NURSING CARE FOR CHILD GLOMERULONEPHRITIS

o Glomeruli inflammation
WITH GU DISORDERS AND o This occurs d/t immune complex disease after
infection with nephritogenic streptococci

INFECTIOUS DISEASES o Complement: cascade of CHON activated by antigen

antibody reactions & plufs or obstructs glomeruli.
Learning Outcomes o Complement fixation reaction -> tissue damage ->
intravascular coagulation occurs in the minute renal
1 Describe GU disorders and infectious disease that
vessels -> ischemic damage -> scarring and
occur in pediatrics.
decreased glomerular function -> decreased GFR ->
2 Assess an infant who is born with GU disorders and
infectious disease. accumulation of Na and H2O in the bloodstream;
3 Utilize knowledge GU disorders and infectious disease inflammation increases permeability -> protein
to promote quality maternal and child health nursing molecules escape into the filtrate
care. o Hx: recent respi infection (1-2wks) or impetigo
(3wks)
Course Outline
o Onset of hematuria and proteinuria (24hr urine)
o Tea-colored/ reddish brown/ smoky urine
GENITOURINARY DISRDERS
o Oliguria, elevated urine specific-gravity, abdominal
□ Urinary Tract Infection
pain, anorexia, vomiting, low grade fever, headache,
□ Glomerulonephritis
edema
INFECTIOUS DISEASES
o The pt is hypertensive d/t hypervolemia
□ Rubella
□ Rubeola Cardiac involvement r/t difficulty managing excessive plasma
□ Varicella fluid
□ Poliomyelitis
 Orthopnea, cvardiac enlargement, liver
□ Parotitis
hypertrophy, pulmonary edema, galloping heart
□ Diptheria rhythm, heart failure
□ Pertussis  ECG: T-wave inversion, prolonged PR interval
□ Helminthic Infections o Course: 1-2 wks
o Heart failure: semi fowlers, digitalization, O2 therapy
GENITOURINARY DISRDERS o Diastolic >90mmHg: Ca channel blocker (nifedipine)
o Phosphate binders, kayexalate
URINARY TRACT INFECT ION

o RF: females
o Ascending infection
o Predominant causative agent: E. Coli
o Classical signs: dysuria, frequency, hematuria
o Cystitis: low-grade fever, mild abdominal pain,
enuresis
o Pyelonephritis: high fever, abdominal/flank pain,
vomiting, malaise
o Any febrile child: evaluate for UTI
o Urine C/S from clean catch, suprapubic aspiration or INFECTIOUS DISEASES
catheterization
o >100 000/mL bacteria RUBELLA
o Proteinuria d/t bacteria and hematuria d/t mucosal o Known as German measles caused by Rubella virus
irritation o Incubation: 14 to 21 days
o pH is greater than 7 o Period of communicability: 7 days before to approx.
o Antibiotics, IOFI, analgesic, acidify urine 5 days after rash
 o Mode of transmission: droplets (direct or indirect)
o Immunity: Contracting the disease offers lasting
natural immunity; a high rubella titer reveals
infection has occurred
o Active artificial immunity: vaccine (altered live virus)
o Passive artificial immunity: immune serum globulin
o Prodromal period (1-5 days): low-grade fever,
headache, malaise, anorexia, mild conjunctivitis,
sore throat, mild cough, swollen lymph nodes
o After prodromal period: erythematous macular rash
on the face spreads downward to trunk & VARICELLA
extremities (cephalocaudally)
o Known as chicken pox caused by Varicella-zoster
o Incubation: 10-21 days
o Period of communicability: 1 day prior rash to 5-6
days after its appearance (when all vesicles crushed)
o Mode of transmission: direct or indirect contact of
saliva & vesicles
o Immunity: contacting the diseases provides natural
immunity; may be reactivate at later time as herpes
zoster (shingles)
o Active artificial immunity: attenuated live virus
vaccine
o 3rd day: rash disappears o Passive artificial immunity: little passive placental
o (-) desquamation; fine flaking (if so) immunity to chickenpox
o Comfort measures for rash, antipyretic, analgesic, o Low-grade fever, malaise
droplet precaution after onset o 24hrs: rash from macule to papule to vesicle to crust
o Lesions usually 2-3mm in diameter accompanied
RUBEOLA fever
o Known as measles caused by Measles virus o Naturally fall scabs after that it will leave white
o Incubation 10 to 12 days round, slightly indented scar at the site
o Period of communicability: 5th day of incution o Advice: don’t scratch & remove scars
through the first few days of rash o Antihistamine, antipyretic, acyclovir
o Mode of transmission: direct/ indirect contact with o It is airborne so wait until all lesions are crusted
droplets o Sequelae: secondary infection of lesion, pneumonia,
o Immunity: contracting disease provides lasing and encephalitis
natural immunity
o Active artificial immunity: attenuated live measles
vaccine
o Passive artificial immunity: immune serum globulin
o Prodromal (10 to 11 day): enlarge lymph nodes, high
fever, malaise
o Prodromal Day 2: coryza, conjunctivitis with
photophobia, cough, Koplik’s spots
o 4th day of febrile: deep-red maculopapular eruption
cephalocaudally then 5-6 day the rash will fade = fine
desquamation
o Provide comfort measures for the rash, antipyretic,
decongestant
o WOF: pneumonia, otitis media, airway obstruction,
acute encephalitis
POLIOMYELITIS o Manifestation: fever, headache, anorexia, malaise,
earache (pointing to jawline in front of earlobe)
o Caused by poliovirus o Chewing aggravate pain
o Incubation period 7-14 days o Swollen parotid glands and tender to palpate
o Period of communicability: virus is present at the o Boys: testicular pain & swelling
throat for 1 to 6 weeks and greatest shortly before & o Soft/liquid diet (6 days), analgesic, antipyretic
after onset of Sx o Droplet & standard precaution
o Mode of transmission: direct & indirect contact o Sequelae: mumps orchitis, meningoencephalitis,
o Immunity: contracting disease causes active severe hearing impairment
immunity against one strain of virus
o Active artificial immunity: IPV
o Passive artificial immunity: none
o Polio: Greek for gray
o Enters to GI where it multiplies
o Manifestation: fever, headache, nausea, vomiting
abdominal pain
o Moderate pain in the neck, back, and legs develops
soon
o CSF: increase CHON & lymphocytes
o Followed by intense pain & tremors of extremities =
paralysis immediate or over period of 1-7 days
DIPTHERIA
o Kernig’s sign
o Tripod sign o Caused by Corynebacterium diphtheriae (Klebs-
o DTR hyperactive at first then diminish when CNS is Löffler bacillus)
fully invaded o Incubation: 2-6 days
o Laryngeal paralysis: impaired or difficult swallowing o Period of communicability: rarely > 2-4wks in
o Respiratory paralysis: halt respiration untreated pt; 1-2 days pt treated with antibiotics
o Bed rest, analgesia, long term ventilation o Mode of transmission: direct or indirect contact
o Sequelae: muscle atrophy or severe arthritis o Immunity: contracting disease = lasting immunity
o Active artificial immunity: diphtheria toxin given as
part of DTaP vaccine
o Passive artificial immunity: Diptheria antitoxin
o Diphtheria bacilli invades & grow in nasopharynx ->
exotoxin production => massive cell necrosis &
inflammation -> necrosing material feeds the bacilli
more
o Gray membrane on nasopharynx, purulent
discharge, brassy cough
o Prognosis if untreated: myocarditis, CNS involvement
o Dx: throat culture for confirmation
PAROTITIS o IV antitoxin, penicillin (erythromycin), complete
bedrest, droplet precaution
o Known as mumps caused by mumps virus o WOF: airway obstruction -> ET intubation
o Incubation: 14-21 days
o Period of communicability: shortly before & after
onset of disease
o Immunity: contracting disease = natural immunity
o Active artificial immunity: attenuated live mumps
vaccine
o Passive artificial immunity: mumps immune globulin
PERTUSSIS HOOKWORMS

o Known as “whooping cough” caused by Bordetella o Blood suckers

pertussis o Eggs found in feces -> enter to skin -> migrate to GI
o Incubation: 5 to 21 days -> attach to intestinal villi -> suck blood from
o Mode of transmission: direct/ indirect contact intestinal wall
o Period of communicability: greatest in catharral
stage
o Immunity: contracting disease = natural immunity
o Active artificial immunity: DTaP
o Passive artificial immunity: Pertussis immune serum
globulin

THREE STAGES

o Catharral Stage: URTI Sx, irritable & listless, lasts 1-2

wks PINWORMS
o Paroxysmal Stage: 5-10 short rapid cough followed
by whoop sounds that lasts 4-6wks o Small, white, threadlike worms live in the cecum
o Convalescent Stage:gradual cessation of coughing & o NIGHT: female pinworm travels to the rectum & lay
vomiting eggs on anal & perianal region -> child awakens at
night crying & scratching
o Some eggs carried from fingernails to mouth (cyclic)
o Worms are large to be seen if child’s buttocs are
o <6mos of age: absence of whooping cough
separated while sleeping
o B. pertussis, C/S from nasopharyngeal secretions
o Press piece of cellophane tape against anus =
o Leukocystosis
microscopic exam for pinworm eggs reveal
o Bedrest, frequent small meals, airway suction, 10
o Single dose mebendazole/ pyrantel pamoate
day course of erythromycin or azithromycin
o All fx members are treated for pinworm infestation
o Droplet precaution 5 days after antibiotic treatment
o Health teaching: avpid nail biting & handwashing
o Sequelae: pneumonia, atelectasis, emphysema,
prior food prep or eating
seizures from asphyxia, epistaxis, alkalosis, &
dehydration

HELMINTHIC INFECTIONS

o Helminths = pathogenic or parasitic worms

o Etiology: dirty hands

ROUNDWORMS (ASCARIASIS)

o Eggs excreted in feces -> larvae -> hatch & penetrate

intestinal wall -> enter circulation
o Loss of appetite, nausea, vomiting
o Intestinal obstruction may occur
o Anthelminthic; pyrantel pamoate