(WK 4 NR 328 Ex#2) The Child with Renal Dysfunction

Which condition is appropriate when considering common postinfectious renal diseases in childhood? 1 Wilms tumor 2 Nephrotic syndrome 3 Acute glomerulonephritis 4 Hemolytic uremic syndrome

3 (Acute glomerulonephritis is the most common post-infectious renal diseases in childhood and the one for which a cause can be established in most cases. Wilms tumor is a common malignant renal and intra-abdominal tumor of childhood. Nephrotic syndrome is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Hemolytic uremic syndrome is an uncommon acute renal disease.)

Which clinical manifestations are appropriate with the diagnosis of acute poststreptococcal glomerulonephritis? 1 Edema, increased urine volume, hypotension 2 Edema, decreased urine volume, hypotension 3 Edema, decreased urine volume, hypertension 4 Edema, increased urine volume, hypertension

3 (Edema, decreased urine volume, and hypertension are common clinical manifestations of acute poststreptococcal glomerulonephritis (APSG) Pallor; cloudy, brown urine; irritability; lethargy; and vomiting are other signs. Increased urine volume and hypotension are not clinical manifestations of acute poststreptococcal glomerulonephritis.)

Which finding is appropriate regarding a newborn child whose urine specific gravity is 1.030? 1 The child is producing normal urine. 2 The specific gravity of the urine is low. 3 The urine possibly contains protein or glucose. 4 The child possibly has distal tubular dysfunction

3 (If a newborn child's urine has a specific gravity of 1.030, it is a high value. It suggests that the urine possibly contains protein or glucose. The normal range for a newborn child is 1.001 to 1.020. Hence, a specific gravity of 1.030 is not normal; it is a high value for this age group. A child with distal tubular dysfunction is likely to produce urine that has a low specific gravity rather than a high specific gravity.)

Which clinical manifestation is appropriate when assessing a child for possible nephrotic syndrome? 1 Cola- or tea-colored urine 2 Excessive loss of body weight 3 Appearance of white lines on the nails 4 Swelling of the genitalia in the morning

3 (When assessing for nephrotic syndrome, the nurse would look for the appearance of white lines on the child's nails. These lines, called Muehrcke lines, appear parallel to the lunula and are caused by prolonged hypoalbuminemia. Cola- or tea-colored urine indicates gross hematuria. In nephrotic syndrome, hematuria is either absent or microscopic. Due to poor appetite and loss of protein, there may be some weight loss. However, it is obscured by the generalized severe edema. Hence, excessive loss of body weight is not seen. Swelling of the genitalia is usually more prominent later in the day.)

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 (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.)

Which reason is appropriate when external defects of the genitourinary tract, such as hypospadias, are repaired early? 1 Acceptance of hospitalization 2 Prevention of separation anxiety 3 Development of normal body image 4 Prevention of urinary tract complications

3 (Promotion of a normal body image is extremely important. Surgery involving sexual organs can be upsetting to children, especially preschoolers, who fear mutilation and castration. Surgical intervention for external defects of the genitourinary system should be done as soon as possible. Prevention of urinary tract complications is important for defects that affect function, but for all external defects, repair should be done as soon as possible!! *KEY WORD in the questions was EXTERNAL* Proper preprocedure preparation can help prevent or at least reduce separation anxiety. Acceptance of hospitalization is important but not the reason for early surgical intervention of external defects of the genitourinary system.)

The nurse is teaching the parents of preschoolers about preventing urinary tract infections (UTIs). Which strategies are appropriate when teaching the parents how to prevent UTIs? Select all that apply. 1 "Put a diaper on your child overnight." 2 "Do not allow your children to urinate in public toilets." 3 "Give cranberry juice to your children on a regular basis." 4 "Ensure that your children evacuate their bowels regularly." 5 "Encourage your children to drink 6 to 8 glasses of water each day."

3,4,5

Which complication is appropriate when assessing a toddler with acute kidney injury resulting from severe dehydration? 1 Hypotension 2 Hypokalemia 3 Hypernatremia 4 Water intoxication

4 (The child with acute renal failure is at risk for water intoxication with hyponatremia. Control of water balance requires careful monitoring of intake, output, body weight, and electrolytes. The child needs to be monitored for hypertension, not hypotension, when hospitalized with acute renal failure. Hyperkalemia, not hypokalemia, is a concern in acute renal failure. Hyponatremia, not hypernatremia, may develop in acute renal failure, because the sodium is diluted in large amounts of water.)

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 (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.)

Is a noninfectious renal disease (autoimmune) • Onset 5 to 12 days after other type of infection Often group A beta-hemolytic streptococci So Reports of previous Sore throat should clue you in. • Most common in children 6 to 7 years old Management: Daily weights to manage edema Accurate I /O's Measure abdominal girth daily Low sodium, low to moderate protein diet Bed rest isnt necessary but most children will be weak and fatigued anyway.

APSG (Acute Poststreptococcal Glomerulonephritis)

Other causes of dysuria: Irritation to the urethra May be due to bubble baths or wearing wet bathing suits for prolonged time

Urethritis ( similar nursing care as for UTI)

Which cause is appropriate when diagnosing acute renal failure in children? 1 Severe dehydration 2 Glomerular disease 3 Renal artery stenosis 4 Obstructive uropathy

1 (Acute renal failure may be due to prerenal, intrarenal, or postrenal causes. Prerenal causes are usually associated with diminished blood flow; intrarenal causes are associated with medication; and postrenal causes are related to obstruction of the outflow of urine. In children, viral or bacterial illness that leads to severe diarrhea and/or vomiting poses a risk of dehydration. When dehydration becomes severe, there is a decrease in renal perfusion leading to acute tubular necrosis, or acute renal failure. Illnesses with profuse diarrhea are considered to be the most common cause of acute renal failure in children)

Which laboratory finding with clinical symptoms indicates nephrosis? 1 Hypoalbuminemia 2 Low specific gravity 3 Decreased hematocrit 4 Decreased hemoglobin

1 (Hypoalbuminemia is a result of the large amounts of protein that leak through the glomerular membrane into the urine in a child with nephrosis. The specific gravity is increased by the large amount of protein in the urine of a child with nephrosis. The hematocrit would be elevated as a result of nephrosis. The hemoglobin would be increased as a result of hypovolemia in a child with nephrosis.)

Which urine test result is appropriate to report to the health care provider? 1 pH of 4 2 Absence of protein 3 Absence of glucose 4 Specific gravity of 1.020

1 (The expected pH of urine is 4.8 to 7.8)

Which finding is appropriate for the increased incidence of bacteriuria in females? 1 Lower urinary tract 2 Higher urinary tract 3 Higher intake of fluids 4 Frequent emptying of the bladder

1 (The lower urinary tract accounts for the increased incidence of bacteriuria in females. Females have a lower, not a higher, urinary tract, which increases the incidence for bacteriuria. Frequent emptying of the bladder and a higher intake of fluids help to prevent infections and are therefore not associated with an increased incidence of bacteriuria in females.)

Which findings are appropriate when observing the child in the acute phase of acute glomerulonephritis? 1 Hematuria and ketosis 2 Hematuria and proteinuria 3 Increased serum complement 4 Positive cultures of the pharynx for streptococci

2 (Urinalysis during the acute phase of acute glomerulonephritis reveals hematuria and proteinuria. Urinalysis during the acute phase of acute glomerulonephritis shows hematuria and proteinuria, not hematuria and ketosis. Serum complement (C3) is decreased, not increased. Streptococci are not typically found on culture.)

Which clinical manifestation is appropriate with a persistent urinary tract infection (UTI)? 1 The infection has spread in the blood. 2 There is pain in the lower abdominal area and a fever. 3 Problem continues despite taking antibiotics prescribed earlier. 4 The child is cured and symptoms begin again within a month's time.

3 (Persistent UTIs are characterized by an infection that persists despite antibiotic treatment. The statement that the child has had an infection in spite of taking antibiotic therapy indicates that the child has persistent UTIs. If the patient with a UTI infection has lower abdominal pain and fever, then the type of UTI would be a symptomatic UTI. If the parents report that the child gets cured and gets the symptoms of infection again within a month's time, then the child has recurrent UTI. If the blood reports reveal the pathogen causing UTI, then the child has urosepsis.)

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

A,B,C,E

one or both of the testes fail to descend from the abdomen into the scrotum: Most common in preemies.

Cryptorchidism

Painful or difficult urination• Common pathogen = E. coli• Accurate and prompt diagnosis and treatment are crucial and may prevent renal scarring.

Dysuria

Urethral opening on dorsal opening of penis

Epispadias

T/F= Nursing intervention when caring for a patient with Acute Glomerulonephritis is to give as much fluids as possible to prevent dehydration and increase GFR.

False ( no need to give lots of fluids as the patient is incapable of making "more" fluids.)

UTI, Glomerulonephritis, Renal Calculi, physical exertion and trauma all have one MAIN COMMON SYMPTOM. What is it?

Gross Hematuria (blood in urine)

Urethral opening on ventral aspect of penis

Hypospadias

The most common type of kidney cancer in children. Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma. • most often affects children ages 3 to 4 and becomes much less common after age 5.• **Avoid disrupting the tumor**

Wilms Tumor

is a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis. This can lead to strangulation of the glans and painful vascular compromise, distal venous engorgement, edema, and even necrosis

paraphimosis (more critical than phimosis).

Which nursing response is appropriate when asked by the parent of a child hospitalized with acute glomerulonephritis (AGN) why blood pressure readings are taken often? 1 Acute hypertension must be anticipated and identified. 2 Hypotension leading to sudden shock can develop at any time. 3 Blood pressure fluctuations are a common side effect of antibiotic therapy. 4 Blood pressure fluctuations are a sign that the condition has become chronic.

1 (Vital signs, in particular the blood pressure, provide information about the severity of AGN and early signs of complications. Acute hypertension is anticipated and requires frequent monitoring for early intervention. Blood pressure does not commonly fluctuate with antibiotic therapy. Blood pressure fluctuations are not indicative of chronic disease. Most children with AGN fully recover. Hypertension, not hypotension, is more likely with AGN.)

Which finding indicates the child with acute glomerulonephritis has progressed to renal failure? 1 Pleural effusion 2 Gross hematuria 3 Moderate proteinuria 4 Elevated serum potassium levels

4

Which nursing collection method is appropriate when obtaining a urine sample for culture? 1 Avoid taking the urine sample from a catheter. 2 Use aseptic techniques while collecting the sample. 3 Store the sample for 2 hours before sending it to the laboratory. 4 Obtain the parents' consent before collecting the sample.

2

Which condition is appropriate for an 8-year-old girl with dehydration who has demonstrated diminished urine output and lethargy since shortly after undergoing surgery? 1 Wilms tumor 2 Acute kidney injury 3 Acute glomerulonephritis 4 Hemolytic uremic syndrome

2 (A child with dehydration who experiences diminished urine output and lethargy within a short time (especially if in shock or after surgery) is at risk for acute kidney injury. Dehydration with decreased perfusion to the kidneys is the most likely cause of this patient's symptoms, considering that the patient has just undergone surgery.)

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 (to prevent infection)

Which clinical manifestations are appropriate when an infant has a suspected urinary tract infection (UTI)? Select all that apply. 1 Jaundice 2 Vomiting 3 Swelling of the face 4 Persistent diaper rash 5 Failure to gain weight

2,4,5 (Vomiting is a clinical manifestation observed in an infant with a urinary tract infection (UTI) and can be related to poor feeding. Persistent diaper rash is a clinical manifestation of UTI in an infant. Failure to gain weight is a clinical manifestation of UTI in an infant related to poor feeding and vomiting. Jaundice is not a clinical manifestation of UTI in an infant. Swelling of the face is not a clinical manifestation of UTI in an infant.)

Which condition is appropriate when a child presents to the pediatric office with incontinence and strong-smelling urine? 1 Sexual abuse 2 Nephritic syndrome 3 Urinary tract infection 4 Structural defect of the urinary tract

3

Which objectives are appropriate in the therapeutic management of a 10-year-old boy with nephrotic syndrome? 1 Decreasing intravascular fluid volume, preventing infection, and minimizing complications related to therapies 2 Reducing excretion of urinary protein, enhancing fluid retention in the tissues, treating infection, and minimizing complications related to therapies 3 Reducing excretion of urinary protein, reducing fluid retention in the tissues, preventing infection, and minimizing complications related to therapies 4 Increasing excretion of urinary protein, reducing fluid retention in the tissues, preventing infection, and minimizing complications related to therapies

3 (Objectives for therapeutic management of the child with nephrotic syndrome include reducing (not increasing) excretion of urinary protein, reducing fluid retention in the tissues, preventing (rather than treating) infection, and minimizing complications related to therapies.)

Which urine test of urinary system function is appropriate to visualize the renal vascular system? 1 Urodynamics 2 Specific gravity 3 Renal angiography 4 Retrograde pyelography

3 (Renal angiography is used to visualize the renal vascular system, especially for renal arterial stenosis. Urodynamics is a set of tests designed to measure bladder filling and storage and evaluate function. Specific gravity is used to determine the specific gravity of the urine and is helpful in determining dehydration status. Retrograde pyelography is used to visualize the pelvic calyces, ureters, and bladder.)

Why do children with chronic renal failure have anemia? 1 Diet 2 Fluid intake 3 Recurrent infection 4 Decreased erythropoietin

4 (Anemia in children with chronic renal failure is related to decreased production of erythropoietin. Recombinant human erythropoietin is offered to these children to eliminate the need for frequent blood transfusions. Diet, fluid intake, and recurrent infection are not related to anemia and chronic renal failure)

Which clinical manifestations are appropriate when diagnosing nephrotic syndrome? 1 Uric acid, edema, hypolipidemia 2 Creatinine, edema, proteinuria, hyperalbuminemia 3 Blood urea nitrogen, proteinuria, hypoalbuminemia 4 Proteinuria, edema, hyperlipidemia, hypoalbuminemia

4 (Nephrotic syndrome is a clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.)

Other causes of dysuria: the UTI extended to kidneys -CHild is febrile -Usually accompanied by nausea/vomiting

Pyelonephritis ( similar nursing care for UTI)

Benign inflammation of the glomeruli which causes intravascular coagulation that resolves in about 1 to 2weeks. • Common features are oliguria, edema, hypertension and circulatory congestion, hematuria, and proteinuria• Ranges in severity from minimal to severe. -Most are post infectious: Pneumococcal, Streptococcal, or viral IMP Labs to L/O for: Urinalysis (+protein), BUN, CREATININE.

Acute Glomerulonephritis

Alterations in the glomerular membrane allow proteins (especially albumin) to pass into the urine, resulting in decreased blood osmotic pressure, which leads to proteinuria, hyperlipidemia, and edema: • It can be primary, secondary, or congenital Characteristics: Proteinuria, hypoalbuminemia, Hyperlipidemia, Edema & Massive Urinary protein loss >Hypoalbuminemia causes the fluid shift from plasma to interstitial spaces = edema, patient will be HYPOvolemic in the cells but edematous and have ascites (fluid in abdomen).

Nephrotic syndrome

A nurse is caring for a school-age child who has acute glomerulonephritis. Which of the following findings should the nurse report to the provider? A. BUN 8 mg/dL B. Blood creatinine 1.3 mg/dL C. Blood pressure 100/74 mm Hg D. Urine output 550 mL in 24 hr

B (Normal Creatinine: 3-6 years 0.3 - 0.7 mg/dL 7-8 years 0.2 - 0.6 mg/dL 9-10 years 0.3 - 0.7 mg/dL)

This is an acute renal disease characterized by acute renal failure, hemolytic anemia and thrombocytopenia .• HUS represents one of the main causes of acute renal failure in early childhood .• Breakdown of red blood cells clog the kidneys. • Toxins enter the bloodstream and destroy red blood cells = Hence the name -Associated with recent bacterial infection: E.COLI Symptoms: Pallor• easy Bruising• Hematuria• Oliguria• Bloody diarrhea• Hypertension• Edema• Irritability. Main intervention: close watch on I/Os, daily weight for edema

Hemolytic Uremic syndrome (HUS)

type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle • Transilluminates (Fluid is visible) • Typically present • Cremasteric present (a superficial reflex in males when inner thigh is stroked. Causes cremaster muscle to CONTRACT and PULL up). **Explain to the parents that the issue will self-resolve (no need for surgery or family counseling)** quiz question

Hydrocele

occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum -Happens spontaneously only .• 6 hours from acute pain onset for viability = emergency! • no cremasteric reflex present (opposite from hydrocele)

Testicular Torsion

Diagnostic Studies for UTI : Dipstick- Identify nitrates, WBCs and leukocyte esterase • Urinalysis is for confirmation & Culture to determine empirical findings. What does nitrates mean when its abnormal?

Usually means positive for E.coli

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.

1,2,3,5,6 (US 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 (goes through abdomen) dialysis does not require an AV fistula (only hemodialysis does).)

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 (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)

Which nursing intervention is appropriate for a child with nephrotic syndrome on bed rest? 1 Restraining the child as necessary 2 Adjusting activities to the child's tolerance level 3 Discouraging the parents from holding the child 4 Performing passive range-of-motion exercises once a day

2 (The child will have a variable level of tolerance for activity. Activity tolerance will also be affected by the labile moods associated with steroid administration. The nurse should assist the family in adjusting activities for the child so they are age appropriate. Restraints would not be used to confine a child to bed unless the child is a threat to self or others. Parents would be encouraged to hold the child. The child would be encouraged to move all extremities while in bed to prevent the complications of immobility.)

Which strategy is appropriate when preparing a 3-year-old child for the examination of the urethra and taking a urine sample? 1 Demonstrate and explain the procedure on a doll. 2 Ask the parents to explain the procedure to the child. 3 Explain the urinary system and procedure to the child. 4 Show pictures of the urinary system and the procedure

1 A 3-year-old child is too young to understand the procedure of examining the urinary system. The nurse would explain the procedure by demonstrating it on a doll. This should be done to eliminate fear in the child's mind before the examination)

Which nursing intervention is appropriate when collecting and storing a urine specimen for culture for a young girl who needs to be evaluated for a urinary tract infection (UTI)? 1 The specimen should be stored in a refrigerator for a maximum of 6 hours after voiding. 2 The child should be seated on the toilet facing the tank to easily collect clean-catch urine. 3 The child should be encouraged to drink large volumes of water to obtain specimen quickly. 4 The specimen should be stored at room temperature for a maximum of 2 hours after voiding.

2 (Collection of clean-catch urine in a young girl is easier when the child is made to sit on the toilet facing the tank. In this position, the labia are naturally separated. There is less chance of contamination of urine. The child is also more stable and relaxed in this position. A fresh urine specimen is needed for sensitivity and specificity of the urinalysis and to prevent growth of organisms. Urine specimens would be stored in a refrigerator for a maximum of 4 hours after voiding. The child would not be encouraged to drink large volumes of water to obtain a specimen quickly, because a recent high fluid intake can lead to a falsely low organism count. A urine specimen should be stored at room temperature for a maximum of 1 hour after voiding.)

In what defect of the genitourinary tract is the meatal opening located on the dorsal surface of the penis? 1 Hydrocele 2 Epispadias 3 Hypospadias 4 Cryptorchidism

2 (Location of the urethral meatal opening on the dorsal surface of the penis is called epispadias. A hydrocele is a fluid-filled sack in the scrotum. Hypospadias is when the urethral opening is located behind the glans penis or along the ventral surface of the penile shaft. Cryptorchidism is the failure of one or both testes to descend normally through inguinal canal.)

Which condition is appropriate for a previously healthy 10-year-old boy who is hospitalized for weight gain over the past several days, generalized edema, and irritability? 1 Wilms tumor 2 Nephrotic syndrome 3 Acute glomerulonephritis 4 Hemolytic uremic syndrome

2 (Weight gain over the several days preceding presentation, generalized edema, and irritability are associated with nephrotic syndrome. Common signs of Wilms tumor include weight loss, abdominal swelling, and fever. Some common signs of acute glomerulonephritis include edema, anorexia, cloudy urine, oliguria, pallor, lethargy, and headaches. Signs of hemolytic uremic syndrome include vomiting, irritability, lethargy, pallor, bruising, and signs of neurologic involvement).

Which manifestations are appropriate for both acute poststreptococcal glomerulonephritis (APSG) and minimal-change nephrotic syndrome (MCNS)? Select all that apply. 1 Generalized edema 2 Microscopic hematuria 3 Elevated blood pressure 4 Elevated serum protein level 5 Normal serum potassium level

2,5 (Microscopic hematuria may be seen in both APSGN and MCNS. In APSGN, hematuria is present and may be either gross or microscopic. In MCNS, there may be microscopic or no hematuria. Serum potassium level remains normal in MCNS. Serum potassium level may be either normal or elevated in APSGN. Children with MCNS have severe, generalized edema. Those with APSGN have primarily periorbital and peripheral edema. Blood pressure is elevated in APSGN and normal or decreased in MCNS. Serum protein levels are decreased in both conditions though marked decrease is seen only in MCNS.

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

Which reason is appropriate as to why a child should not hold or wait to urinate who has been diagnosed with a urinary tract infection (UTI)? 1 Inhibits the process of urine formation 2 Reduces the blood supply of the kidneys 3 Causes severe abdominal pain in the child 4 Increases the chances of another infection

4 (Urinary stasis is the most important factor influencing the occurrence of UTI. Children at times may tend to hold urine for long periods of time, even when their parents repeatedly ask whether they feel the need to urinate. This is very important to prevent infections. Holding urine does not reduce the blood supply to the kidneys significantly. Abdominal pain is associated with UTIs and is not caused by holding urine. A child holding urine does not impact urine formation.)

a bulging of the contents of the abdomen through a weak area in the lower abdominal wall • Usually increase with crying, straining • Refer for surgical consult • Observe for signs of incarceration (meaning that content that bulges through gets stuck and is "strangulated" =less blood supply)

Inguinal Hernia

Results from irritation, inflammation of hyperestrogenization of labia minora

Labial adhesion

Supportive care for Nephrotic syndrome: Diet: ______ • Sodium restrictions if large amount of edema • Steroids: 2 mg/kg divided into BID doses: ______ drug of choice (cheapest and safest) • Immunosuppressant therapy (Cytoxan)• Diuretics: ____ • NURSING ACTIONS: Encourage the child to eat foods that are high in potassium. Monitor blood electrolyte levels periodically (hypokalemia)

Low to mod protein Prednisone Furosemide

is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. May appear as a tight ring or "rubber band" of foreskin around the tip of the penis, preventing full retraction

Phimosis