PEDIATRIC Renal and Urinary

toddler/preschooler UTI Signs and symptoms

-abdominal pain -vomiting or diarrhea -flank pain -fever (especially related to pyelonephritis) -malodors -altered voiding pattern -diaper rash -enuresis -malaise

neonate UTI Signs and symptoms

-failure to thrive -jaundice -hypothermia -vomiting or diarrhea -cyanosis -abdominal distention -lethargy -sepsis

UTI

-gender -age -race -renal tissue -poor hygiene -constipation -nutritional status -adaptive and resistant qualities -structural abnormalities -catheterization -urinary tract instrumentation -sexual activity All contribute to he incidence and etiology of what?

boy structural differences: UTI

-longer urethra -phimosis: narrowing of the opening of the prepuce over the glans penis

infant UTI Signs and symptoms

-poor feeding -fever (especially related to pyelonephritis) -vomiting or diarrhea -malodor -dribbling urine -abdominal pain/colic irritability -malaise -poor weight gain

nephrotic syndrome: clinical manifestations

-Edema (periorbital and dependednt: feet and ankles) -Decreased urine production, dark in color -Hypertension -Hypo albuminemia -Hyper cholesterolemia -ascites with respiratory compromise -anorexia -diarrhea -vomiting -growth failure and muscle wasting if prolonged

school-age/adolescent UTI Signs and symptoms

-Enuresis -malodor -dysuria with frequency, urgency, and discomfort -fever/chills -abdominal pain -flank pain -malaise -vomiting or diarrhea

kidney function

-removes excess fluid and water from body -filters blood -balance fluid content -produce renin -help to control BP -produces erythropoietin to help make RBCs -activates vitamin D for healthy bones -adjusts levels of minerals and other chemicals

girl structural differences: UTI

-shorter urethra -Labial adhesions: Sticking together of the outer lips of the vagina -cultural factors: female circumcision

a

What is included in the therapeutic management of nephrotic syndrome? a. Corticosteroids b. Long-term diuretics c. Antihypertensive agents d. Fluid and salt restrictions

d

A nurse is planning care of a child who has a UTI. Which of the following interventions should the nurse include? a. administer an antidiuretic b. restrict fluids c. evaluate the child's self-esteem d. encourage frequent voiding

Pathophysiology of dehydration; acute renal failure

1. Fluids and some electrolytes lost from extracellular fluid 2. If fluid loss continues, loss of intracellular fluid can occur 3. Insufficient amount of fluid in the circulatory system, can lead to shock and eventual death acute dehydration can be a cause of acute ______ _____ in children

development of acute pyelonephritis bc back flow of urine to kidneys causes renal damage

What is the danger of vesicoureteral reflux?

Unexplained fever

What is the most important and may be the only presenting sign or symptom in pediatric UTI?

A child is admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which findings should the nurse expect to observe? Select all that apply. 1.Ascites 2.Anorexia 3.Weight loss 4.Proteinuria 5.Decreased serum lipids 6.Periorbital and facial edema

1.Ascites 2.Anorexia 4.Proteinuria 6.Periorbital and facial edema Nephrotic syndrome is a kidney disorder that is characterized by massive proteinuria, hypoalbuminemia, periorbital and facial edema, ascites, elevated serum lipids, and anorexia. The urine volume is decreased and the urine is dark and frothy in appearance. The child with this condition gains weight.

A nurse caring for a 2-month-old febrile infant is asked to collect a urine specimen for a culture and sensitivity. The nurse collects the specimen by performing which action? 1.Catheterizing the infant using the smallest available straight catheter 2.Attaching a urinary collection device to the infant's perineum for collection 3.Place cotton balls in the diaper and then after the infant voids aspirating the urine with a syringe 4.Noting the time of the next expected voiding and preparing to collect the specimen into a cup when the infant voids

1.Catheterizing the infant using the smallest available straight catheter In young infants less than 3 months of age who are febrile, urine specimens should be collected by bladder catheterization with a straight catheter. A urine collection bag would not get a sterile specimen and may take too long. For some types of urine testing, such as specific gravity, ketones, glucose, and protein, the nurse can aspirate urine directly from the cotton balls in the diaper. But would not be appropriate for a culture and sensitivity urine specimen. It is not reasonable to try to identify the time of the next voiding to attempt to collect the specimen

The nurse is assisting in developing a plan of care for a child diagnosed with acute glomerulonephritis. The nurse should include which intervention in the plan of care? 1.Encourage limited activity and provide safety measures. 2.Force intake of oral fluids to prevent hypovolemic shock. 3.Catheterize the child to strictly monitor intake and output. 4.Encourage classmates to visit and to keep the child informed of school events.

1.Encourage limited activity and provide safety measures. Activity is limited and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease. Catheterization may cause a risk of infection. Fluids should not be forced. Visitors should be limited to allow for adequate rest.

The nurse is assigned to care for a child who is suspected of having glomerulonephritis. The nurse reviews the child's record and notes that which findings are associated with the diagnosis of glomerulonephritis? Select all that apply. 1.Headache 2.Hypotension 3.Red-brown urine 4.Periorbital edema 5.Increased urine output 6.A low blood urea nitrogen (BUN) level

1.Headache 3.Red-brown urine 4.Periorbital edema Signs of glomerulonephritis include headache, abdominal or flank pain, gross hematuria resulting in dark, smoky, cola-colored or red-brown urine and periorbital edema or facial edema. Clients are hypertensive and have decreased urine output. BUN levels may be elevated.

The nurse is assisting in developing a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. Following review of the plan of care, the nurse determines that which intervention is the priority for the child? 1.Promoting bed rest 2.Restricting oral fluids 3.Encouraging visits from friends 4.Allowing the child to play with the other children in the playroom

1.Promoting bed rest ed rest is required during the acute phase, and activity is gradually increased as the condition improves. Providing for quiet play according to the developmental stage of the child is important. Fluids should not be forced or restricted. Visitors should be limited to allow for adequate rest.

The nurse is reviewing the record of a child admitted to the hospital with nephrotic syndrome. Which finding should the nurse expect to note documented in the record? 1.Proteinuria 2.Weight loss 3.Increased appetite 4.Hyperalbuminemia

1.Proteinuria The term nephrotic syndrome refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. The child experiences fatigue, anorexia, increased weight, abdominal pain, and a normal blood pressure.

The nurse is planning care for a child with hemolytic-uremic syndrome (HUS). The child has been anuric and will be receiving peritoneal dialysis treatment. The nurse should plan to include which interventions in the care of the child? Select all that apply. 1.Provide adequate nutrition. 2.Restrict fluids, as prescribed. 3.Institute measures to prevent infection. 4.Monitor the arteriovenous (AV) fistula. 5.Administer blood products to treat severe anemia. 6.Anticipate the child will have central nervous system involvement.

1.Provide adequate nutrition. 2.Restrict fluids, as prescribed. 3.Institute measures to prevent infection. 5.Administer blood products to treat severe anemia. 6.Anticipate the child will have central nervous system involvement. HUS is thought to be associated with bacterial toxins, chemicals, and viruses that cause acute kidney injury in children. A child with HUS who is undergoing peritoneal dialysis for the treatment of anuria will be prescribed fluid restrictions. The treatment also involves providing adequate nutrition, preventing infection and anticipating CNS involvement which may include seizure, stupor, and coma. Peritoneal dialysis does not require an AV fistula (only hemodialysis does).

The nurse is assisting in planning discharge instructions to the mother of a child following orchiopexy, which was performed on an outpatient basis. Which is the priority in the plan of care? 1.Wound care 2.Pain control measures 3.Measurement of intake 4.Cold and heat applications

1.Wound care The most common complications associated with orchiopexy are bleeding and infection. Discharge instruction should include demonstration of proper wound cleansing and dressing and teaching parents to identify signs of infection such as redness, warmth, swelling, or discharge. Testicles will be held in a position to prevent movement, and great care should be taken to prevent contamination of the suture line. Analgesics may be prescribed but are not the priority, considering the options presented. Option 2 is not necessary. Option 4 is not a prescribed treatment measure

c

What is the primary objective of care for the child with minimal change nephrotic syndrome (MCNS)? a. Reduce blood pressure. b. Lower serum protein levels. c. Minimize excretion of urinary protein. d. Increase the ability of tissue to retain fluid.

The nurse is reviewing the record of a child scheduled for a primary health care provider's visit. Before data collection, the nurse notes documentation that the child has enuresis. Based on this diagnosis, the nurse plans to focus on which factor when collecting data? 1. Bowel function 2. Bladder function 3. Motor development 4. Nutritional status and weight gain

2. Bladder function Enuresis refers to a condition in which the child is unable to control bladder function, although he or she has reached an age at which control of voiding is expected. Nocturnal enuresis, or bed-wetting, is common in children.

between 2-6 years old

What is the usual onset for nephrotic syndrome?

less than or equal to 2 (RBCs are big and normally our kidneys would not let these pass through the nephrons, we will usually hold there in the glomerulus; irritation would be at the nephron level for RBCs to be able to pass through)

What is the value for Urine RBCs?

0-4 in low power field

What is the value for urine WBCs?

The nurse is preparing a 2-year-old child with suspected nephrotic syndrome for a renal biopsy to confirm the diagnosis. The mother asks the nurse, "Will my child ever look thin again?" The nurse should respond by giving which statement? 1."Do you feel guilty about your child's weight gain?" 2."In most cases, medication and diet will control fluid retention." 3."Wearing loose-fitting clothing should help conceal the extra weight." 4."When children are little, it's expected that they'll look a little chubby."

2."In most cases, medication and diet will control fluid retention." It is important to give the mother information that addresses the issue that is the parent's concern. Most children experience remission with treatment. Options 1 and 3 are nontherapeutic and may add to the mother's guilt. Option 4 does not acknowledge the concern and is a stereotypical response.

An infant, weighing 12 kg, is receiving diuretic therapy, and the nurse is closely monitoring the intake and output. Which is the amount of hourly urine output should the nurse expect as adequate? 1.5 to 11 mL/hour 2.12 to 24 mL/hour 3.25 to 30 mL/hour 4.32 to 40 mL/hour

2.12 to 24 mL/hour Normal urinary output for an infant is 1 to 2 mL/kg/hr. Therefore for an infant weighing 12 kg, 12 to 24 mL/hour would be the expected amount as adequate.

A urinalysis has been prescribed for an infant and the nurse plans to collect the specimen. The nurse implements which appropriate method to collect the specimen? 1.Catheterizes the infant, using a No. 5 French Foley 2.Attaches a urinary collection device to the infant's perineum 3.Obtains the specimen from the diaper, using a syringe, after the infant voids 4.Monitors the urinary patterns and prepares to collect the specimen into a cup when the infant voids

2.Attaches a urinary collection device to the infant's perineum Although many methods have been used to collect urine from an infant, the most reliable method is the urine collection device. This device is a plastic bag that has an opening lined with adhesive so that it may be attached to the perineum. Urine for certain tests, such as specific gravity, may be obtained from a diaper. Urinary catheterization is not to be done unless specifically prescribed because of the risk of infection. It is not reasonable to monitor urinary patterns and attempt to collect the specimen in a cup when the infant voids.

An 18-month-old child is being discharged after surgical repair of hypospadias. Which postoperative nursing care measure should the nurse stress to the parents as they prepare to take this child home? 1.Leave diapers off to allow the site to heal. 2.Avoid tub baths until the stent has been removed. 3.Encourage toilet training to ensure that the flow of urine is normal. 4.Restrict the fluid intake to reduce urinary output for the first few days.

2.Avoid tub baths until the stent has been removed. After hypospadias repair, the parents are instructed to avoid giving the child a tub bath until the stent has been removed to prevent infection. Diapers are placed on the child to prevent the contamination of the surgical site. Toilet training should not be an issue during this stressful period. Fluids should be encouraged to maintain hydration.

The nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. The nurse reviews the child's record for the laboratory results of the urine test and would most likely expect to note which finding? 1.Hematuria 2.Bacteriuria 3.Glucosuria 4.Proteinuria

2.Bacteriuria Epispadias is a congenital defect that involves the abnormal placement of the urethral orifice of the penis. In clients with this condition, the urethral opening is located anywhere on the dorsum of the penis. This anatomical characteristic leads to the easy access of bacterial entry into the urine. Options 1, 3, and 4 are not characteristically noted with this condition.

The nurse caring for a child with nephrotic syndrome reviews the medication record. The nurse notes that prazosin hydrochloride is prescribed for the child. The nurse determines that this medication has been prescribed to achieve which result? 1.Reduce proteinuria. 2.Control hypertension. 3.Decrease inflammation. 4.Suppress the autoimmune response.

2.Control hypertension. Prazosin hydrochloride may be used to control hypertension. The child also may be placed on diuretic therapy until protein loss is controlled. Corticosteroids, such as prednisone, may be prescribed to decrease inflammation. Corticosteroids also suppress the autoimmune response and stimulate vascular reabsorption of edema. Cyclophosphamide is an alkylating agent.

A 1-year-old child with hypospadias is scheduled for surgery to correct this condition. The nurse is asked to assist in preparing a plan of care for this child. During this developmental time period, which factor should the nurse take into account? 1.Sibling rivalry will cause regression to occur. 2.Fears of separation and mutilation are present. 3.Embarrassment of voiding irregularities is common. 4.Concern over size and function of the penis is present.

2.Fears of separation and mutilation are present. At the age of 1 year, a child's fears of separation and mutilation are present because the child is facing the developmental task of trusting others. As the child gets older, fears about virility and reproductive ability may surface. The question does not provide enough data to determine that siblings exist. Options 3 and 4 may be issues if the child were older.

The nurse is assisting with gathering admission assessment data on a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that which is a common characteristic associated with nephrotic syndrome? 1.Hypotension 2.Generalized edema 3.Increased urinary output 4.Frank, bright red blood in the urine

2.Generalized edema Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, and edema. The urine is dark, foamy, and frothy, but microscopic hematuria may be present. Frank, bright red blood in the urine does not occur. Urine output is decreased and the blood pressure is normal or slightly decreased

the grade (I, II, III, IV, V)

What is treatment for VUR based on?

A male child who had surgery to correct hypospadias is seen in a primary health care provider's office for a well-baby checkup. The nurse provides instructions to the mother, knowing that which long-term complication is associated with hypospadias? 1.Infertility 2.Renal anomalies 3.Erectile dysfunction 4.Decreased urinary output

2.Renal anomalies The nurse should ask the child's parents about the child's kidney function because hypospadias may be associated with renal anomalies. The incorrect options are not associated with a long-term effect of hypospadias.

d

What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome? a. Low specific gravity b. Decreased hemoglobin c. Normal platelet count d. Reduced serum albumin

The nurse is collecting data on a child recently diagnosed with glomerulonephritis. Which question to the mother should elicit information about the cause of this disease? 1."Has your child had any diarrhea?" 2."Have you noticed any rashes on your child?" 3."Did your child recently complain of a sore throat?" 4."Did your child sustain any injuries to the kidney area?"

3."Did your child recently complain of a sore throat?" Group A beta-hemolytic streptococcal infection is a cause of glomerulonephritis. Often the child becomes ill with streptococcal infection of the upper respiratory tract and then develops symptoms of acute poststreptococcal glomerulonephritis after an interval of 1 to 2 weeks. The questions to the mother in options 1, 2, and 4 are unrelated to a diagnosis of glomerulonephritis.

The nurse has reinforced discharge instructions to the mother of an 18-month-old child following surgical repair of hypospadias. Which statement by the mother indicates a need for further teaching? 1."I should encourage fluid intake." 2."I should avoid toilet training right now." 3."I should carry my child by straddling the child on my hip." 4."I should use double diapers to hold the surgery site in place."

3."I should carry my child by straddling the child on my hip." Parent teaching following hypospadias repair includes restricting the child from activities that put pressure on the surgical site. Straddling the child on the hip will cause pressure on the surgical site. The parents should be instructed to use double diapers to hold the stent in place and should be instructed how to hold the child during the postoperative period. Fluids should be encouraged to maintain hydration. Toilet training should not be an issue during this stressful period.

A parent with a 6-year-old child diagnosed with enuresis discusses with the nurse the measures that are being taken to help her child. Which statement by the parent indicates a need for further teaching? 1."I make sure that my child goes potty before going to bed." 2."I have my child help with changing the wet sheets in the morning." 3."I take away privileges such as TV time when the bed is wet in the morning." 4."I make sure that my child does not have anything to drink 2 hours before bedtime."

3."I take away privileges such as TV time when the bed is wet in the morning." Providing a reward system appropriate for the child is more effective than a punitive system to treat enuresis. Interventions for treatment of enuresis include involving the child in caring for the wet sheets and changing the bed, to assist with the child taking ownership of the problem. Limiting fluid intake at night and encouraging the child to void just before going to bed is another effective intervention.

The nurse is reinforcing discharge instructions to the parent of a 2-year-old child who has had an orchiopexy to correct cryptorchidism. Which statement by the parent indicates a need for further teaching? 1."I'll check his temperature." 2."I'll give him medication so he'll be comfortable." 3."I'll let him decide when to return to his play activities." 4."I'll check his voiding to be sure there are no problems."

3."I'll let him decide when to return to his play activities." All vigorous activities should be restricted for 2 weeks after surgery to promote healing and prevent injury. This will prevent dislodging of the suture, which is internal. Normally, 2-year-old children will want to be very active. Therefore, allowing the child to decide when to return to his play activities may prevent healing and cause injury. The parents should be taught to monitor the child's temperature; provide analgesics, as needed; and monitor the urine output

The nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which statement should the nurse make to the mother? 1."Children always look a little bit fat, so don't be concerned." 2."Dress the child in loose-fitting clothing to hide the extra weight." 3."The fluid retention should be controlled by medication and diet." 4."The child will always have this appearance, and preparing the child for the body image change is important."

3."The fluid retention should be controlled by medication and diet." Most children experience remission with treatment and corticosteroids. Diuretics also may be a component of the treatment plan, and a restricted sodium diet is recommended. It is important to give the parent information in a matter-of-fact manner and address the issue that is the parent's concern. Options 1, 2, and 4 are inaccurate and inappropriate statements to the mother.

A 2-year-old child is admitted to the hospital with a diagnosis of nephrotic syndrome. In planning care for this child, which nursing intervention should be of highest priority? 1.Weigh morning and afternoon. 2.Maintain a strict intake and output. 3.Dipstick the urine for protein every 4 hours. 4.Take vital signs with blood pressure every 2 hours.

3.Dipstick the urine for protein every 4 hours. Continuous monitoring of fluid retention and excretion is an important nursing intervention in the care of the child with nephrotic syndrome. Although it is important to maintain a strict intake and output in monitoring fluid retention and excretion, the goal of treatment with this child is to decrease the amount of protein lost in the urine. Because this is the goal, option 3 has the highest priority. Although weight is monitored, it is not necessary to check the weight morning and evening. Taking vital signs with blood pressure is important but is not the priority in this situation and does not have to be monitored every 2 hours.

The nurse is administering medications to a 6-year-old child with nephrotic syndrome. To reduce proteinuria, the nurse would expect which medication to be prescribed? 1.Enalapril 2.Prednisone 3.Furosemide 4.Cyclophosphamide

3.Furosemide The child is usually placed on diuretic therapy with furosemide until protein loss is controlled. Enalapril is most commonly used to control hypertension. Corticosteroids, such as prednisone, may be prescribed to decrease inflammation. Corticosteroids also suppress the autoimmune response and stimulate vascular reabsorption of edema. Cyclophosphamide is an alkylating agent.

The child with cryptorchidism is being discharged after orchiopexy, which was performed on an outpatient basis. The nurse should reinforce instructions to the parents about which priority care measure? 1.Measuring intake and output 2.Administering anticholinergics 3.Preventing infection at the surgical site 4.Applying cold, wet compresses to the surgical site

3.Preventing infection at the surgical site The most common complications associated with orchiopexy are bleeding and infection. The parents are instructed in postoperative homecare measures, including the prevention of infection, pain control, and activity restrictions. The measurement of intake and output is not required. Anticholinergics are prescribed for the relief of bladder spasms; they are not necessary after orchiopexy. Cold, wet compresses are not prescribed. The moisture from a wet compress presents a potential for infection

The nurse assists in preparing a plan of care for the infant with bladder exstrophy. The nurse identifies which immediate problem as the priority for the infant? 1.Infection 2.Elimination 3.Skin disruption 4.Lack of parental understanding

3.Skin disruption In bladder exstrophy, the bladder is exposed and external to the body. The highest priority is skin disruption related to the exposed bladder mucosa. Although the infant needs to be monitored for elimination patterns and kidney function, this is not the priority concern for this condition. Lack of parental understanding related to the diagnosis and treatment of the condition will need to be addressed, but again, is not the priority. Although infection related to the anatomically located defect can be a problem, it is not the immediate one.

b c d

A nurse is teaching a parent of a child who has a UTI. Which of the following should the nurse include in the teaching? Select all that apply a. wear nylon underpants b. avoid bubble baths c. empty bladder completely with each void d. watch for manifestations of infection e. wipe perineal area back to front

b

What measure of fluid balance status is most useful in a child with acute glomerulonephritis? a. Proteinuria b. Daily weight c. Specific gravity d. Intake and output

The parents of a newborn have been told that their child was born with bladder exstrophy and the parents ask the nurse about this condition. Which response should the nurse give to the parents about bladder exstrophy? 1."It is a hereditary disorder that occurs in every other generation." 2."It is caused by the use of medications taken by the mother during pregnancy." 3."It is a condition in which the urinary bladder is abnormally located in the pelvic cavity." 4."It is an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall."

4."It is an extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall." Bladder exstrophy is a congenital anomaly that is characterized by the extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause is unknown and there is a higher incidence among males. Options 1, 2, and 3 are not characteristics of this disorder.

The nurse is assigned to care for an infant with cryptorchidism. One testis cannot be palpated. The nurse anticipates that which diagnostic study will be prescribed to determine where the undescended testis is located in the body? 1.Cystocopy 2.Abdominal x-ray 3.Urodynamic study 4.Computed tomography scan

4.Computed tomography scan If the testis is not palpable, an ultrasonography, computed tomography scan, or magnetic resonance imaging can determine its location. The missing testis may be found at any point along the process vaginalis, may be located in the abdomen, or may follow an aberrant course and come to lie in the inguinal area, base of the penis, or perineum. A cystoscopy is an examination of the bladder and lower urinary tract. An abdominal x-ray would not show the presence of the testis in the abdominal cavity. A urodynamic study is done to determine voiding dysfunction and an abnormal urinary tract.

A nursing instructor is observing a nursing student caring for an infant with a diagnosis of bladder exstrophy. The nursing student provides appropriate care to the infant by performing which action? 1.Covering the bladder with a dry sterile dressing 2.Covering the bladder with a wet-to-dry dressing 3.Applying sterile water soaks to the bladder mucosa 4.Covering the bladder with a nonadhering plastic wrap

4.Covering the bladder with a nonadhering plastic wrap Care should be taken to protect the exposed bladder tissue from drying while allowing drainage of urine. This is best accomplished by covering the bladder with a nonadhering plastic wrap. The use of wet-to-dry dressings should be avoided because this type of dressing adheres to the mucosa and may damage the delicate tissue when removed. Sterile dressings and dressings soaked in solutions can also dry out and damage the mucosa when removed.

The nurse is assisting with preparing a plan of care for a 4-year-old child hospitalized with nephrotic syndrome. Which intervention is most appropriate for this child? 1.Provide a high-salt diet. 2.Provide a high-protein diet. 3.Discourage visitors at mealtimes. 4.Encourage the child to eat in the playroom.

4.Encourage the child to eat in the playroom. Mealtimes should center on pleasurable socialization. The child should be encouraged to eat meals with other children on the unit. A diet that is normal in protein with a sodium restriction is normally prescribed for a child with nephrotic syndrome. Parents or other family members should be encouraged to be present at mealtimes with a hospitalized child.

The nurse is assigned to care for a 2-year-old child who has been admitted to the hospital for surgical correction of cryptorchidism. What is the highest priority in the postoperative plan of care for this child? 1.Force oral fluids. 2.Encourage coughing. 3.Test the urine for glucose. 4.Prevent tension on the suture.

4.Prevent tension on the suture. When a child returns from surgery, the testicle is held in position by an internal suture that passes through the testes and scrotum and is attached to the thigh. It is important not to dislodge this suture. Depending on the type of anesthesia used, option 2 may be appropriate but is not the priority in this surgery. Although adequate hydration is important to maintain, fluids should not be forced. Testing urine for glucose is not related to this type of surgery.

A child is seen in the clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. Which should the nurse relay to the mother about primary nocturnal enuresis? 1.Primary nocturnal enuresis does not respond to treatment. 2.Primary nocturnal enuresis is caused by a psychiatric problem. 3.Primary nocturnal enuresis requires surgical intervention to improve the problem. 4.Primary nocturnal enuresis is common, and most children will outgrow bed-wetting without therapeutic intervention.

4.Primary nocturnal enuresis is common, and most children will outgrow bed-wetting without therapeutic intervention. HomeHelpCalculator Study Mode Question 19 of 33 ID: 1232 | file: Pediatric PreviousGoNext StopBookmark Rationale Strategy Reference Submit A child is seen in the clinic, and the primary health care provider documents a diagnosis of primary nocturnal enuresis. The mother asks the nurse about the diagnosis. Which should the nurse relay to the mother about primary nocturnal enuresis? Rationale:Primary nocturnal enuresis is bed-wetting and is described as occurring in a child that has never been dry at night for extended periods. It is common in children, most of whom will outgrow bed-wetting without therapeutic intervention. The child is not able to sense a full bladder and does not awaken to void. The child may have delayed maturation of the central nervous system (CNS). It is not caused by a psychiatric problem. Behavioral conditioning with use of alarms has been used for treatment in the older child with nocturnal enuresis. A device that contains a moisture-sensitive alarm is worn on the child's pajamas. As the child starts to void, the alarm goes off, awakening the child. The alarm system may need to be used consistently over 15 weeks for resolution.

c

A child with minimal change nephrotic syndrome has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving furosemide (Lasix) twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema? a. an increase in the amount and frequency of furosemide b. addition of a second diuretic, such as mannitol c. administration of IV albumin d. elimination of all fluids and sodium from the child's diet

a

A nurse is teaching the parents of a child diagnosed with a UTI secondary to vesicoureteral reflux. How should the nurse explain how the reflux contributes to the infection? a. "it prevents complete emptying of the bladder" b. "it causes urine backflow into the kidney" c. "it results in painful bladder spasms" d. "it causes painful urination"

b c e

A nurse is caring for a child who has acute poststreptococcal glomerulonephritis. Which of the following manifestations should the nurse expect? Select all that apply a. pale urine b. periorbital edema c. ill appearance d. decreased creatinine e. hypertension

a

A 6 month old child is discharged with a urinary stent after a procedure to repair a hypospadias. The nurse should tell the parents to a. avoid tub baths until the stent is removed b. measure output in the urinary bag c. avoid giving fruit juice d. clean the tip of the penis three time a day with soap and water

pyelonephritis

A UTI that has ascended into the kidneys, increases the liklihood of sepsis, and may lead to renal scarring and subsequent renal damage

a

A child had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has bad no other problems until this visit when the child was diagnosed with another UTI. Which is the most appropriate plan? a. obtain urinalysis and urine culture b. evaluate for renal failure c. admit to the pediatric unit d. send home on an antibiotic

b

A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show? a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity

b

A child with acute glomerulonephritis is in the playroom and experiences blurred vision and a headache. What action should the nurse take? a. Check the urine to see if hematuria has increased. b. Obtain the childs blood pressure and notify the health care provider. c. Obtain serum electrolytes and send urinalysis to the laboratory. d. Reassure the child and encourage bed rest until the headache improves.

a b d

A child with periorbital edema, decreased urine output, pallor, and fatigue is admitted to the pediatric unit. The child is being examined for acute glomerular nephritis. Which of the following nursing measures should be considered? Select all that apply a. on examination there is usually a mild to moderate elevated in BP compared with normal values for age, although severe hypertension may be present b. urinalysis during the acute phase characteristically shows hematura, proteinuria, and increased specific gravity c. the primary objective is to reduce the excretion of urinary protein and maintain protein-free urine d. assessment of the child's appearance for signs of cerebral complications is an important function because the severity of the acute phase is variable and unpredictable e. because these children are particularly vulnerable to upper respiratory infection, protect them from contact with infected roommates, family, or visitors

d

A father brings his 4 week old son to the clinic for a checkup, stating that he believes his son's testicle is missing. Which explanation would be most appropriate? a. "although the testes should have descended by now, it is not a cause for worry" b. "it does appear that one of his testes has not descended. I will palpate his scrotum to check whether both testes are present" c. "the testes are present in the scrotal sac at birth, but surgery can remedy the situation" d. "although the testes normally descend by 1 year of age, I can understand your concern"

c

A girl, age 5 1/2 years, has been sent to the school nurse for urinary incontinence three times in the past 2 days. The nurse should recommend to her parent that the first action is to have the child evaluated for what condition? a. School phobia b. Glomerulonephritis c. Urinary tract infection (UTI) d. Attention deficit hyperactivity disorder (ADHD)

c

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. What nursing goal is appropriate for this child? a. Stimulate appetite. b. Detect evidence of edema. c. Minimize risk of infection. d. Promote adherence to the antibiotic regimen.

b c e

A nurse is assessing a child who has a urinary tract infection. Which of the following are manifestations of UTIs? Select all that apply a. night sweats b. swelling of the face c. pallor d. pale-colored urine e. fatigue

a b c e

A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? Select all that apply a. urine dipstick +2 protein b. edema in the ankles c. hyperlipidemia d. polyuria e. anorexia

b d e

A nurse is assessing an infant who has a suspected UTI. Which of the following are expected findings? Select all that apply a. increase in hunger b. irritability c. decrease in urination d. vomiting e. fever

d

A parent asks the nurse what would be the first indication that acute glomerulonephritis was improving. What would be the nurses best response? a. Blood pressure will stabilize. b. Your child will have more energy. c. Urine will be free of protein. d. Urine output will increase.

a

A recent history of which problem should alert the nurse to gather additional information about the possibility of a UTI in a 2 year old child who is exhibiting fever and fussiness? a. abdominal pain b. swollen lymph glands c. skin rash d. back pain

c

A teenage girl has been diagnosed with a UTI. The nurse recognizes the need for teaching when the teenager states a. "I will not take bubble baths" b. "I will drink plenty of water" c. "I can drink coffee" d. "I can drink cranberry juice"

d

A toddler diagnosed with nephrotic syndrome has a fluid volume excess related to fluid accumulation in the tissues. Which measure should the nurse anticipate including in the child's plan of care? a. limit visitors to 2-3 hours a day b. maintain strict bed rest c. test urine specific gravity every shift d. weight the child before breakfast

c

A young child is diagnosed with vesicoureteral reflux. What is a common recurrent complication in a child with this diagnosis? a. Incontinence b. Urinary obstruction c. Recurrent urinary tract infections d. Infarction of renal vessels

enuresis

Additional factors that increase risk if this include •Red dyes •Caffeine •Citrus foods •Artificial flavors/colors

•Hypnotherapy •Bed Alarms- bedwetting alarm •Motivational Therapy •Environmental Interventions to lessen risk

Additional treatments for enuresis include?

b

After teaching the parents about the urethral catheter placed after surgical repair of their son's hypospadias, the nurse determines that the teaching was successful when the mother states that the catheter in her child's penis accomplishes which goal? a. decreases the pain at the surgical site b. keeps the new urethra from closing c. measures his urine correctly d. prevents bladder spasms

d

What recommendation should the nurse make to prevent urinary tract infections (UTIs) in young girls? a. Avoid public toilet facilities. b. Limit long baths as much as possible. c. Cleanse the perineum with water after voiding. d. Ensure clear liquid intake of 2 L/day.

c

An infant is scheduled for a hypospadias and chordee repair. The parent asks the nurse, "I understand why the hypospadias repair is necessary, but do they have to fix the chordee as well?" Which is the nurse's best response? a. "I understand your concern. Parents do not want their children to undergo extra surgery" b. "the chordee repair is done strictly for cosmetic reasons that may affect your son as he ages" c. "the repair is done to optimize sexual functioning when he is older" d. "this is the best time to repair the chordee because he will be having surgery anyway"

no

Are urine casts, crystals, or bacteria expected to be in the urine?

after about 6 years old

At what age is enuresis considered abnormal?

The mother of a child diagnosed with pyelonephritis asks if the kidneys were damaged because of this. What is the best response by the nurse? a) Yes, all children who get pyelonephritis have renal scarring. b) The child's risk for renal scarring is increased with pyelonephritis. c) As long as IV antibiotics are started, there is no risk of renal damage. d) No, if the child is urinating normally, the kidneys were not damaged.

B. The child's risk for renal scarring is increased with pyelonephritis. Explanation: It would not be possible to determine if the child has renal scarring with pyelonephritis until more testing is performed. It can result in renal scarring with this type of problem, but that does not mean there will definitely be complications. Antibiotics are usually the treatment of choice in this situation, but it cannot be determined when the damage had occurred.

3-18 mg/dL

BUN values

Encopresis treatment and nursing management

Bowel Program •Prevent constipation •Stool softeners •Timed BM • Prevention •Relieve stressors •Behavioral/motivational therapy

a b d e

What signs and symptoms are indicative of a urinary tract disorder in the infancy period (1-4 months)? (Select all that apply) a. Pallor b. Poor feeding c. Hypothermia d. Excessive thirst e. Frequent urination

less water loss will do more damage

Children have a greater % of water than adults so

a

Clinical manifestations of nephrotic syndrome include a. hyperlipidemia, hypoalbuminemia, edema, and proteinuria b. hematuria, hypertension, periorbital edema, flank pain c. oliguria, hypolipidemia, and hyperalbuminemia d. hematuria, generalized edema, hypertension, and proteinuria

nephrotic syndrome

Clinical state characterized by increased glomerular permeability to plasma protein which results in massive urinary protein loss.

VUR

Congenital and can be seen in 50% of siblings?

d

Congenital defects of the genitourinary tract, such as hypospadias, are usually repaired as early as possible to accomplish what? a. Minimize separation anxiety. b. Prevent urinary complications. c. Increase acceptance of hospitalization. d. Promote development of normal body image.

Encopresis

Constipation and withholding BM leading to megacolon and bowel incontinence. Begin to release liquid stool that is bypassing hard stool which will begin to damage the nerves

d

Ms. Sanford, age 8 years, has been diagnosed with pyelonephritis. The nurse would expect medical management to include all of the following except a. admission to the hospital with IV antibiotics administered for the first 48 hours b. blood and urine cultures obtained on admission c. urine cultures repeated after therapy d. administration of nitrofurantoin

Acidic (4.5-0)

What type of pH can be related to acidosis, diets heavy in meat?

0.2-1.0 mg/dL

Creatinine value

c

When assessing an infant with an undescended testis, the nurse should be alert for which symptom? a. abnormal lower extremity reflexes b. a history of frequent emesis c. a bulging in the inguinal area d. poor weight gain

A school nurse is trying to prevent poststreptococcal glomerulonephritis in children. Which of the following would be the best way to prevent this? a) Prophylactic antibiotics after strep throat are important. b) Tell parents to give ibuprofen if their child has a sore throat. c) All children in the child's class should be tested for strep throat if there is a positive. d) Encourage the child to take all the antibiotics if diagnosed with strep throat.

D) Encourage the child to take all the antibiotics if diagnosed with strep throat. Explanation: Encouraging the child to take all the antibiotics if diagnosed with strep throat is important. It is not necessary to test the people in the community that the child came in contact with unless they are symptomatic. Ibuprofen does not cure strep throat and that is what usually causes poststreptococcal glomerulonephritis. Prophylactic antibiotics after a strep infection are not necessary.

low sodium

Diet for nephrotic syndrome?

c

During a clinic visit, the mother of an infant with hydrocele states that the infant's scrotum is smaller now than when he was born. After teaching the mother about the infant's condition, which statement by the mother indicates that teaching has been effective? a. "I guess keeping his bottom up has helped" b. "massaging his groin area is working" c. "it seems like the fluid is being reabsorbed" d. "keeping him quiet and in an infant seat has helped"

creatinine

End product of protein metabolism in muscle and freely filtered by glomerulus -•Measurement of renal excretory function

Urine leukocyte esterase

Enzyme released by WBCs. If present, marker for infection

d

For minimal change nephrotic syndrome (MCNS), prednisone is effective when what occurs? a. Appetite increases and blood pressure is normal b. Urinary tract infection is gone and edema subsides c. Generalized edema subsides and blood pressure is normal d. Diuresis occurs as urinary protein excretion diminishes

Grade I (ureter only) to Grade V (severe)

Gradations for VUR are found in the International Reflux grading system ranging from

6 months to 3 years

Hemolytic Uremic Syndrome (HUS) is seen in what ages

-I & O -Daily weights -increased intracranial pressure -congestive heart failure: change in LOC -bleeding: thrombocytopenia, petichiae, epistaxis, prolonged bleeding at venipuncture sites, ecchymosis -hypertension -electrolytes, arterial blood gases, BUN and creatinine

Hemolytic Uremic Syndrome (HUS) management?

beef comntaminated with E coli or other organisms.

Hemolytic Uremic Syndrome (HUS) most often is associated with children ingesting what?

after UTIs or Child can be born with a Defect or obstruction that can be formed from abnormal tissue which can allow Urine to back flow into ureters

How does vesicoureteral reflux occur?

nephrotic syndrome

Hyperlipidemia, hypoalbuminemia, and edema are the triad of associated problems for which condition?

history and anatomical differences major risk factor is presence of urinary tract abnormalities that cause urinary stasis ends up being something greatly related to UTI, obstruction, reflux, or dysfunctional voiding

If an infant has positive UTI consider what?

that they are not menstruating

If finding RBCs in urinalysis, what should you check with he patient?

acute glomerulonephritis

Immune complex disease 10-21 days after infection, pathophysiology uncertain, thought to be related to antibody complexes creating problems with filtering waste

c

In teaching the parent of a newly diagnosed 2-year-old child with pyelonephritis related to vesicoureteral reflux (VUR), the nurse should include which information? a. Limit fluids to reduce reflux. b. Give cranberry juice twice a day. c. Have siblings examined for VUR. d. Surgery is indicated to reverse scarring.

Hemolytic Uremic Syndrome (HUS) due to the bleeding

In what condition will you see petechiae(pinpoint round spots?)

acute glomerulonephritis

Inflammation of the glomeruli leads to difficulty filtering waste and acute and chronic manifestations.

enuresis

Involuntary discharge of urine "bedwetting"

E. coli (can also be virus, fungal, bacterial)

Most UTI's are caused by what?

enuresis

Most cases of this are not pathophysiological can be caused by: •Small bladder capacity •Difficulty arousing in the middle of the night (deep sleep) •Stress •Family change (ex: new baby, recent divorce)

b

Nursing interventions in caring for the child with acute glomerulonephritis includes a. enforced bed rest b. daily weights c. keeping the child NPO d. a high-sodium diet

d

Shortly after an infant is returned to his room following a hydrocele repair, the infant's parent approaches the nurse in the hall to report that the child's scrotum looks swollen and bruised. Which response by the nurse would be most appropriate? a. "let me see if the surgeon has prescribed aspirin for him. If he did, I will get it right away" b. "can you wait in his room? Then you can ask me any questions when I get there" c. "what you are describing is unusual after this type of surgery. I will let the surgeon know" d. "this is normal after this type of surgery. Let us look at it together just to be sure"

flank pain, abdominal pain, enuresis

Signs/symptoms of vesicoureteral reflux?

Voiding Cystourethragram (VCUG)

Test for VUR in which a Foley is placed, Contrast dye inserted and followed radiographically for diagnosis and grading of reflux. The child will be asked to void also because some reflux only happens during voiding

Renal/Bladder Ultrasound

Test that will not diagnose VUR but quantifies hydronephrosis (abnormal condition of water in the kidney)

a

The charge nurse is reviewing the laboratory results of a child admitted with nephrotic syndrome with a nurse new to the pediatric unit. The nurse is aware that teaching is required when the new nurse states than an expected finding in nephrotic syndrome is a. hyperalbuminemia b. elevated triglycerides c. elevated cholesterol d. proteinuria

b

The clinical manifestations of minimal change nephrotic syndrome are due to which of the following? a. chemical changes in the composition of albumin b. increased permeability of the glomeruli c. obstruction of the capillaries of the glomeruli d. loss of the kidneys' ability to excrete waste and concentrate urine

c

The diet requirement for minimal-change nephrotic syndrome includes a. water restriction b. low-protein diet in both acute and remission stages c. salt restriction during periods of edema and while on corticosteroid therapy d. high-protein diet during both acute and remission stages

d

The nurse evaluates the parent's understanding of the teaching about an inguinal hernia as successful when they say which of the following? a. "there are no risks associated with waiting to have the hernia reduced; surgery is done for cosmetic reasons" b. "it is normal to see the bulge in the baby's groin decrease with a bowel movement" c. "we will wait for surgery until the baby is older because narcotics for pain control will be required for several days" d. "it is normal for the bulge in the baby's groin to look smaller when the baby is asleep"

d

The nurse is asked to obtain a urine specimen from 5 year old Gary Berringer. Which of the following is the correct procedure? a. place a urine bag on Gary to collect the next specimen b. obtain a catheterized specimen c. encourage Gary to drink large volumes of water in an attempt to obtain a specimen d. obtain a midstream specimen, preferable the first morning specimen

a c e

The nurse is caring for a 4 year old girl with a history of frequent UTIs. What should the nurse be aware of before obtaining a urine sample? Select all that apply a. to obtain a clean-catch urine specimen, have the child sit on the toilet facing backward toward the tank b. since children who have a UTI will have painful urination, have the child drink a large amount of fluid before obtaining the sample c. the specimen must be fresh, less than 1 hour after voiding with a storage at room temperature or less than 4 hours after voiding with refrigeration d. if a urinalysis obtained by a bag specimen is negative, a specimen still needs to be obtained by catheterization or suprapubic aspiration e. the key to distinguishing a true UTI from asymptomatic bacteriuria is the presence of pyuria

c

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? a. "circumcision is a fading practice and is now contraindicated in most children" b. "circumcision in children with hypospadias is recommended because it helps prevent infection" c. "circumcision is an option, but it cannot be done at this time" d. "circumcision can never be performed in a child with hypospadias"

b

The nurse is conducting discharge teaching with the parent of a 7-year-old child with minimal change nephrotic syndrome (MCNS). What statement by the parent indicates a correct understanding of the teaching? a. My child needs to stay home from school for at least 1 more month. b. I should not add additional salt to any of my childs meals. c. My child will not be able to participate in contact sports while receiving corticosteroid therapy. d. I should measure my childs urine after each void and report the 24-hour amount to the health care provider.

a

The nurse is planning interventions for a school-age child hospitalized with acute poststreptococcal glomerulonephritis in need of diversional activity. Which activity should the nurse expect to include? a. playing a card game with someone the same age b. putting together a puzzle with mother c. playing video games with a 4 year old d. watching a movie with a younger brother

c

The nurse is teaching a child experiencing severe edema associated with minimal change nephrotic syndrome about his diet. The nurse should discuss what dietary need? a. Consuming a regular diet b. Increasing protein c. Restricting fluids d. Decreasing calories

c

The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause? a. Poor hygiene b. Constipation c. Urinary stasis d. Congenital anomalies

b

The nurse notes that a child has lost 3.6 kg (8 lb) after 4 days of hospitalization for acute glomerulonephritis. What is the most likely cause of this weight loss? a. Poor appetite b. Reduction of edema c. Restriction to bed rest d. Increased potassium intake

c

The parent of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressure readings are being taken so often. What knowledge should influence the nurses reply? a. The antibiotic therapy contributes to labile blood pressure values. b. Hypotension leading to sudden shock can develop at any time. c. Acute hypertension is a concern that requires monitoring. d. Blood pressure fluctuations indicate that the condition has become chronic.

b

The parent of a child with glomerulonephritis asks the nurse why the urine is such a funny color. Which is the nurse's best response? a. "it is not uncommon for the urine to be discolored when children are receiving steroids and blood pressure medications" b. "there is blood in your child's urine that causes it to be tea-colored" c. "your child's urine is very concentrated, so its appears to be discolored" d. "a ketogenic diet often causes the urine to be tea-colored"

b

The parent of a toddler with nephrotic syndrome asks the nurse what can be done about the child's swollen eyes. Which measure should the nurse suggest? a. apply cool compresses to the child's eyes b. elevate the head of the child's bed c. apply eyedrops every 8 hours d. limit the child's television watching

c

The parents of a child hospitalzied with minimal change nephrotic syndrome ask why the last blood test reveal elevated lipids. Which is the nurse's best response? a. "if your child has just eaten a fatty meal, the lipids may have been falsely elevated" b. "it's not unusual to see elevated lipids in children because of the dietary habits of today" c. "because your child is losing so much protein, the liver is stimulated and makes more lipids" d. "your child's blood level is very concentrated because of the edema, so the lipids are falsely elevated"

a e

The parents of a child with glomerulonephritis ask how they will know their child is improving after they go home. Which are the nurse's best responses? Select all that apply a. "your child's urine output will increase, and the urine will become less tea-colored" b. "your child will have more energy as lab tests become more normal" c. "your child's appetite will decrease as urine output increases" d. "your child's laboratory values will become more normal" e. "your child's weight will increase as the urine becomes less tea-colored"

b

The parents of a neonate with hypospadias and chordee wish to have him circumcised. Which explanation should the nurse incorporate into the discussion with the parents concerning the recommendation to delay circumcision? a. the associated chordee is difficult to remove during circumcision b. the foreskin is used to repair the deformity surgically c. the meatus can become stenosed, leading to urinary obstruction d. the infant is too small to have a circumcision

b

The single most important host factor influencing the occurrence of a urinary tract infection is? a. Urethra b. Urinary stasis c. Uric acid d. Urination

b

The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, which instruction should the nurse include in the teaching? a. administer pain medication as needed b. keep the child away from others with an infection c. notify the HCP if there is an increase in the child's urine output d. administer acetaminophen daily

c

Vesicoureteral reflux is closely associated with which of the following? a. acute glomerulonephritis b. nephrotic syndrome c. renal scarring and kidney damage d. high alkaline content in the urine

cooking meats and veggies

What is important teaching in prevention for Hemolytic Uremic Syndrome (HUS)?

particles seen in urinalysis made up of RBCs or kidney cells

What are casts?

-diuretics -albumin replacement -prednisone (steroid tapering)

What are medications for nephrotic syndrome?

DDAVP (synthetic analogue of ADH); watch for hyponatremia This meds help to lower the noctural urine production

What are medications to help with enuresis? And what should you watch for with this?

d

What are the common clinical manifestations of nephrotic syndrome? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Proteinuria, hypoalbuminemia, and edema

Voiding Cystourethragram (VCUG) and Renal/Bladder Ultrasound

What are the two VUR diagnostic tests?

kidney stones, gout, or chemotherapy

What can crystals be related to?

d e

What dietary instructions should the nurse give to parents of a child with minimal change nephrotic syndrome with massive edema? (Select all that apply) a. Soft diet b. High protein c. Fluid restricted d. No salt added at the table e. Restriction of foods high in sodium

d

What do the clinical manifestations of minimal change nephrotic syndrome include? a. Hematuria, bacteriuria, and weight gain b. Gross hematuria, albuminuria, and fever c. Hypertension, weight loss, and proteinuria d. Massive proteinuria, hypoalbuminemia, and edema

negaive

What do we expect urine ketones and glucose to be?

negative

What do we expect urine nitrites to be?

negative (no protein in urine) (protein in urine may indicate problem with kidney)

What do we normally expect regarding protein in the urine?

inflammation

What does nephrotic syndrome trigger?

b

What factors predisposes the urinary tract to infection? a. Increased fluid intake b. Short urethra in girls c. Ingestion of highly acidic juices d. Frequent emptying of the bladder

clear and yellow

What is a normal urine appearance?

c

When developing the discharge plan for a school age child diagnosed with acute poststreptococcal glomerulonephritis, which instruction should the nurse plan to discuss? a. restrict dietary protein b. monitor pulse rate and rhythm c. prevent respiratory infections d. restrict foods high in potassium

b

When developing the preoperative teaching plan for a 14 month old child with an undescended testis who is scheduled to have surgery, which method is appropriate? a. tell the child that his penis and scrotum will be "fixed" b. explain to the parents how the defect will be corrected c. tell the child that he will not see any incisions after surgery d. use an anatomically correct doll to show the child what will be "fixed"

after the 1st or 2nd UTI

When is vesicoureteral reflux most likely diagnosed?

a b c e f

When observing manifestations of a urinary tract infection in the 24-month old, what might the student nurse expect to see? Select all that apply a. Painful urination b. Poor feedings c. Frequent urination d. Not thirsty e. Fever f. Foul-smelling urine

c

Which combination of signs is commonly associated with glomerulonephritis? a. massive proteinuria, hematuria, decreased urinary output, and lethargy b. mild proteinuria, increased urinary output, and lethargy c. mild proteinuria, hematuria, decreased urinary output, and lethargy d. massive proteinuria, decreased urinary output, and hypotension

c

Which meal would be most appropriate for a 15 year old with glomerulonephritis with severe hypertension? a. egg noodles, hamburger, canned peas, milk b. baked ham and potato, peak, canned carrots, milk c. baked chicken, rice, beans, orange juice d. hot dog on a bun, corn chips, pickle, cookie, milk

b

Which of the following clinical manifestations are associated with acute glomerulonephritis? a. normal blood pressure, generalized edema, oliguria b. periorbital edema, hypertension, dark-colored urine c. fatigue, elevated serum lipid levels, elevated serum protein levels d. temperature elevation, circulatory congestion, normal BUN and creatinine serum levels

b

Which of the following discharge instructions should not be included for the child who is post hypospadias repair and still has a catheter or stent? a. position the urine bag below the waist b. the child is allowed to take a tub bath daily c. an antibacterial ointment may be applied to the penis d. avoid straddle toys, sandboxes, and rough activities

c

Which question should the nurse ask first when obtaining a history from the mother of a 10 year old with a fever, malaise, and swelling around the eyes? a. "has the child had a sore throat recently?" b. "is the child playing with friends as usual?" c. "does the child urinate as much as usual?" d. "is the urine pale in color?"

a

Which statement by a parent is most consistent with minimal change nephrotic syndrome? a. "my child missed 2 days of school last week because of a really bad cold" b. "after camping last week, my child's legs were covered in bug bites" c. "my child came home from school a week ago because of vomiting and stomach cramps" d. "we have a pet turtle, but no one washes their hands after playing with the turtle"

a

Which symptom suggests pyelonephritis in a 3 year old? a. flank pain and tenderness b. foul-smelling urine c. dysuria or urgency d. enuresis or daytime incontinence

a

Which would the nurse expect to hear the parents of an infant with an incarcerated hernia report? a. acute onset of pain, abdominal distention, and a mass that cannot be reduced b. gradual onset of pain, abdominal distention, and a mass that cannot be reduced c. acute onset of pain, abdominal distention, and a mass that is easily reduced d. gradual onset of pain, abdominal distention, and a mass that is easily reduced

b

While assessing the penis of a child who has had surgery for repair of a hypospadias, the nurse observes the appearance of the penis. The nurse should report which aspect to the surgeon? a. swollen b. dusky blue at the tip c. somewhat misshapen d. pink

c

While preparing to examine a 6 week old infant's scrotal sac and testes for possible undescended testes, which would be the most important for the nurse to do? a. check the diaper for recent urination b. give the infant a pacifier c. ensure that the room is kept warm d. tap lightly on the left inguinal ring

Infants and young children are more likely to become septic compared to older children and adolescents

Who is more likely to become septic from a UTI?

between the ages of 2 and 3; girls more than boys; and commonly congenital! in families (50% of siblings)

Who is vesicoureteral reflux most likely to occur in?

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? a) "Let's meet with the dietitian and plan some meals." b) "Here is some written information from the dietitian." c) "She must severely restrict her sodium intake." d) "She should try to avoid protein."

a) "Let's meet with the dietitian and plan some meals." Explanation: Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions.

A nurse is developing a teaching plan for the parents of an 8 year old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify which of the following as an appropriate measure? a) Engaging the child in stress reduction measures b) Giving desmopressin intranasally c) Encouraging fluid intake after dinner d) Practicing bladder-stretching exercises

a) Encouraging fluid intake after dinner Explanation: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

A nurse is performing an assessment on a child. Which of the following would be indicative of a potential for a urinary tract infection? a) Holding urine while at school. b) Not using cleansing towelettes routinely. c) Washing the genital area with water daily. d) Not using soap when cleaning the urethral area.

a) Holding urine while at school. Explanation: UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI.

A child diagnosed acute glomerulonephritis will most likely have a history of which of the following? a) Recent illness such as strep throat b) Hemorrhage or history of bruising easily c) Sibling diagnosed with the same disease d) Hearing loss with impaired speech development

a) Recent illness such as strep throat Explanation: Symptoms of acute glomerulonephritis often appear one to three weeks after the onset of a streptococcal infection such as strep throat.

The nurse is caring for a child admitted with acute glomerulonephritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Smoky colored urine b) Jaundiced skin c) Strawberry red tongue d) Loose, dark stools

a)Smoky colored urine Explanation: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody. Periorbital edema may accompany or precede hematuria. Loose stools are seen in diarrhea. A strawberry colored tongue is a symptom seen in the child with Kawasaki disease. Jaundiced skin is noted in Hepatitis.

You obtain a history from the mother of a child with glomerulonephritis about how he became ill. Which of the following would you expect her to tell you she noticed? a) Headache, loss of appetite b) Dark brown urine c) Loss of weight, oliguria d) Diuresis and pallor

b) Dark brown urine Explanation: Acute glomerulonephritis often presents with glomeruli bleeding, which is revealed as black or brown urine from old blood.

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body? a) Sacrum b) Eyes c) Hands d) Ankles

b) Eyes Explanation: Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands and sacrum are not noted in acute glomerulonephritis.

Most urinary tract infections seen in children are caused by which of the following? a) Hereditary causes b) Intestinal bacteria c) Dietary insufficiencies d) Fungal infections

b) Intestinal bacteria Explanation: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. Hereditary and dietary concerns are not causes of urinary tract infections.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which of the following actions? a) Give the child fluids and report back to the nurse in a few hours. b) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. c) Give the child a diuretic and report back to the nurse in a few hours. d) Weigh the child in the same clothes she had been weighed in the day before and report the two weighs to the nurse while the nurse is on the phone.

b) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Explanation: Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? a) Teach her to take frequent tub baths to clean her perineal area. b) Teach her to wipe her perineum front to back after voiding. c) Suggest she drink less fluid daily to concentrate urine. d) Encourage her to be more ambulatory to increase urine output

b) Teach her to wipe her perineum front to back after voiding. Explanation: Escherichia coli can be easily spread from the rectum to the urinary meatus and cause infection if girls do not take precautions against this.

urine nitrites

biproduct formed due to the action of a bacteria getting into the urinary tract and reproducing rapidly. Some have enzymes converting nitrates into these

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTI's). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which of the following statements would be accurate for the nurse to tell this mother? a) "It is unlikely that your daughter is practicing good cleaning habits after she voids." b) "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." c) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." d) "The position of the urethra in girls makes girls more susceptible than boys to UTI's."

c) "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." Explanation: Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also complains of a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have a) Rheumatic fever b) A urinary tract infection c) Acute glomerulonephritis d) Lipoid nephrosis (idiopathic nephrotic syndrome)

c) Acute glomerulonephritis Explanation: Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear one to three weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103 to 104 degrees Fahrenheit at the onset but decreases in a few days to about 100 degrees Fahrenheit. Slight headache and malaise are usual, and vomiting may occur.

The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? a) Sacrum b) Abdomen c) Eyes d) Fingers

c) Eyes Explanation: Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles.

The nurse is collecting data on a 6-year-old child admitted with a possible urinary tract infection. Which of the following vital signs might indicate the possibility of an infection? a) Respirations 22 per minute b) Blood Pressure 100/70 c) Pulse rate 135 bpm d) Pulse oximetry 93% on room air

c) Pulse rate 135 bpm Explanation: Data to collect regarding the child includes temperature, pulse (be alert for tachycardia) and respiration rates; normal vital signs for a 6-year-old would be a pulse rate of 70 to 115 beats per minute, so this rate shows tachycardia,. The other vital signs are all within normal limits for this age child.

The nurse is teaching a group of nursing students about genitourinary conditions. The nurse tells these students about a condition that occurs when there is an inflammation of the kidney and renal pelvis. The condition the nurse is referring to is which of the following? a) Ascites b) Oliguria c) Pyelonephritis d) Amenorrhea

c) Pyelonephritis Explanation: Pyelonephritis is an inflammation of the kidney and renal pelvis. Oliguria is a subnormal volume of urine. Amenorrhea is the absence of menstruation. Ascites is edema in the peritoneal cavity.

The nurse knows which of the following is a description of peritoneal dialysis when compared to hemodialysis? a) The child must go into a facility to get peritoneal dialysis. b) There are strict diet and fluid restrictions. c) The child can live a more normal lifestyle. d) Therapy is only 3 to 4 days per week.

c) 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.

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as which of the following? a) Bladder exstrophy b) Patent urachus c) Epispadias d) Hypospadias

d) Hypospadias Explanation: Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present when the urethral opening is on the dorsal surface of the penis. Patent urachus refers to a fistula between the bladder and umbilicus. Bladder exstrophy involves the bladder lying open and exposed on the abdomen.

The nurse is caring for an 8-year-old hospitalized child with nephrotic syndrome. Which of the following nursing interventions would be appropriate for this child? a) Test the urine for ketones twice a day b) Weigh the child once a week. c) Administer antipyretics as needed. d) Measure the abdominal girth daily.

d) Measure the abdominal girth daily. Explanation: Measure the child's abdomen daily at the level of the um bilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing. Test the urine regularly for albumin and specific gravity. Elevated temperature is not an issue with nephrotic syndrome.

In caring for a child with nephrotic syndrome, which of the following interventions will be included in the child's plan of care? a) Ambulating three to four times a day b) Testing the urine for glucose levels regularly c) Increasing fluid intake by 50 cc an hour d) Weighing on the same scale each day

d) Weighing on the same scale each day Explanation: The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss.

The child with nephrotic syndrome who has ascites and difficulty breathing is probably most comfortable sleeping in which position? a) Supine b) Sims' position c) Prone d) Fowler's

d)Fowler's Explanation: A Fowler's position (sitting upright) allows ascites fluid to settle downward and not press against the diaphragm, compromising breathing.

vesicoureteral reflux (VUR)

disorder caused by the failure of urine to pass through the ureters to the bladder and ends up refluxing back into the ureters and possibly kidneys, usually due to impairment of the valve between the ureter and bladder or obstruction in the ureter

Nephrons

each kidney has one million _____ responsible for filtration

glomerulus and tubules

each nephron has a ____ and _____

primary enuresis

failure to achieve night time continence

edema

glomeruli normally filters salt, water, and waste products from the blood and they keep protein in the blood which helps them absorb water from the tissues. When those filters are damaged protein can leak from the blood into the urine leading to proteinuria. when less protein in the blood goes into the urine, this will lead to _____

pyelonephritis

if seeing fever at any age, really start thinking

blood urea nitrogen (BUN)

is an end product of protein metabolism in the liver and measures excretory function of kidney

nephrotic syndrome

mass protein losses?

Dehydration: weight loss

mild: 3-5% moderate: 6-9% severe: > = 10%

dehydration: urine output

mild: decreased moderate: oliguria severe: anuria

dehydration: fontanel

mild: normal moderate: normal/ slightly sunken severe: sunken

dehydration: skin

mild: normal moderate: dry cap refill 2-4 seconds severe: parched, cap refill > 4 sec

dehydration: behavior

mild: normal moderate: irritable severe: irritable, lethargic

dehydration: vital signs

mild: normal moderate: slight increase RR and HR, normal BP severe: tachycardia, tachypnea, orthostatic BP

dehydration: fluid replacement

mild: oral moderate: oral severe: IV

dehydration: tears

mild: present moderate: decreased severe: absent

resolve spontaneously; surgical; antibiotics; anticholinergics

milder types of VUR may ____________ as child grows up, and the more severe cases may need _______ intervention and may require long-term _______ in addition to ______ agents to reduce bladder pressure

Hemolytic Uremic Syndrome (HUS)

one of the most frequent causes of acute renal failure in children; "from diarrhea to dialysis"

glomerulonephritis

post streptococcyl relationship?

glomerulus

series of specialized capillary loops where water and small particles are filtered from blood

urinalysis (UA)

shows appearance, pH, specific gravity, protein, glucose, ketones, nitrites, leukocyte esterase, RBCs, WBCs, Bacteria, Micro exam

urine culture

shows gram stain and aerobic culture

Urine Specific Gravity: 1.005-1.030 neonates: 1.001-1.020

value of urine specific gravity _______; value in neonates ________

pH

variation in ____ can be due to many factors including: -types of foods consumed -kidney stones -UTIs -renal disorders -vomiting

thrombocytopenia, anemia, acute renal failure

what are the three triad symptoms of Hemolytic Uremic Syndrome (HUS)

Acute post-streptococcal glomerulonephritis (occurs after strep throat)

what is the most common post-infectious renal disease in childhood?

4.6-8.0 (average 6.0)

what is the urine pH value?

Alkaline (8.1-14)

what type of pH values can be indicative of some type of infection? (but can also be related to dieting, diuretic therapy, gastric suction, vomiting)

secondary enuresis

when a child was continent and then suddenly have involuntary control

fluid losses such as fever, vomiting, diarrhea may also indicate problems with renal function

when may high urine specific gravity be seen and what does this typically mean?

may be seen in diabetes insipidous, glomerulonephritis, pyelonephritis, and other renal abnormalities kidney has lost its ability to concentrate due to tubular damage

when may low urine specific gravity be seen and what does this typically mean?

Diagnosis for dysfunctional elimination syndrome

•Assess for underlying contributing factors (ex; neurogenic bladder? VUR?) •VCUG •XR to assess for constipation •History!

Dysfunctional Elimination Syndrome

•Bladder and bowel withholding and incontinence •can be Associated with UTI and constipation among other issues

Nursing care management : UTI

•Careful history and physical •Collecting specimen in appropriate manner •Preparing children for procedures •Education re: proper antibiotic regimen •Prevention: teaching child to void more frequently, hand-washing, loose fitting clothing (cotton underwear), wipe front to back, prevent dehydration and constipation

acute glomerulonephritis: clinical manifestations

•Gross hematuria •Edema, particularly periorbital •Possible development of headache and hypertension •May have decreased urine output (tea or red colored) •Possible renal failure are all clinical manifestations of what?

Signs & Symptoms of Dysfunctional Elimination syndrome

•Increased frequency •Urinary incontinence •Urgency •UTI •Constipation

Hemolytic Uremic Syndrome (HUS) pathophysiology

•Infection causes injury to the endothelial lining of the glomerular arterioles, which become swollen and occluded. •Coagulation Cascade •RBCs trying to flow through accumulate and become damaged (anemia). •Platelets become trapped or damaged, destroyed by the spleen (thrombocytopenia)

Nursing Care Management: Nephrotic Syndrome

•Monitoring of fluid retention, I&O •Edematous skin may easily breakdown •Monitoring for signs of infection: routine immunizations during steroid use •Nutrition and Diet: low sodium, emphasis on fruits and veggies, protein based on what is needed for the child •Family support and education re: medications, at-home monitoring s/s of infection

acute glomerulonephritis: nursing care management

•Treat Strep pharyngitis if still active infection. •Careful monitoring, vital signs, fluid balance, and behavior •Daily weights!! •Strict I & 0 •Watch for patterns and changes to recognize complications early. •May need diuretic or anti-hypertensive therapy -may require dialysis or may need to use steroid therapy