Transcript Care of the Pediatric Patient with Elimination Problems

Care of the Pediatric
Patient with Elimination
Problems
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Elizabeth Allen RN, MSN
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Identify anatomic and physiologic differences
between the adult & pediatric renal system
Describe pathologic conditions of the renal
system in the pediatric patient
Discuss treatment, testing and specimen
collection for a UTI in a pediatric patient
Learning Objectives
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Kidneys less efficient until 2 years
Kidney grow most in first 5 years
Bladder capacity increases with age
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Bladder capacity age + 2 in oz.
Bladder control >2 years due to nerve
development
Low set ears associated with urinary tract
abnormalities
Anatomic and Physiologic
Differences
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Gomerulonephritis
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Acute Post-infectious Gomerulonephritis
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Most often results from Strep infection on skin
(impetigo) or throat
Also from staphylococcus, Pneumococcus and
Coxsackie
Develops 10-21 days post infection
Most common 2-6 years
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Renal
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Gomerulonephritis
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Immune complex Reaction
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Renal
Antigen-Antibody complexes lodge in glomeruli
Inflammation and Obstruction
Increased permeability to RBCs & Protein
Decreased ability to filter wastes, regulate fluid
balance
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Glomerulonephritis
Symptoms
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Renal
Hematuria
Mild to Moderate
Proteinuria
Elevated BUN,
Creatinine
Fever
Flank or midabdominal
Pain
Edema- periorbital and
dependent
Acute HTN- possible
encephalopathy and
headache from HTN
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Hypertension: defined by percentiles for Age &
Height per National Heart Lung and Blood
Institute
Hypertension is defined as a reading >95th
percentile for children of similar gender, age and
height
http://www.nhlbi.nih.gov/files/docs/guidelines/
child_tbl.pdf
Renal- Definition of HTN
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Glomerulonephritis
Treatment
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Acute Phase
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Risk for infection
Risk for skin breakdown
Fluid and electrolyte correction
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Renal
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Monitor urine output
Fluid restriction
Low protein, low sodium diet
Treat HTN, pain
Antibiotic for infection
Dialysis as needed
Resolves 3 weeks or longer
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Nephrotic Syndrome
Clinical State: Increased protein
permeability in glomeruli
 85% have Minimal Change Nephrotic
Syndrome (MCNS)
 Congenital
 Primary (i.e. glomerulonephritis)
 Secondary (disease, drugs, toxins)
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Renal
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Nephrotic Syndrome Signs
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Edema
Massive Proteinuria- frothy urine!
Altered immunity
Hyperlipidemia
Hypoalbuminemia, hypoproteinemia
Hypercoagulability
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Renal
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Nephrotic Syndrome Treatment
Corticosteroid
 Risk for Skin Breakdown
 Risk for Infection
 Treat Pain
 IV Albumin and Furosemide to reduce
edema
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Renal
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Renal
National Kidney and Urologic Diseases
Information Clearinghouse (NKUDIC)
Resource for Nephrotic Syndrome
http://kidney.niddk.nih.gov/KUDiseases/pubs/c
hildkidneydiseases/nephrotic_syndrom/#sec8
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Polycystic Kidney Disease
Genetic Disorder
 Autosomal dominant and recessive
 Cysts form in collecting ducts- become
larger as child grows
 Cysts replace kidney mass and reduce
function
 Cysts also develop in liver
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Renal
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Autosomal Dominant
90% of PKD
 Symptoms usually
develop age 30-40,
can begin in
childhood
 Symptoms of Renal
Failure
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Autosomal Recessive
Rare
 Symptoms start
perinatally to 1 year
 Low set ears, small
jaw, flat nose
 Symptoms
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Renal
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HTN
UTIs
Oliguria
Respiratory Distress
Developmental Delay
Liver problems
Treatment is
supportive
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Wilm’s Tumor (Nephroblastoma)
Most often 2-3 years
 Palpable mass on 1 side or other abdomen
 Fast growing- doubles in size in 11-13 days
 Staging of tumor
 Preoperatively, do not palpate after diagnosis
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Do not know what stage/lymph involvement
Renal
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Wilm’s Tumor Treatment
Nephrectomy- involved kidney only
 Post op care of patient
 Chemotherapy or Radiation as needed
for Staging
 Single Kidney
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Renal
http://www.healthychildren.org/English/healthissues/conditions/genitourinarytract/Pages/Children-with-a-Single-Kidney.aspx
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Urinary Tract Infections
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0-6 months more common in boys
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Especially uncircumcised males
>2 years more common in girls
 Cystitis and pyelonephritis
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Urinary
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UTI
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Specimen collection
Sterile: straight cath in non toilet trained
Clean catch: hat for toilet trained
VCUG (Voiding cystourethrogram) for
repeated UTIs
Renal Ultrasound
Treatment with Antibiotics
Education for parents or patient
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http://www.healthychildren.org/English/agesstages/baby/bathing-skin-care/Pages/Care-for-anUncircumcised-Penis.aspx
Urinary
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Congenital Urinary Tract Disorders
Increased risk for Latex Allergy
 Usually require surgical correction
 Neurogenic bladder: may result from congenital
defect affecting spinal cord or acquired condition
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Urinary
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Hypospadias
Congenital
 Hypospadias may be anywhere on
ventral shaft of penis
 Associated with Chordee
 Surgical repair < 1 year
 Delay circumcision
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Urinary
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Hypospadias
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Post Op Care
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Urinary catheter or stent stitched in place
Double diapering or dressing to protect
stent
Pain management
Restricted activity
Monitor urine output
Urinary
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Enuresis
Nocturnal or diurnal
 Primary or Secondary
 Thorough assessment including family hx
 Strategies to promote dryness
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Evening fluid restriction
Positive rewards
Waking to void
Alarms
Pharmacological approach
Urinary
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Encopresis
Stool holding or soiling at inappropriate times
 Primary or secondary
 Retention of stool in rectum- becomes hard and
painful
 Leads to irregular/unpredictable elimination
pattern
 Liquid stool may ooze around it
 Often present as constipation or diarrhea
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Bowel
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Encopresis
Studies to rule out disorder
 Evacuate bowel- enema
 Dietary management of constipation
 Positive reinforcement
 Toileting schedule
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Bowel