Transcript Chapter 15

Chapter 15
Fluid Balance, Renal, and
Reproductive Disorders
Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.
Fluid Imbalance
• Dehydration: Infants
• Subject to greater evaporation of water from skin
• Rapid respirations increase fluid loss
• When diarrhea is present, additional fluid is lost
• Immature infant kidneys = poor water conservation
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Fluid Imbalance
• Classification of dehydration is based on serum
sodium levels
– Isotonic
– Hypotonic
– Hypertonic
• Maintenance therapy vs. deficit therapy
– Adjusted continually for patient’s condition
• Oral fluids
• Parenteral fluids
– Given by route other than digestive tract
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Fluid Imbalance
• Overhydration
– Body receives more fluid than it can excrete
– Can occur in patients with normal kidneys who
receive intravenous fluids too rapidly
– Can also occur in a patient receiving acceptable
rates of fluid, especially when the patient’s illness
is related to disorders of fluid mechanism
– Edema: presence of excess fluid in the interstitial
spaces
• Edema in infants may first be seen about the eyes and
in the presacral, occipital, or genital areas
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Urinary Tract Infection
• Description
– Bacterial invasion of the upper urinary tract (kidney
and ureters) or lower urinary tract (bladder and
urethra)
• Vesicoureteral reflux
– Primary contributing factor to upper UTIs
• Rated I-V
– Malfunctioning valve at the junction of the ureter and
bladder lets urine reflux up the ureters toward the kidney
– Bacteria from urine can cause pyelonephritis and renal
damage
– Diagnosed via ultrasound and voiding cystourethrogram
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Urinary Tract Infection
• Signs and symptoms
– Poor feeding, fussiness, delayed growth, foulsmelling urine, and incontinence (in a child who
has been previously trained)
– Many adolescent girls exhibit classic signs of UTI
(frequency, urgency, pain on urination, blood in
the urine) after the first episode of sexual
intercourse
– High fever, chills, flank pain, and abdominal pain
can indicate kidney infection (pyelonephritis)
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Urinary Tract Infection
• Treatment and nursing care
– 7- to 14-day course of an appropriate antibiotic,
generally sulfamethoxazole-trimethoprim (Bactrim,
Septra)
• Penicillins and cephalosporins may also be ordered
– Nurses need to teach proper hygiene
• No bubble baths or irritating diaper wipes
• Wiping from front to back
– Other preventive measures include wearing cotton
underwear, adequate fluid intake, encouraging
children to not put off going to the bathroom when the
urge is felt, investigating and treating signs of
intestinal parasites (pinworms)
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Acute (Post-streptococcal)
Glomerulonephritis
• Description
– Occurs as an immune reaction (antigenantibody) to an infection in the body
– Generally caused by a Group A betahemolytic streptococci infecting the throat or
the skin
– Oliguria: Decreased urine output, often
caused by sodium/fluid retention
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Acute (Poststreptococcal)
Glomerulonephritis
• Signs and symptoms
– Urine is smoky brown in color or bloody
– Periorbital edema may also be present in the
morning, and the edema spreads to the
abdomen and extremities as the day
progresses due to gravity
– The child may have fatigue, headache,
abdominal discomfort, and vomiting
– Anuria: body’s suppression of urine
formation; may necessitate dialysis
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Acute (Poststreptococcal)
Glomerulonephritis
• Treatment and nursing care
– Every effort is made to prevent the child from
becoming overtired, chilled, or exposed to
infection
– A low-sodium diet may be ordered
– Furosemide (Lasix) may be given if significant
edema and fluid overload are present and renal
failure is not severe
– Penicillin is given if the streptococcal infection
persists, but it usually does not alter the course of
the disease
– Persistent anuria may necessitate dialysis
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Nephrotic Syndrome (Nephrosis)
• Description
– Refers to a number of different types of kidney
conditions that are distinguished by the
presence of marked amounts of protein in the
urine
– Glomeruli: Filter blood in the kidneys;
damage allows protein to enter the urine
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Nephrotic Syndrome (Nephrosis)
• Signs and symptoms
– The characteristic symptom of nephrosis is
edema
– The edema shifts with the position of the child
during sleep
– The urine appears dark and frothy
– Urine output can be decreased
– Vomiting and diarrhea may also be present
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Nephrotic Syndrome (Nephrosis)
• Treatment and nursing care
– Control of edema—steroids, diuretics, and
albumin
– Diet—should be well-balanced and high in
protein; salt is restricted
– Fluid balance—the patient’s urine must be
carefully measured; weight daily
– Care of the skin—good skin care is especially
important during periods of marked edema
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Nephrotic Syndrome (Nephrosis)
• Treatment and nursing care (continued)
– Positioning—the child is repositioned
frequently to prevent respiratory infection and
skin breakdown
– Infection prevention—assessment for and
protection from infection is critical
– Emotional support—parental guidance,
education and support should be given by all
members of the nursing team
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Enuresis
• Bed-wetting
– Primary: child has never been dry for an
extended period of time
– Secondary: bed-wetting after the child has been
dry
• Child should never be punished
• Time is usually all that is needed; out grow it
• Therapy includes medications, fluid restriction
after evening meal, waking a child to void,
bladder training, alarms upon initiation of
voiding
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Hydrocele
• An excessive amount of fluid in the sac that
surrounds the testicle; causes the scrotum to
swell
• Common in the neonate, and in many cases,
the condition corrects itself as the baby grows
• If a chronic hydrocele persists in the older
child, it is corrected with surgery
• Routine postoperative nursing care is given
• Same-day or outpatient surgery may be
arranged
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Undescended Testes (Cryptorchidism)
• Description
– One or both testes fail to descend into the
scrotum
– Because the testes are warmer in the
abdomen than in the scrotum, the sperm cells
begin to deteriorate
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Undescended Testes (Cryptorchidism)
• Treatment and nursing care
– Occasionally, spontaneous descent of the
testis or testes occurs during the first 6
months of life
– If this does not happen, treatment is
recommended at 9 to 15 months
– The testis or testes can be brought down to
the scrotum with a surgical intervention called
orchiopexy
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Hypospadias and Epispadias
• Description
– Hypospadias—the urinary meatus appears on
the ventral or underside of the penis’ shaft
– Epispadias—the urethral opening is on the
dorsal or upper surface of the shaft
• Treatment and nursing care
– Surgical repair is usually performed between
6 and 12 months of age using the foreskin
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Dysmenorrhea (Primary)
• Description
– Painful menstruation; denotes pain associated
with the menstrual cycle in the absence of
organic pelvic disease
– Secondary dysmenorrhea: Patient may have
an underlying condition such as
endometriosis, PID, ovarian cysts, adhesions,
congenital abnormalities
– Mittelschmerz: Midcycle pain during
ovulation
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Dysmenorrhea (Primary)
• Signs and symptoms
– Cramping, abdominal discomfort, and leg aches, all of
which begin at the onset of menses
– Systemic symptoms such as nausea, vomiting,
dizziness, diarrhea, backache, and headache
– Premenstrual syndrome: symptoms overlap with
dysmenorrhea, but include weight gain, breast
tenderness, irritability, and insomnia
• Treatment and nursing care
– Ibuprofen or naproxen should be taken every 4 hours;
usually 2 to 3 days of medications are required
– Warm heating pad applied to the lower abdomen
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Sexually Transmitted Disease
• Description
– The general name given to infections that are
spread through direct sexual activity
• Signs and symptoms
– Table 15-3 describes the clinical
manifestations of the major STDs in the
United States
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Sexually Transmitted Diseases
• Chlamydia infection
– Most common STD in the U.S.
– Often asymptomatic
• Gonorrhea
– Anaerobic bacterium
– GC, clap, a dose, strain, the drip
– Men: Symptoms within 2-7 days of contact
• Painful urination, pus discharge, inflamed scrotum
– Women: 80-90% asymptomatic
• Mild burning in genital area, possible yellow discharge, swelling
of Bartholin glands, abdominal discomfort. Can cause PID.
– Minors can receive free, confidential treatment without
parental consent from the city/state health department, or
most physicians
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Sexually Transmitted Diseases
• Syphilis
– Caused by spirochete Treponema pallidum
– Can be passed to unborn children
– Incubation period: 10-90 days
• Stages of syphilis symptoms
– Primary: chancre sores where spirochete enters the
body
– Secondary: begins 4 weeks to 6 months after
infection. Disease enters a latent period if left
untreated
– Tertiary: After the fourth year. Spirochetes attack
heart, blood vessels, brain, spinal cord
• Insanity and blindness, crippling or paralysis, death
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Sexually Transmitted Diseases
• Genital herpes
– Herpes simplex virus (HSV) type II frequency
among teenagers is increasing
– Lesions can persist for 3-6 weeks
– Fever, headache, malaise, anorexia
– HSV Type II can be passed to infants via the
birth canal
• Cesarean section is generally performed
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Sexually Transmitted Diseases
• Treatment and nursing care
– Table 15-4 describes treatment methods for
frequently seen STDs
– Hospitalization is uncommon
– Nurses need to create a comfortable
environment and approach teenagers without
judgment
– The reporting of sexual contacts, required by
law, often prevents patients from seeking
help; assuring confidentiality is important
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Acquired Immunodeficiency Syndrome
(AIDS)
• Description
– A retrovirus identified as the human
immunodeficiency virus attacks T-helper cells
that support immune functioning
• Signs and symptoms
– Failure to thrive, chronic diarrhea, repeated
respiratory infections, oral candidiasis, and
enlargement of the liver and spleen
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Acquired Immunodeficiency Syndrome
• Treatment and nursing care
– There is no cure for AIDS
– Several antiviral drugs are being used for
treatment in children
– Assessment for signs of infection, including
vital signs, and observation of the skin and
general condition of the child should be done
routinely
– Psychological support of the child and family
is critical
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