Describe how urinary output changes as children age.
– urinary output per kg decreases as the child ages because the kidneys become more efficient
* infants = 1 - 2 mL/kg/hr
* children = 0.5 - 1 mL/kg/hr
* adolescents = 40 - 80 mL/hr
What is a UTI? Differentiate between cystitis and pyelonephritis.
- urinary tract infection caused by bacteria, viruses, or fungi (but most commonly E. coli)
- can also be caused by urinary stasis or vesicoureteral reflux
- can be the lower or upper urinary tract
– cystitis: lower UTI (urethra/bladder)
– pyelonephritis: upper UTI (ureters/kidneys)
Do males or females experience UTIs more frequently?
- more common in males in first 6 months of life – uncircumcised infants
- more common in females after 6 months – shorter urethra
What is a neurogenic bladder?
interrupted nerve supply to the bladder that impairs ability to urinate
What is vesicoureteral reflux (VUR)?
backflow of urine from bladder into ureters; fairly common
What is hydronephrosis?
overfilling and stretching of one or both of the kidneys d/t excessive urine
What is pyelonephritis?
infection of the kidneys
Approximately how many times per day should children be voiding?
5 - 6x per day
What are the signs and symptoms of UTIs?
11 s/s
- depend on location of infection and age of child
– newborns = non-specific – poor feeding, FTT, vomiting, diarrhea, strong-smelling urine, irritability
– older children = more classic s/s – abdominal tenderness, foul-smelling urine - urinary frequency
- urinary hesitancy
- dysuria – discomfort during urination
- bladder cramping
- bladder spasms
- cloudy or blood-tinged urine
- musty-smelling urine
- fever
- poor feeding
- FTT
How do the s/s of lower UTI compare with s/s of upper UTI?
– lower UTI:
* fever
* irritability
* foul-smelling urine
* enuresis
* dysuria
* dehydration
– upper UTI:
* high fever
* chills
* abdominal pain – indicative of kidney infection
* flank pain – indicative of kidney infection
* costovertebral-angle tenderness (CVA) – indicative of kidney infection
How is UTI diagnosed?
- clean urine collection – look for leukocytes or nitrates
- C&S test – ID infecting organism
What are some nursing interventions for UTIs?
7 interventions
- encourage fluids
- encourage frequent voiding
- perineal hygiene
- discourage holding in urine
- use of cotton underwear – discourage tight, thong, or nylon underwear
- discourage bubble baths
- encourage abstinence – if sexually active, encourage voiding before and after
How is VUR diagnosed?
renal ultrasound (VCUG) – this also grades the progression
How is VUR treated?
4 treatments
- surgery – usually done in infancy
- prophylactic antibiotics to prevent UTIs
- urine output monitoring
- pain control
What is enuresis?
- repeated, involuntary voiding of urine in children old enough to have bladder control
- usually diagnosed ~5 - 6 y.o.
- can be either nocturnal (night) or diurnal (day)
What is the difference between primary and secondary enuresis?
– primary:
* child has never had a dry night
* caused by maturational delay or small functional bladder
* no psychological cause
– secondary:
* child who has been reliably dry for at least 6 months begins to wet the bed
* caused by stress, infections, or sleep disorders
What is nephrotic syndrome?
kidney disorder characterized by hyperproteinuria – the glomerular membrane allows proteins to pass into urine
What are the s/s of nephrotic syndrome?
12 s/s
- generalized edema – worse in scrotum and abdomen
- ascites
- hypoalbuminemia
- hypoproteinemia
- hypolipidemia
- altered immunity
- dramatic weight gain
- pale
- fatigue
- anorexia
- decreased urinary output
- dark, frothy urine
How is nephrotic syndrome diagnosed?
3 diagnostics
- urinalysis – proteinuria, color change
- serum chemistry – hypoalbuminemia, hyperlipidemia, hemoconcentration
- kidney biopsy
How is nephrotic syndrome treated?
10 treatments
- monitor I&Os
- daily weights
- monitor edema – measurement of abdominal girth
- prevent infections
- diet restriction – restrict Na during edema phase
- fluid restriction
- skin assessment – risk for breakdown
- assess for respiratory distress
- monitor for HTN
- meds:
– corticosteroids – reduce inflammation
– diuretics – not too quickly –> shock
– albumin
– cyclophosphamide
What is acute postinfectious glomerulonephritis (APGN)?
- inflammation of the glomeruli of kidneys d/t immune reaction and obstruction
- occurs usually after GABHS infections
- more common in boys, and more common in children 2 - 6 y.o.
What are the s/s of APGN?
7 s/s
- asymptomatic
- abrupt flank or midabdominal pain
- irritability
- fever
- cloudy, tea-colored urine – d/t hematouria
- edema
- HTN
What is renal failure? What is the difference between acute and chronic?
– renal failure: kidney cannot excrete wastes and concentrate urine
– acute (AKI):
* sudden loss of renal function – days to weeks
* may be reversible
– chronic (CKD):
* develops gradually
* irreversible
* caused by developmental abnormalities of kidney or urinary tract
* usually ends with end-stage renal disease (ESRD)
* usually requires dialysis
How is acute renal failure treated compared to chronic renal failure?
– acute:
* treatment depends on cause
* diuretics
* fluid restriction
* diet – restrict protein, Na, K, P
* dialysis if poor response to meds
– chronic:
* treatment depends on course of disease
* medications
* fluid restrictions
* diet – restrict protein, Na, K, P
* dialysis once significant impairment occurs
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Chapter 6: Communicable and Infectious Diseases32
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Chapter 18: Cognitive & Sensory Impairment29
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Chapter 21: Respiratory Dysfunction59
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Chapter 22: GI Dysfunction35
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Chapter 26: Genitourinary Dysfunction33
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Chapter 28: Endocrine Dysfunction53
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Chapter 23: Cardiovascular Dysfunction22
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Chapter 24: Hematologic & Immunologic Dysfunction27
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Chapter 25: Cancer13
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Chapter 19: Family Centered Care3
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Chapter 28 Review: Endocrine Dysfunction20
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Chapter 27: Neurologic Dysfunction36
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Chapter 29 & 30: Musculoskeletal and Neuromuscular Dysfunction38
