonephritis is?
6-7 years
Monitor for side effects of long term steroid treatment in nephrotic syndrome:
Rounding of face Weight gain Increased appetite Growth retardation Hypertension Hyperglycemia Infection
Nursing Management of Nephrotic Syndrome (5)
Strict I's & O's Daily weight and measurement of abdominal girth Monitor vital signs (d/t increased risk of infection) Urine examination for protein (UA dipstick) Monitor fluid retention or excretion
***Treatment and Management of AG*** (3 things!)
antibiotic therapy, diuretics, antihypertensive medications Dietary restrictions: sodium and fluid
Which physical assessment technique will the nurse omit when caring for a 2-year-old diagnosed with Wilms' tumor? a. Performing range-of-motion exercises on lower extremities b. Palpating the abdomen c. Assessing for bowel sounds d. Percussing ankle and knee reflexes
b. Palpating the abdomen
What is an initial sign of nephrosis that the nurse might note in a child? a. Raspberry-like rash b. Periorbital edema c. Temperature elevation d. Abdominal pain
b. Periorbital edema
Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome? a. Reduce blood pressure. b. Reduce excretion of urinary protein. c. Increase excretion of urinary protein. d. Increase ability of tissues to retain fluid.
b. Reduce excretion of urinary protein.
Which is included in the diet of a child with minimal change nephrotic syndrome? a. High protein b. Salt restriction c. Low fat d. High carbohydrate
b. Salt restriction
A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show: a. bacteriuria, hematuria. b. hematuria, proteinuria. c. bacteriuria, increased specific gravity. d. proteinuria, decreased specific gravity.
b. hematuria, proteinuria.
Which statement made by a parent of a child with nephrotic syndrome indicates an understanding of discharge teaching? a. "I will make sure he gets his measles vaccine as soon as he gets home." b. "He can stop taking his medication next week." c. "I should check his urine for protein when he goes to the bathroom." d. "He should eat a low-protein diet for the next few weeks."
c. "I should check his urine for protein when he goes to the bathroom."
The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. "You will need to decrease the number of calories in your child's diet." b. "Your child's diet will need an increased amount of protein." c. "You will need to avoid adding salt to your child's food." d. "Your child's diet will consist of low-fat, low-carbohydrate foods."
c. "You will need to avoid adding salt to your child's food."
Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis? a. Risk for Injury related to malignant process and treatment b. Fluid Volume Deficit related to excessive losses c. Fluid Volume Excess related to decreased plasma filtration d. Fluid Volume Excess related to fluid accumulation in tissues and third spaces
c. Fluid Volume Excess related to decreased plasma filtration
A parent tells the nurse that her child is scheduled for an x-ray of the bladder and urethra that is done while the child is urinating. What is this test known as? a. Cystometrogram b. Cystoscopy c. Voiding cystourethrogram d. Intravenous pyelogram
c. Voiding cystourethrogram
The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of: a. poor appetite. b. increased potassium intake. c. reduction of edema. d. restriction to bed rest.
c. reduction of edema. This amount of weight loss in this period is a result of the improvement of renal function and mobilization of edema fluid. Poor appetite and bed rest would not result in a weight loss of 8 pounds in 4 days. Foods with substantial amounts of potassium are avoided until renal function is normalized.
what is really seen first hand in nephrotic syndrome?
facial edema!!!
UTI is most common during what years?
first year of life, potty training, teenage girls
What is believed to account for the increased incidence of infection in females?
shorter urethra
differences in urethra
shorter-- risk for bacteria going into the bladder (UTI)
If VUR, (vesicouretal reflux), may require
surgical correction
DIAGNOSTIC CRITERIA for nephrotic syndrome
urinalysis- 3+ protein 24-hour urine protein >50mg/kg/day Serum albumin- Low Serum protein- Low Renal biopsy Other labs: hyperlipidemia, elevated BUN
Single most important contributing factor in UTI is? and also..
urinary stasis (incomplete emptying of the bladder) and also.. Reflux (bladder urine into the ureters), anatomic abnormalities, dysfunction of the voiding mechanism or bladder compression.
If less than 2 months old and has a UTI what happens?
will likely need admission and IV antibiotics
if kidneys are scarred..
will scar glomerulus vital cells for filtration and excretion.
Diagnostic Evaluation of UTI if infant? if older?
you would do a urine culture. if infant- suprapubic aspiration if older- clean catch/Sterile catheterization
How to treat a UTI?
ANTIBIOTICS
Clinical Manifestations of AG (4)
Edema (especially periorbital) & generalized edema Proteinuria - Increased amount of protein = increased severity of renal disease Hypertension Hematuria --3+ ---Bleeding in upper urinary tract smoky urine ---Tea colored urine
Pre-op and post-op management Wilm's Tumor? WHAT DO YOU MONITOR
Monitor BP closely as they are at increased risk of HTN
Characteristics of nephrotic syndrome? (4 things!)
Proteinuria Frothy and foamy urine Hypoalbuminemia - losing protein in the urine Hyperlipidemia - losing lipids, body trying to make it up
diagnosing AG
Rapid strep and throat cx
Reproductive organs are immature at birth until
adolescence
Acute Post Streptococcal Glomerulonephritis
An antibody-antigen reaction that injures the glomeruli caused by an infection with a nephritogenic strain of group A, beta hemolytic streptococcus Most are post-infectious -Pneumococcal -Streptococcal -Viral
Upper UTI is also called
acute pyelonephritis
Which is a common side effect of short-term corticosteroid therapy? a. Fever b. Hypertension c. Weight loss d. Increased appetite
d. Increased appetite
Which is the most common cause of acute renal failure in children? a. Pyelonephritis b. Tubular destruction c. Urinary tract obstruction d. Severe dehydration
d. Severe dehydration
Childhood CM's of UTI
(more like adult) lower abdominal pain Frequency and urgency on urination Dysuria Poor appetite Vomiting Growth failure Excessive thirst Enuresis/incontinence Facial swelling Pallor Back pain Fatigue hematuria
Hemolytic Uremic Syndrome- priority of care?
ALL ABOUT SAFETY & INJURY PREVENTION safety is important because you don't want them to bleed, provide them with rest, may get iron and blood transfusions
The nurse is caring for a 4-year-old with a suspected urinary tract infection. Which of the following would be most appropriate when obtaining a urine specimen from the child? A) "I will need a urine sample." B) "Let your mom help you tinkle in this cup." C) "Please tinkle in this cup right now." D) "Please void in this cup instead of the toilet."
B) "Let your mom help you tinkle in this cup."
The nurse is assessing a child with acute poststreptococcal glomerulonephritis. Which of the following would the nurse expect to assess? Select all answers that apply. A) Irritability B) Abdominal pain C) Hypertension D) Crackles E) Polyphagia
B) Abdominal pain C) Hypertension D) Crackles
A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which of the following? A) Decreased blood urea nitrogen (BUN) and creatinine B) Decreased platelets and leukocytosis C) Hypernatremia and hypokalemia D) Respiratory acidosis and proteinuria
B) Decreased platelets and leukocytosis
Acute Post Streptococcal Glomerulonephritis- progression of disease
Begins with periorbital edema Loss of appetite Decreased urinary output Progresses to lower extremities and then to ascites Cola or tea-colored urine
The nurse is reviewing the laboratory test results of a child with nephrotic syndrome. Which of the following would the nurse least likely expect to find? A) Hyperlipidemia B) Hypoalbuminemia C) Decreased blood urea nitrogen (BUN) D) Hypoproteinemia
C) Decreased blood urea nitrogen (BUN)
What type of meds for nephrotic syndrome?
Corticosteroids 2mg/kg/day for 6 weeks followed by 1.5mg/kg/day for 4 weeks
differences in GFR risk for (2)?
GFR is slower in the infant risk for dehydration or overload -> is immature, cannot filter like adult
differences in kidney
LARGE related to other organs- prone to injury
Goals of Care
Maintain fluid and electrolyte balance Promote adequate nutrition Promote adequate urinary elimination and successful bladder emptying Promoting activity
Wilm's Tumor
Tumor that originates on one or both kidneys; linked to inactivation of a tumor suppressor gene at chromosome locu that affect cellular growth of the kidney Malignant renal and intra-abdominal tumor of childhood
One of the most common conditions of childhood?
UTI
The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output
a. Abdominal swelling
Which is instituted for the therapeutic management of minimal change nephrotic syndrome? a. Corticosteroids b. Antihypertensive agents c. Long-term diuretics d. Increased fluids to promote diuresis
a. Corticosteroids
What special considerations are related to long-term prednisone therapy in preschoolers? (Select all that apply.) a. Delayed immunization b. Hypertension c. Enlargement of the sex organs d. Alteration in nutrition e. Increased risk for infection
a. Delayed immunization e. Increased risk for infection
The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture b. Proteinuria and edema c. Oliguria and hypertension d. Anemia and thrombocytopenia
a. Fever with a positive blood culture
The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication? a. Infection b. Hypertension c. Encephalopathy d. Edema
a. Infection
A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.
a. Prevent infection.
A 7-year-old child with acute glomerulonephritis has gross hematuria and has been confined to bed. What is the most appropriate nursing intervention for this child? a. Providing activities for the child on restricted activity b. Feeding the child a protein-restricted diet c. Carefully handling edematous extremities d. Observing the child for evidence of hypotension
a. Providing activities for the child on restricted activity
The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected? (Select all that apply.) a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash
a. Vomiting c. Failure to gain weight f. Persistent diaper rash
Which should the nurse recommend to prevent urinary tract infections in young girls? a. Wear cotton underpants. b. Limit bathing as much as possible. c. Increase fluids; decrease salt intake. d. Cleanse perineum with water after voiding.
a. Wear cotton underpants.
What is an appropriate intervention for the edematous child with reduced mobility related to nephrotic syndrome? a. Reach the child to minimize body movements. b. Change the child's position frequently. c. Keep the head of the child's bed flat. d. Keep edematous areas moist and covered.
b. Change the child's position frequently.
A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess? (Select all that apply.) a. Weight loss b. Facial edema c. Cloudy smoky brown-colored urine d. Fatigue e. Frothy-appearing urine
b. Facial edema d. Fatigue e. Frothy-appearing urine
Which best describes acute glomerulonephritis? a. Occurs after a urinary tract infection b. Occurs after a streptococcal infection c. Associated with renal vascular disorders d. Associated with structural anomalies of genitourinary tract
b. Occurs after a streptococcal infection
The mother of a 5-year-old child taking prednisone for nephrotic syndrome tells the nurse he needs to get immunizations to enter kindergarten. What does the nurse clarify about receiving immunizations while on prednisone? a. Can interfere with the treatment for nephrosis b. Require that the child have antibiotic coverage c. Can be given in smaller, divided doses d. Should be delayed
d. Should be delayed
bacteria that mostly causes UTI is?
e.coli
Dietary restrictions for nephrotic syndrome (2) what for severe cases?
low Na diet Fluid restrictions-And sometimes diuretic therapy in severe cases
UTI may involve?
lower urinary tract- bladder, urethra upper urinary tract- ureters, renal pelvis, calyces, and renal parenchyma
Wilm's tumor is also known as
nephroblastoma
Most common presentation of glomerular injury in children?
nephrotic syndrome
