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Nursing Care of Children with altered Genitourinary Function (2)

Learn about the assessment, diagnosis, and management of nephrotic syndrome and renal failure in children, as well as the complications and nursing care involved.

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Nursing Care of Children with altered Genitourinary Function (2)

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  1. Nursing Care of Children with altered Genitourinary Function (2) Dr. Manal Kloub

  2. Outline • Nephrotic Syndrome • Renal Failure • Acute • Chronic

  3. Nephrotic Syndrome ( Nephrosis ) • It is a clinical state that includes massive Proteinuria, Hypoalbuminemia ,hyperlipidemia and  edema • The disorder can occur as • A primary disease known as idiopathic Nephrosis . Childhood Nephrosis, Minimal change nephritic Syndrome (MCNS). • A secondary disorder that occur as a clinical manifestation after or in association with Glomerular damage

  4. Nephrotic Syndrome 3. Congenital form inherited as an autosomal recessive disorder. • Nephrotic Syndrome occur in children between 2-7 years of age ; it is rare in children younger than 6 months of age • Patients with (MCNS) are twice as likely to be male .

  5. Pathophysiology • It is not understood • There may be a metabolic , biochemical, physiochemical or immune- mediated disturbances that cause the basement membrane of the glomeruli to become increasingly permeable to protein

  6. Pathophysiology • Renal Glomerular damage -----Proteinuria ( massive) ---- hypoprotienemia • Hypoprotienemia– increased hepatic synthesis of protein and lipids --hyperlipidemia • hypoprotienemia – deceased oncotic pressure 1- edema 2- hypovolemia

  7. Pathophysiology • Decreased renal blood flow --- Renin release ---- vasoconstriction • increased secretion of ADH and aldosterone --- Na+ and water reabsorption --- Edema

  8. Assessment Clinical Manifestation • Weight gain • Periorbital edema especially in morning from head dependent position • abdominal cavity edema ( ascities )    •   Scrotal edema extremely marked • anorexia ,vomiting • Diarrhea caused by intestinal edema and poor absorption by edematous membrane • Pleural effusion • Ankle/leg swelling. • Irritability, easily fatigued , lethargic

  9. Diagnostic Evaluation • Blood pressure normal or slightly decreased • Susceptibility to infections • Urine alterations decreased volume and frothy • Laboratory studies reveal • Marked Proteinuria ( +3 or higher ) which almost entirely albumin • low serum protein concentration ,reduced serum albumin significantly , elevated plasma lipids serum and platelets count may be elevated • Renal biopsy if the patient dose not respond to a 4-8 weeks courses of steroids

  10. Management • Dietary restriction includes a low salt diet and fluid restriction • Diuretic therapy • Sometimes infusions of 25% albumin are used • Acute infection are treated with appropriate antibiotics • Corticosteroids are the first line of therapy for MCNS • Relapse are treated with a repeated course of high dose steroid therapy • MCNS episodes often happen in conjunction with viral or bacterial infection • Relapses in children may continue over many years

  11. Complications • Infection peritonitis, cellulites and pneumonia • Circulatory insufficiency secondary to hypovolemia • Thromboembolism

  12. Prognosis • The prognosis for ultimate recovery in most cases is good • It is self limited disease • In children who respond to steroid therapy the tendency to relapse decreases with time

  13. Nursing care • Daily monitoring of intake and out put • Weight the child daily • Examine urine daily for albumin • Measure abdominal girth daily • Assessment of edema (pitting, color& texture of skin • Monitor V/S to detect any signs of shock or infections( respiratory )

  14. Nursing care • Formulate a nutritionally adequate and attractive diet • Adjust activities according to children tolerance level • Edema and fluids restricted during the edema phase and allowed when edema subsides. • Family support and home care ( urine examination , medication taken , prevent infection(

  15. Renal Failure(RF) • RF Is the inability of the kidney to excrete waste material, concentrate urine and conserve electrolytes. • The disorder can be • Acute • Chronic Terms used in RF • Azotemia : a accumulation of nitrogenous waste products within the blood • Uremia: retention of notoriousness products produce toxic symptoms often involve other body systems • and its a life threatening

  16. Acute Versus Chronic • Acute • sudden onset • rapid reduction in urine output • Usually reversible • Tubular cell death and regeneration • Chronic • Progressive • Not reversible • Nephron loss • 75% of function can be lost before its noticeable

  17. Acute Renal Failure • Most often occurs because of sudden body insult such as sever dehydration • Resulted in Oliguria • Azotemia • Acidosis • Diverse electrolytes disturbance • Causes • Prerenal • Intrinsic renal • Post renal

  18. Causes of ARF • Pre-renal = • vomiting, diarrhea, poor fluid intake, fever, use of diuretics, and heart failure • cardiac failure, liver dysfunction, or septic shock • Intrinsic = • Interstitial nephritis, acute glomerulonephritis, tubular necrosis, ischemia, toxins • Post-renal = • prostatic hypertrophy, cancer of the prostate or cervix, or retroperitoneal disorders • neurogenic bladder • bilateral renal calculi, papillary necrosis, coagulated blood, bladder carcinoma, and fungus

  19. Assessment • Decrease urine output (70%) • Edema, esp. lower extremity • Mental changes • Heart failure • Nausea, vomiting • Pruritus • Anemia • Tachypenic • Cool, pale, moist skin

  20. Diagnosis of Renal Failure • Blood studies include • BUN and creatinine elevated • Hyperkalemia ( 6meq/l ) • Hypocalcaemia which leads to osteodystrophy • Increase phosphorus • Urine creatinine clearance urine specific gravity decreased

  21. Acute Renal Failure Management • Treat life threatening conditions • Identify the cause if possible • Treat reversible elements • Hydrate • Remove drug • Relieve obstruction

  22. Hyperkalemia Symptoms • Weakness • Lethargy • Muscle cramps • Paresthesias • Lowered blood pressure • Dysrhythmias

  23. Hyperkalemia Treatment • Calcium gluconate (carbonate) • Sodium Bicarbonate • Insulin/glucose • Kayexalate • Lasix • Hemodialysis

  24. Diet • low in protein, potassium , sodium • Increase Carbohydrates • Restrict fluids • Daily weight • Accurate recording for intake & out put

  25. Chronic Renal Failure • It begins when the diseased kidneys can no longer maintain the normal chemical structure of body fluids under normal conditions • Glomerular filtration rate decreased below 10 to 15 % of normal .

  26. Chronic Renal Failure Causes • The most common causes before 5 years are congenital renal and urinary tract malformation such as renal hypoplasia, obstructive uropathy & Vesicoureteral reflux • Glomerular and hereditary diseases in children ages 5-15 years • Chronic pyelonephritis , chronic glomerulonephritis • Systematic diseases such as (Lupus erythematosus, anaphylactic purpura) • Polycystic kidney disease • Renal vascular disorder such as hemolytic Uremic syndrome (HUS) vascular thrombosis

  27. CRF Symptoms • Seizure • Constipation • Peptic ulceration • Anemia • Pruritus • Abnormal hemostasis • Malaise • Weakness • Fatigue • Neuropathy • CHF • Anorexia • Nausea • Vomiting

  28. Treatment • low protein, phos, & potassium diet • Daily fluid intake restriction • Low sodium intake such as ( chips) • Calcium supplement •  anti- hypertension •  blood transfusion • Human erythropoietin • Growth hormone may be given in some children • Dialysis • kidney transplant

  29. Dialysis • Patients with CRF eventually require dialysis • Diffuse harmful waste out of body • Control BP • Keep safe level of chemicals in body • 2 types • Hemodialysis • Peritoneal dialysis

  30. Hemodialysis • 3-4 times a week • Takes 2-4 hours • Machine filters blood and returns it to body

  31. Peritoneal Dialysis • Abdominal lining filters blood • types • Continuous ambulatory • Intermittent

  32. Thankyou

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