Nursing Care of Children with altered Genitourinary Function (2)

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

17. 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

18. 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

19. 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

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

22. 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

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

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

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

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

29. 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 .

30. 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

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

32. 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

33. 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

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

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

36. Thankyou