Renal

Question 1

Etiology of UTI?

Answer 1

Escherichia coli most common pathogen (80% of cases)

Question 2

UTI manifestations in an Infant?

Answer 2

• Nonspecific symptoms
• Poor feeding
• Vomiting
• Irritability
• Failure to Thrive
• Fever in some cases- may be afebrile

Question 3

UTI manifestations in a Child?

Answer 3

• Dysuria (e.g., crying on urination or vocalized pain)
• Frequent urination (>q 2 h)
• Urgency
• Suprapubic discomfort or pressure “Tummy/belly aches”
• New onset bedwetting or incontinence

Question 4

UTI diagnostic tests?

Answer 4

• Catherization is the preferred sample in child not potty-trained
• U-bag– not used to diagnose UTIs-easily contaminated
• Clean-catch outpatient older child

Question 5

UTI treatment?

Answer 5

• 3rd generation Cephalosporin
• Septra-Trimethoprim-sulfamethoxazole (Bactrim)
  
  • Sulfa allergy contraindication
• Nitrofurantoin (Macrobid)
• Amoxicillin
• Pyridium (OTC and prescribed)
  
  • Stains urine reddish-orange (mistaken for blood)

Question 6

What is Normal and Minimum Urine Output?

Answer 6

• Normal urine output: 1-2cc/kg/hour
• Minimum urine output = 1cc/kg/hour

Question 7

What is Normal and Minimum Urine Output for a child who weighs 10kg?

Answer 7

• Normal urine output: 10cc-20cc per hour
• Minimal urine output per hour 10cc per hour

Question 8

Etiology of Acute Poststreptococcal Glomerulonephritis?

Answer 8

• Caused by group A β-hemolytic streptococci (strep throat)
• Onset 14 days after infection

Question 9

Pathophysiology of Acute Poststreptococcal Glomerulonephritis?

Answer 9

• Immune response to infection –antigen- antibody complexes collect in the glomeruli causing inflammation
• Leukocytes occlude capillary

Question 10

Acute Poststreptococcal Glomerulonephritis manifestations?

Answer 10

Sudden onset of:

- Gross hematuria
- Proteinuria
- Oliguria (decreased urinary output)
- Edema
- Hypertension

Question 11

Acute Poststreptococcal Glomerulonephritis laboratory tests?

Answer 11

• Urinalysis: Proteinuria and Hematuria
• Renal function: Elevated BUN and creatinine (renal insufficiency)
• C-Reactive Protein (CRP) increased indicating inflammation
• Erythrocyte Sedimentation Rate (ESR)
• Antistreptolysin O (ASO) blood test: circulating antibodies in the body in response to streptococcal infection. (4-6 weeks)

Question 12

Acute Poststreptococcal Glomerulonephritis treatment?

Answer 12

• Diuretics (Furosemide-Lasix)
• Daily weights
• Strict I&O
• Sodium restriction if hypertension or edema present
• Monitor vital signs

Question 13

Etiology of Nephrotic Syndrome?

Answer 13

• Nephrotic syndrome is the most common chronic glomerular injury in children
• Etiology is not completely understood: 70-80% cases from “minimal change disease” or MCD

Question 14

Pathophysiology of Nephrotic Syndrome?

Answer 14

glomerular membrane becomes permeable to large proteins → albumin lost in urine → due to low albumin in blood, fluid shifts to interstitial spaces resulting in edema.

Question 15

Nephrotic Syndrome manifesations?

Answer 15

• Massive proteinuria
• Hypoalbuminemia
• Hyperlipidemia
  Edema: most common presentation
• BP is usually normal or slightly decreased
• At risk of chronic kidney disease and end stage renal disease
• 10-20% of children will have Steroid Resistant Nephrotic Syndrome

Question 16

Nephrotic Syndrome nursing considerations?

Answer 16

Evaluate a child who exhibits the following symptoms for the possibility of nephrotic syndrome:

• Periorbital, abdominal, gonadal, or lower extremity edema
• Weight gain greater than expected based on previous pattern
• Decreased urinary output (Fluid goes to interstitial space)
• Pallor, fatigue

Question 17

Nephrotic Syndrome treatment?

Answer 17

• Diet
  
  • Protein restricted if azotemia (excess nitrogen in the blood) or renal failure
    - Sodium restrictions
• Steroids (Prednisone)
• Immunosuppressant therapy (Cytoxan)
• Diuretics (Lasix-Furosemide)

Question 18

Acute Kidney Injury (AKI) manifesations?

Answer 18

• **Principal feature is oliguria: urine output < 1ml/kg/hr **
• Most common cause of AKI results from severe dehydration
• Usually reversible
• Dialysis may be needed temporarily

Question 19

Describe Chronic Renal Failure (CRF).

Answer 19

• Progressive deterioration over months to years
• Final stage (End Stage Renal Disease) is irreversible
• Treatment with dialysis and medication
• Transplant if a candidate

Question 20

Chronic Renal Failure (CRF) manifestations?

Answer 20

• Uremia (anorexia, vomiting)
• Growth Failure
• Osteodystrophy
  
  • bone pain, deformity (knock knees) or waddling gate, rickets
• Convulsions (Seizure)
• Hypertension, hypocalcemia
• Anemia

Question 21

Renal Failure nursing considerations?

Answer 21

• Monitor BP
• Monitor labs (BUN/creatinine)
• Monitor growth
• Administer diuretics
• Regulation of diet most effective means 2nd to dialysis
  
  • Low sodium, fluid restrictions initially
  • Recommended Dietary Allowance (RDA) protein
  • Potassium limitations if increased creatinine

Question 22

Who would be a better candidate for Hemodialysis?

Answer 22

• Preferred dialysis method for children over 20 kg
• Best suited for children who live close to dialysis center (requires 3 visits per week for 3-5hrs
• Requires creation of a vascular access and special dialysis equipment
• Achieves rapid correction of fluid and electrolyte abnormalities

Question 23

Who would be a better candidate for Peritoneal Dialysis?

Answer 23

• Can be managed at home-child can receive treatment while sleeping.
• Slower and gentle compared to hemodialysis
  Indicated for neonates, children.
• Dialysate absorbs or pulls waste and fluids from blood vessels in the abdominal lining.

Question 24

Peritoneal Dialysis nursing considerations?

Answer 24

• Assess peritoneal insertion site for redness, edema, discharge
• Assess peritoneal fluid (if cloudy contact provider)- R/O peritonitis
• Daily weight
• Measure abdominal girth