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46 Cards in this Set
- Front
- Back
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What are the fx of the renal system?
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Urine Formation and Elimination of Waste
Electrolyte Balance Acid-Base Balance BP regulation RBC synthesis and maturation (ethropoietin) |
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What must happen for the renal system to fx correctly?
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Patent renal flow
adequate glomerular filtration Normal Tubular Fx Unobstructed urine flow |
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What are the age related differences in renal fx?
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Fluid takes up a larger part of the TBW - less blood flow through kidney
unable to concentrate urine as well less efficient in regulating electrolyte and acid-base balance during first 2 yrs no stretch in bladder wall until 2 yrs urethra shorter kidneys more suseptible to trauma |
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What are the S/S of a UTI in infants?
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V/D
abd distention fever constant squirming strong smelling urine urethral discharge Jaundice Failure to gain weight back pain persistent diaper rash can be without sx, sepsis |
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What is the normal pH, specific gravity, protein, urobilinogen in peds urinanalysis?
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Ph:5-9
SG: 1.001-1.030 Protein <20 Uro: up to 1mg/dl |
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What should not be found in a normal urinanalysis in peds?
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Glucose, Keytones, Hgb, WBC, RBC, Casts, Nitrates
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What is the nursing management of UTIs?
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Eradicating infection, promoting comfort, preventing recurrence of infection
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At what age does a UTI usually occur in peds?
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females between the ages 2-6yo
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What are the predisposing factors for UTIs?
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constipation
antimicrobials pregnancy not enough fluid intake sex bubble baths short urethra urinary stasis Caths tight clothes or diapers (cotton) poor hygiene |
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What are the s/s of UTI in children >2yo?
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enuresis
dysuria fever strong smelling urine inc frequency urgency L abd pain dark color urethral discharge sepsis |
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What are the dx tests for UTI?
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Urinanalysis (determines if a culture is necessary)
urine culture (bateria confirms UTI) renal US (for structural damage after bacteria subsides Voiding Cystourethrogram |
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What are important nursing considerations for a urine culture?
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Do not drink a lot of H2O right before culture bec of dilution
clean catch by cath or suprapubic aspiration |
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What are nursing interventions for UTI?
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UA
Urine and blood cultures priority on admission antibiotic compliance and followups teaching |
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What is the tx for repeated UTIs?
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Prophylactic or suppressive antibiotics
TMP-SMX (bactrim, pediazole) qday or before events likely to cause it |
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What is education is important for UTIs?
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frequent bladder emptying
cotton underwear and keep dry toileting inc fluid intake |
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What is acute pyleonephritis and its causes?
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Infection of the kidney caused by bacteria, fungi, protozoa, viruses
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What is urosepsis?
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system infection from urologic source and can lead to septic shock and death
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What is Vesicoureteral Reflux (VUR) and its causes?
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obstruction uropathy characterized by the backflow of urine in the ureters when voiding leading to renal damage
severity r/t "grading" of reflux I-V caused by congential or aquired illness & recurrent UTIs |
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What is the tx of VUR?
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continuous low dose antibiotic therapy
grades I and II have a high chance of remission IV and V require surgery (ureteral reimplant) |
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what is Hypospadias?
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location of the urinary meatus on the ventral (lower) surface of the penile shaft
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What is epispadias?
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location of the urinary meatus on the dorsal (top) surface of the penile shaft
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What is important to understand about the dx of hypospadias/epispadias?
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speedy dx in nursery, bec circumcision delayed
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What is the tx for hypospadias/epispadias?
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surgical correction b/w 6-12 mo to enable voiding in standing position
improve physical appearance, sexual adequacy |
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What is the nursing care for hypospadias/epispadias?
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Cath care (no bath until removed after surgery and for it to stay in place)
infection prevention (no baths until healed) increased fluid intake No straddle toys, sandboxes, swimming and rough activities (toddlers and infants not limited post-op) |
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What is cryptorchidism?
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one or both testies have not decended into scrotal sac leading
Cx to infertility or cancer tx by HCG or surgery |
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What is the patho for Nephrotic Syndrome?
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group of sx not diseases
Glomerular Membrane becomes permeable to proteins (albumin), losing it in urine serum albumin dec making fluid shift from plasma to interstitial spaces (dec Na, hypovolemia, ascites) |
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What is the presentation of nephrotic syndrome?
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Proteinuria
hyponatremia hypoalbuminemia hyperlipidemia edema Cr high, BUN high |
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What is minimal change nephrotic syndrome?
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idiopathic, found in ages 2-6yo
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What are the Sx of nephrotic syndome?
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children <3yo
periorbital edema (first sign) weight gain Dec UOP Normal or slightly dec BP high specific gravity dark frothy urine fatigue |
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What is the Rx Tx for nephrotic syndrome?
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Corticosteroid therapy (prenisone BID)
Diuretics (reducing edema) IV albumin Immunosuppressant therapy (cytoxan) |
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What is the dietary management for nephrotic syndrome?
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Low protein diet, Na restriction
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What are nursing interventions for nephrotic syndrome?
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I/O
daily weight abd girth test urine for protein assess RR for fluid overload bedrest during acute phase prevent infection (relapse) |
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What is Acute Glomerulonephritis (AGN)?
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inflammation of the glomerular capillaries causing swelling and capillary death
autoimmune (not infection) that occurs post infection |
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What is the most common type of AGN?
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post strep glomerulonephritis
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When does post strep glomerulonephritis occur?
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peaks at age 6-7yo
more common in boys latent period 10-14days between infection and onset of s/s |
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What are the s/s of AGN?
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dec in GFR
hematuria fluid retention dec UOP HTN fx changes 10-21days |
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What are the nursing interventions for AGN?
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Fluid balance (wt, I/O)
Reg diet with restricted Na usually voluntary activity restriction Meds (antiHTN, antibiotics - if persistent) edu about ARF Cx |
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What are the differences in AGN and nephrotic syndrome?
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AGN:
High hematuria marked HTN acute illness 6-7yo Nephrotic: Dec Na frothy dark urine massive proteinurea massive edema normal or dec BP chronic illness <3yo |
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What is Hemolytic Uremic Syndrome?
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Injury to the GF arteriols causing Anemia, thrombocytopenia, and renal injury bec they are stuck
occuring in 6mo-3yo can progress to chronic renal failure |
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What are the s/s of HUS?
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usually follows a GI or URI of ecoli with
oliguria fever diarrhea appears ill seizures inc BP |
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What is the management of HUS?
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antibiotics
fluid balance controlling HTN control electrolytes replenish RBC dialysis if needed |
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How can you prevent HUS?
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hand washing
swim diapers cook meats wash fruits and veges avoid unpasturized dairy products and fruit juices |
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What is peritoneal dialysis?
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preferred method
abd cavity acts as a impermeable membrane for filtration managed at home with warm fluid in, remain in, and removed, call dr if cloudy |
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What is hemodialysis?
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requires creation of vascular access and special dialysis equiptment
for children who can be seen 3x/wk for 4-6hrs rapid correction of electrolyte imbalances |
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Who can give transplant and what is the goal of it?
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living related donor or cadaver, long term survival of grafted tissue
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What are s/s of rejection?
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use immunosuppressants indefinately
fever, swelling, tenderness, diminshed UOP, inc BP, inc Cr |
