Transcript NURS 2410 unit 10 and 11

Nancy Pares, RN, MSN
Metro Community College
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Maintains balance of fluid and electrolytes
Removal of waste products
Functionally immature until puberty
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Function through filtration, reabsorption, and
secretion
Nephrons—the kidney’s functional unit
Filtration occurs at the glomerulus, Bowman’s
capsule, and the basement membrane
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As child grows, concentration of urine
becomes more efficient
Under 2 years old, kidneys less efficient
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Carry waste fluid from kidneys to bladder
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Stores urine
Bladder capacity in ounces estimated by
adding 2 to child’s age
Muscular organ—contraction of detrusor and
relaxation of sphincters result in bladder
emptying
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Excretes urine
Urine excretion occurs around the 12th week
of gestation
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Structural defects and various disorders
May result in reduced or obstructed urine
flow
Testing
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Discuss pathophysiology and nursing process
for the pediatric patient with alterations in
the GU system.
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Most common inflammation of the glomeruli
of the kidneys
Results from group A beta H strep infection
of throat or skin
More common in boys
Mostly asymptomatic, but could be abrupt
flank pain, tea colored urine and edema
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Bedrest
Supportive therapy
Sodium restriction
Emergency care
◦ Increased BP with cerebral dysfunction
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Prognosis:
◦ Good; 90% recover without problems
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Slow, irreversible reduction in kidney function
over months or years
Caused by congenital defects, cystic and
inherited diseases, glomerulonephritis,
hereditary disorders, and acquired disorders
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Delay in growth and development is a
common outcome
High-quality protein diet is needed to
support growth
Optimal intake is 2.5g/kg/day
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Monitor height and weight
Assess development
Meet nutritional needs
Provide emotional support
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Discuss pathophysiology and nursing process
associated with the pediatric client with
structural defects of the GU system
◦ Enuresis (review 1400)
◦ Epispadias/hypospadias
◦ Bladder extrophy
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Congenital abnormalities involving abnormal
location of urethral meatus
◦ Hypospadias—urethral meatus located on ventral
surface
◦ Epispadias—urethral opening located on dorsal
surface
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Congenital abnormalities involving abnormal
location of urethral meatus
◦ Pathophysiology—result from failure of urethral
folds to fuse completely over urethral groove
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Congenital abnormalities involving abnormal
location of urethral meatus
◦ Nursing management
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Preoperative teaching
Fluid intake and output documentation
Education
Catheter and stent care
Incision and penis care
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Congenital abnormalities involving abnormal
location of urethral meatus
◦ Postoperative care
 Protect surgical site
 Pain management
 Double diapering
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Obstuctive uropathy and posterior urethral
valves
◦ Definition—abnormalities that result in urine
backflow into the kidneys
◦ Pathophysiology—caused by several congenital
lesions
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Obstuctive uropathy and posterior urethral
valves
◦ Nursing management
 Monitor urine output
 Pain management
 Monitor for infection
◦ Pre- and postoperative care
 Diaper placement
 Ostomy care
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Vesicoureteral reflux
◦ Definition—retrograde flow of urine from bladder
into ureters
◦ Pathophysiology—reflux prevents complete
emptying of bladder, reservoir for bacterial growth
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Vesicoureteral reflux
◦ Postoperative care
 Monitor urine
 IV administration
◦ Family teaching
 Monitor for infection
 Incision care
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Cryptorchidism
◦ Definition—undescended testes
◦ Pathophysiology—occurs when one or both testes
fail to descend through inguinal canal into scrotum
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Inguinal hernia and hydrocele
◦ Definition—painless inguinal or scrotal swelling
◦ Pathophysiology—peritoneal sac precedes the
testicles’ descent into scrotum
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Definition—viral, bacterial, or fungal infection
of the lower or upper urinary tract
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Pathophysiology—organism enters
genitourinary tract and ascends from the
urethra to the bladder toward the kidney
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Assessment
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History of UTI
I&O
Physical exam of abdomen and perineal region
Collection of urine
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Nursing diagnosis
◦ Impaired Urinary Elimination
◦ Urinary Retention
◦ Risk for Deficient Fluid Volume
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Nursing management
◦ Medication administration
◦ Hydration status
◦ Assess renal function
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Teaching
◦ Prevention
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Discuss nutritional concepts applicable to the
pediatric client experiencing GU disorders
Apply the nursing process to the care of the
pediatric client experiencing GU disorders
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Chronic renal failure:
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Small frequent meals high in protein (2.5g/kg/day)
High calorie intake
Adequate calcium
May require enteral feedings
Complex carbohydrates
Fruits and vegetables low in potassium
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Chronic renal failure:
◦ Limit phosphorous, potassium, and sodium
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Nephrotic syndrome
◦ Regular protein
◦ Low-sodium diet
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Acute glomerulonephritis
◦ Low protein
◦ No-added-salt diet
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Describe psychosocial issues for the child
requiring surgery on the genitourinary tract.
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Infancy vs. older child
Parental concerns
◦ Injury, infection, disfigurement, and preservation of
renal and reproductive function
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Parental teaching
◦ Bladder elimination procedures, special dressing
and diapering, bathing, hydration assessment,
wound care, and infection control
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Assess family coping mechanisms and
support systems
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Assess level of understanding of the surgery
and concerns
Provide parents with the opportunity to
discuss concerns
Psychological counseling may be beneficial
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Reduce postoperative complications
Reduce parental and child stress
Promote positive body image
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Hemodialysis
Peritoneal
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Electrolyte monitoring
Intake and output
Vital signs
Heparin administration
Monitor for bleeding and infection
Complications: hypotension, rapid fluid and
electrolyte exchange, and disequilibrium
syndrome
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Pathophysiology: numerous bacterial,
parasitic, and viral organisms transmit
sexually due to avoidance of protective
barriers, multiple sexual partners, frequent
sexual activity, failure to seek medical
treatment, and sexual abuse
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Nursing management
◦ Identify signs and symptoms, assess for
asymptomatic STI
 Symptoms: 75% are asymptomatic
 Symptoms may include endocervical discharge, pelvic
pain, vaginal spotting, urethritis, dysuria
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Nursing management
◦ Assess for psychosocial impact
◦ Good communication and nonjudgmental approach
◦ Education and prevention
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Anatomy
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Functions
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Fetus differentiation
Growth regulation
Coordination of reproduction
Hormone maintenance
homeostasis
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Endocrine glands and their functions
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Endocrine system controls cellular activity
through release of hormones
Hormones have specific controlling effects on
the cells in the body
The glands of the endocrine system
◦ Anterior pituitary, posterior pituitary, thyroid,
parathyroid, adrenal, pancreas, ovaries, and testes
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Feedback mechanism in hormonal stimulation
of the gonads during puberty
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Actions of the major hormones in the anterior
pituitary
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Recall pathophysiology and nursing process
for the pediatric client with thyroid, adrenal
and pituitary disorders
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Disorders of pituitary function
◦ Growth hormone deficiency
 Signs and symptoms
◦ Diabetes insipidus
 Signs and symptoms
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Syndrome of inappropriate diuretic hormone
(SIADH)
◦ Signs and symptoms
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Precocious puberty
◦ Signs and symptoms
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Disorders of thyroid function
◦ Hypothyroidism
 Signs and symptoms
◦ Hyperthyroidism
 Signs and symptoms
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Disorders of the parathyroid
◦ Hyper- and hypoparathyroidism
 Signs and symptoms
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Disorders of adrenal function
◦ Cushing syndrome
 Signs and symptoms
◦ Adrenal insufficiency (Addison’s disease)
 Signs and symptoms
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Disorders of gonadal function
◦ Amenorrhea
 Signs and symptoms
◦ Dysmenorrhea
 Signs and symptoms
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Disorders related to sex chromosome
abnormalities
◦ Turner syndrome
◦ Klinefelter syndrome
◦ Inherited metabolic diseases
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Stimulates linear growth, bone mineral
density, and growth of all body tissues
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Growth hormone deficiency
Familial short stature
Hypothyroidism
Turner syndrome
Constitutional growth delay
Chronic renal failure
Malnutrition
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Cushing syndrome
Down syndrome
Inborn error of metabolism
Severe cardiac, pulmonary, immunologic, or
gastrointestinal disease
Psychosocial dwarfism
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Disorders related to sex chromosome
abnormalities
Turner syndrome
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Assessment
Diagnosis
Planning and implementation
Evaluation
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Klinefelter syndrome
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Assessment
Diagnosis
Planning and implementation
Evaluation
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Disorders of the adrenal gland affect
production and release of steroid hormones
and mineralocorticoids
Cortisol—main glucocorticoid
Affects the metabolism of proteins, glucose,
and fats; affects stress response; and inhibits
inflammation
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Disorders that have a deficiency in cortisol
require replacement therapy
Administering cortisol early in the morning or
every other day mimics the normal diurnal
pattern of cortisol secretion
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Hydrocortisone (Cortef, Solu-Cortef, and
cortisone acetate) is available in liquid, tablet,
or injectable form
Educate parents regarding medication
compliance
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Discuss the pathophysiology and nursing
process of the pediatric client with diabetes
mellitus.
S/S
◦ Polyphagia, polydypsia, polyuria, DKA
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Diabetes type 1 and 2 are both disorders of
pancreatic function
Nursing management—type 1
– Assess the child’s physiologic status and the child’s
and parents’ psychosocial responses
– Administer insulin, fluids, and electrolytes
– Monitor for complications
– Provide extensive teaching
– Provide emotional support
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Nursing management—type 2
◦ Manage the child’s blood glucose levels and
hypertension
◦ Assess for growth and dietary intake
◦ Evaluate for weight loss and exercise
◦ Review the child’s knowledge about management at
home
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Collaborative management
Insulin action
Insulin pump therapy criteria
Hospitalization
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Discuss with the family signs of
hyperglycemia, hypoglycemia, and diabetic
ketoacidosis
Educate family and care providers on ways to
treat hypoglycemia
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Develop a nursing care plan for the child with
an inherited metabolic disorder.
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Nursing assessment
Phenylketonuria (PKU)
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Galactosemia
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Mitochondrial oxidation of fatty acids
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Maple syrup urine disease
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Explain the pathophysiology and nursing
process of the pediatric patient with burns
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Assessment
◦ Airway and circulation
◦ Measurement burn depth, percentage of body
surface affected, and involvement of specific body
parts
◦ Reassessment after 48 hours
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Assessment
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Vital signs and pain assessment
Monitor electrolytes, intake and output
Monitor for signs of infection in burned skin
Psychosocial assessment should identify child and
family’s stressors
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Nursing diagnoses
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Hyperthermia
Disturbed Body Image
Anxiety
Risk for Infection
Planning and implementation
◦ Treatments to promote healing and prevent
complications
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Evaluation
◦ Effective pain management
◦ Prevention of complications
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Burns
◦ Prevention
◦ Management
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Sunburn
◦ Prevention
◦ Management
Partnering with Families (continued) Preventing Sunburn
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Frostbite
◦ Prevention
◦ Management
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Bites and stings
◦ Prevention
◦ Management
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Review information from 1400
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Objective 4:
◦ Review pathophysiology and nursing process of
atopic dermatitis and impetigo
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Differences in anatomy and physiology of the
skin = higher risk
Newborn’s skin: thin, little subcutaneous fat
Infant’s skin: more water, loosely attached
cells
Adolescent’s skin: thickens, cells tightly
bound, eccrine and apocrine glands mature
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Dermatitis
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Atopic dermatitis
Contact dermatitis
Diaper dermatitis
Seborrheic dermatitis
Drug reactions
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Bacterial infections
◦ Impetigo
◦ Cellulitis
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Fungal infections
◦ Tinea infections
◦ Thrush
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Viral infections
◦ Molluscum contagiosum
◦ Warts
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Infestations
◦ Pediculosis capitus
◦ Scabies
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Atopic eczema—chronic, relapsing,
superficial inflammatory skin disorder
Nursing management
– Hydrate and lubricate skin
– Reduce pruritis
– Minimize inflammatory changes
– Determine triggers
– Apply topical corticosteroids
– Provide emotional support
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Psoriasis—chronic, pruritic, papulosquamous
skin condition
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Nursing management
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Application of topical steroids and vitamin D
Tar shampoo
Ultraviolet B phototherapy
Systemic drug therapy
Provide emotional support
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Medications
Nursing care
Teaching
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Dermatitis
◦ Contact dermatitis
◦ Diaper dermatitis
◦ Seborrheic dermatitis
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Drug reactions
Clinical Manifestation Drug Reactions (continued)
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Bacterial infections
◦ Impetigo
◦ Cellulitis
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Fungal infections
◦ Tinea infections
◦ Thrush