Transcript Chapter 15 - Amazon S3

Fluid Balance, Renal, and Reproductive
Disorders
Copyright © 2012 by Saunders, an imprint of
Elsevier, Inc.
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Dehydration
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Occurs whenever fluid output exceeds fluid intake,
regardless of the cause
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Homeostasis: fluid intake and output are balanced
Infants
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Subject to greater evaporation of water from skin
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Rapid respirations increase fluid loss
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When diarrhea is present, additional fluid is lost
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Immature infant kidneys = poor water conservation
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Overhydration
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Body receives more fluid than it can excrete
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Can occur in patients with normal kidneys who
receive intravenous fluids too rapidly
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Can also occur in a patient receiving acceptable
rates of fluid, especially when the patient’s
illness is related to disorders of fluid mechanism
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Edema: presence of excess fluid in the
interstitial spaces
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Edema in infants may first be seen about the eyes
and in the presacral, occipital, or genital areas
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Elsevier, Inc.
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Description
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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
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Rated I-V
Malfunctioning valve at the junction of the ureter and
bladder allows urine reflux into the ureters toward
the kidney
– Bacteria from urine can cause pyelonephritis and renal
damage
– Diagnosed via ultrasound and voiding cystourethrogram
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Signs and symptoms
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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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Treatment and nursing care
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7- to 14-day course of an appropriate antibiotic,
generally sulfamethoxazole-trimethoprim
(Bactrim, Septra)
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Nurses need to teach proper hygiene
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Penicillins and cephalosporins may also be ordered
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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Description
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Occurs as an immune reaction (antigen-antibody)
to an infection in the body
Generally caused by a Group A beta-hemolytic
streptococci infecting the throat or the skin
Oliguria: Decreased urine output, often caused
by sodium/fluid retention
Anuria may necessitate need for dialysis
Signs and symptoms
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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
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Treatment and nursing care
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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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Description
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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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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
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Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.
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Treatment and nursing
care
Control of edema—
steroids, diuretics, and
albumin
– Diet—should be wellbalanced and high in
protein; salt is restricted
– Fluid balance—the
patient’s urine must be
carefully measured
– Care of the skin—good
skin care is especially
important during periods
of marked edema
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Bed-wetting
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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
Therapy includes medications, fluid
restriction after evening meal, waking a child
to void, bladder training, alarms upon
initiation of voiding
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Elsevier, Inc.
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An excessive amount of fluid in the sac that
surrounds the testicle causes the scrotum to
swell
Its appearance in the neonate is not
uncommon, 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
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Description
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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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Treatment and
nursing care
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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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Description
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Hypospadias—the opening of the urinary meatus
appears on the ventral or underside of the shaft
of the penis
Epispadias—the urethral opening is on the dorsal
or upper surface of the shaft
Treatment and nursing care
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Surgical repair is usually performed between 6
and 12 months of age
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Description
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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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Signs and symptoms
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Premenstrual syndrome: symptoms overlap with
dysmenorrhea, but include weight gain, breast
tenderness, irritability, and insomnia
Treatment and nursing care
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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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Elsevier, Inc.
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Chlamydia infection
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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
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Women: 80-90% asymptomatic
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Painful urination, pus discharge, inflamed scrotum
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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Syphilis
Caused by spirochete Treponema pallidum
– Can be passed to unborn children…what do we give
newborns to prevent this?
– Incubation period: 10-90 days
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Stages of syphilis symptoms
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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
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Insanity and blindness, crippling or paralysis, death
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Genital herpes
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Herpes simplex virus (HSV) type II frequency
among teenagers is increasing
Lesions persist for 3-6 weeks
Fever, headache, malaise, anorexia
HSV Type II can be passed to infants via the birth
canal
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Cesarean section is generally performed
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Treatment and nursing care
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Nurses must 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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Description
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A retrovirus identified as the human
immunodeficiency virus attacks T-helper cells
that support immune functioning
Signs and symptoms
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Failure to thrive, chronic diarrhea, repeated
respiratory infections, oral candidiasis, and
enlargement of the liver and spleen
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Treatment and nursing care
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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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What is the most common STD in the U.S.?
A. Gonorrhea
B. Chlamydia
C. Syphilis
D. AIDS
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