NURS 405 Renal Disorders - Peds

What are clinical features of nephrotic syndrome?

- Proteinuria − Urinary protein excretion greater than 50 mg/kg per day - Hypoalbuminemia − Serum albumin concentration less than 3 g/dL (30 g/L) - Edema (or anasarca) - Hyperlipidemia

What are indications for dialysis?

- Severe fluid overload leading to hypertension, pulmonary edema and respiratory failure, or heart failure - Metabolic and electrolyte imbalance not amenable to medical therapy (e.g., severe hyperkalemia or metabolic acidosis) - Symptomatic uremia (e.g., bleeding, pericarditis, and encephalopathy)

what are symptoms of a urinary tract infection in children?

- fever, - nausea, - vomiting, - foul-smelling urine, - weight loss, and - increased urination. Occasionally there is little or no fever. Vomiting is common, and diarrhea (not constipation) may occur.

What are clinical features of AKI?

-Edema -Decreased or no urine output -Hematuria (gross or microscopic) -Hypertension

The nurse is caring for a 7-month-old female infant diagnosed with a urinary tract infection (UTI). The parents are upset as this is the infant's second UTI with a fever. Which instruction is mosthelpful? Select all that apply. UTI's are common in male infants at this age. A fever is commonly noted with a UTI. Change diapers promptly, especially after bowel movements. After 3 days on antibiotics, the infection is clear. Female urethras are shorter and straighter than males.

A fever is commonly noted with a UTI. Change diapers promptly, especially after bowel movements. Female urethras are shorter and straighter than males. Explanation: Urinary tract infections are common in females in the "diaper age" because the female urethras are shorter and straighter than in the males. This poses a potential for infection. Males have a higher rate of UTI's in the first 4 months. A fever is common with this diagnosis. Changing the diapers promptly eliminates the time that the infant is exposed to E-coli. The infant may feel better after 3 days of antibiotic use but it takes a full course of antibiotics to clear an infection.

An 8-year-old boy and his father visit the pediatrician's office with reports of a sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the boy's health history, the nurse learns that he had strep throat a little over a week ago. Which condition should the nurse suspect? Acute glomerulonephritis Kidney agenesis Polycystic kidney Nephrosis

Acute glomerulonephritis Explanation: Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described above. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old. Nephrosis is altered glomerular permeability apparently due to an autoimmune process or a T-lymphocyte dysfunction that results in fusion of the glomeruli membrane surfaces, which, in turn, leading to abnormal loss of protein in urine. The highest incidence is at 3 years of age, and it occurs more often in boys than in girls. In addition to proteinuria, a major symptom of nephrosis is edema, which is absent in this case.

symptoms of glomerulonephritis

Brown, tea, or cola-colored urine (due to hematuria) Proteinuria Hematuria Flank pain Hypertension Edema (e.g., periorbital) Cardiopulmonary congestion such as increased work of breathing or cough. Fever (usually decreasing) Lethargy Headache Decreased urine output Abdominal pain Vomiting Anorexia

White cottage-cheese-like discharge is associated w/ which pathogen and which condition?

Candida albicans - yeast infection

Candidiasis

Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida. the most common is Candida albicans. Candidiasis in the vagina is commonly referred to as a yeast infection. Candidiasis that develops in the mouth or throat is called thrush or oropharyngeal candidiasis.

A nurse is teaching the parents about the kidney transplant their child is going to receive. What would be included in the teaching? Immunosuppression is common after a kidney transplant. Induction therapy medication will prevent infection with the transplant. As long as the medications are used properly, the transplant will not be rejected. The child can stop medication after 3 months of therapy.

Immunosuppression is common after a kidney transplant. Explanation: A kidney may be transplanted into the child with end stage renal failure as a way of sustaining life and promoting adequate cognitive skills and growth. Because the kidney is a foreign object to the body it can be rejected. To prevent this, immunosopressants are given. It is extremely important for these medications to be given on schedule. The levels of the drugs should be monitored to make sure the drugs stay within safe ranges. The drugs are extremely helpful in preventing rejection but they are not a 100% guarentee. There are other factors that play into the role of rejection. Taking these medications will be for the rest of the life of the transplant recipient. Induction therapy is related to the beginning of chemotherapy administration.

How to distinguish AKI from nephrotic syndrome?

Nephrotic syndrome has gross proteinuria

The nurse is taking a history from an adolescent girl with suspected pelvic inflammatory disease (PID). What data will be most helpful in determining this girl's risk factors for PID? Number of sexual partners Age Race Age at first menses

Number of sexual partners Explanation: Multiple sexual partners are a risk factor for PID. Race, age, and age at first menses are not considered risk factors for PID.

what should the nurse assess for in dialysis patients?

The nurse should always auscultate the site for presence of a bruit and palpate for presence of a thrill. The nurse should immediately notify the physician if there is an absence of a thrill.

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? Loose, dark stools Tea-colored urine Strawberry-red tongue Jaundiced skin

Tea-colored urine Explanation: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea or cola colored. 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.

A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? There is a chance the testicles will descend on their own. This problem needs to be corrected immediately in the newborn period. If the infant is having swelling or pain, then surgery will be performed. Surgery is not needed for this type of problem.

There is a chance the testicles will descend on their own. Explanation: The Association of American Physicians recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year old. This problem does not cause pain or swelling.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis? Thick, white cheese-like discharge Frothy, gray-green discharge Milky, gray, fishy-odor discharge Yellow-green discharge

Thick, white cheese-like discharge Explanation: With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.

Hydronephrosis s/s complications

a condition in which the pelvis and calyces of the kidney are dilated s/s: History of repeated urinary tract infections Abdominal mass on palpation Crying on voiding Failure to thrive Intermittent hematuria UTI symptoms: fever, vomiting, poor feeding, and irritability Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: performing a suprapubic aspiration. placing a cotton ball in the underwear to catch urine. placing an indwelling urinary catheter. obtaining a clean catch voided urine.

obtaining a clean catch voided urine. Explanation: In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.

pelvic inflammatory disease cause? symptoms? complications?

an inflammation of the upper female genital tract and nearby structures. The fallopian tubes, ovaries, or peritoneum may be involved, and endometriosis may also be present. PID results from bacterial invasion through the cervix and vagina, ascending into the uterus and fallopian tubes. The most common causes of PID are Chlamydia trachomatis and Neisseria gonorrhoeae, although other bacteria and normal vaginal flora may be implicated. PID may result in fever, abdominal pain, pain with intercourse, dysmenorrhea (painful menstrual cycles), and abnormal uterine bleeding. Long-term complications include chronic pelvic pain, ectopic pregnancy, and infertility related to scarring.

acute glomerulonephritis

inflammation of the glomeruli in the kidneys from injury or illness; leads to impaired kidney function; also called glomerular disease in this condition, the immune processes injure the glomeruli. It appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. It often occurs following an infection, usually an upper respiratory or skin infection.

Vulvovaginitis risk factors?

inflammation of the vulva and vagina. May be the result of bacterial or yeast overgrowth or from chemical factors such as bubble bath, soaps, or perfumes found in personal care products. s/s: vaginal or vulval inflammation, pain odor, and purititis. Risk factors: Young age (toilet-trained preschooler) Poor hygiene Sexual activity Immune disorders Diabetes mellitus

Most urinary tract infections seen in children are caused by:

intestinal bacteria. Explanation: Although many different bacteria may infect the urinary tract, intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes.

hypospadias

occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circumcised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair.

dysmenorrhea

painful menstruation

Secondary amenorrhea

the absence of menstruation after a period of normal menses

how is a UTI diagnosed?

urine culture

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea? "It is caused from taking birth control pills when a girl is younger than 13 years old." "This disorder is usually seen after a girl has had a spontaneous abortion." "Emotional stress can be a cause of this disorder." "This is what happens if a 16-year-old girl has never had any periods at all."

"Emotional stress can be a cause of this disorder." Explanation: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.