Nursing Care of the Child

with GU disorders

Dr RNgt Amin Samiasih,SKp.Msi.Med

Dual Role of the Kidneys
• Kidneys make urine, through which
they excrete most of the waste
products of metabolism.
• Kidneys control the concentrations of
most constituents of body fluids,
especially blood.
 Basic Structure and
Function
• Structures
– Basic unit is the nephron
• Glomerulus
• Tubules
• Function
– Excretory and regulatory
– Endocrine
Basic Structure
 Renal Nephrons
• Basic functional unit of the kidney
• Major nephron functions
– Filtration of materials in blood
– Reabsorption of needed substances
– Secretion of hydrogen ions to maintain acid-base balance
– Excretion of waste materials
• Additional functions
– Renin secretion (for body water balance)
– Erythropoietin secretion (for red cell production)
– Vitamin D activation
 Nephron Structures
• Glomerulus
– Cluster of branching capillaries
– Cup-shaped membrane at the head of each nephron forms the Bowman’s
capsule
– Filters waste products from blood
– Glomerular filtration rate: Preferred method of monitoring kidney
function
• Tubules
– Proximal tubule
– Loop of Henle
– Distal tubule
– Collecting tubule
Tubules
Causes of Kidney Disease
• Infection and obstruction
• Damage from other diseases
• Toxins
• Genetic defect
• Risk factors
Causes of Kidney
Disease, cont’d
 Risk Factors and Causes
of Kidney Disease
• Sociodemographic factors
– Older age
– Racial or ethnic minority status
– Exposure to certain chemical and
environmental conditions
– Low income or education
Risk Factors and Causes
of Kidney Disease, cont’d
• Clinical factors
– Poor glycemic control in diabetes
– Hypertension
– Autoimmune disease
– Systemic infections
– Urinary tract infections
– Urinary stones
Risk Factors and Causes
of Kidney Disease, cont’d
• Clinical factors
– Lower urinary tract obstruction
– Neoplasia
– Family history of chronic kidney disease
– Recovery from acute kidney failure
– Reduction in kidney mass
– Exposure to certain nephrotoxic drugs
– Low birth weight
– Copyright National Kidney Foundation.
 Renal System Assessment
• Physical assessment
– Palpation, percussion
• Health history
– Previous UTIs, calculi, stasis, retention,
pregnancy, STDs, bladder cancer
– Meds: antibiotics, anticholinergics,
antispasmodics
– Urologic instrumentation
– Urinary hygiene
– Patterns of elimination
 Radiography and other
tests of urinary system
function
Urine Renal/ Testicular
culture & bladder US US
sensitivity
Renal bx,
VCUG Imaging
studies IVP cystoscopy
 Physical tests for Gu
function
• Volume for polyuria, oliguria
• Specific gravity
• Osmolality
• Appearance
• Chemistries on urine (√ for blood,
WBCs, bacteria, casts)
 Blood tests of renal
function
• BUN (blood urea nitrogen)
• Uric acid
• Creatinine
 Nursing responsibilities
with testing
• Responsible for preparation and
collection of urine or blood
• Maintains careful intake and output
• Recognizes that renal disease can
diminish the glomerular filtration
rate
Urinary Tract Infections
 Urinary tract infections
• Most common type of bacterial
infections occurring in children
• Bacteria passes up the urethra into
the bladder
• Most common types of bacteria are
those near the meatus…staph as well
as e.coli
 Contributing factors

• Those with lower resistance, particularly

those with recurrent infections
• Unusual voiding and bowel habits may
contribute to UTI in children
• “forget to go to bathroom”
• Symptoms vary by age of child
Therapeutic management
• Eliminate the current infections
• Identify contributing factors to
reduce the risk of re-infection
• Prevent systemic spread of the
infection
• Preserve renal function
 Therapeutic
Interventions
• Drug Therapy
– Antibiotics – specific to causative organism
– Analgesics –
• Nursing Care
– Force fluids – childs choice
– Dysuria – sit in warm water in bathtub
and void into the water
 Parent Teaching
Change diaper frequently
Teach girls to wipe front to back
Discourage bubble baths
Encourage fluids frequently throughout day
Bathe daily
Adolescent girls when menstruating are to
change of pad every 4 hours
• The single most important host
factor influencing the occurrence of
UTI is urinary stasis
• What is the chief cause of urinary
stasis?
 Glomerular diseases

• Acute glomerulonephritis (AGN)

• Nephrotic syndrome or minimal-change
nephrotic syndrome
Nephrotic Syndrome

Chronic renal disorder in which the

basement membrane surfaces of the
glomeruli are affected, cause loss of
protein in the urine.
Nephrotic syndrome
Nephrotic syndrome, cont
Contrast of normal gloumerular activity with
changes seen in Nephrotic Syndrome
 Etiology

• Insidious onset with periods of remission /

exacerbations throughout life- No cure
• 95% idiopathic, possibly a hypersensitivity
reaction.
• Other causes: post acute glomerulonephritis,
sickle cell disease, Diabetes Mellitus, or
drug toxicity.
• Usually seen in preschool yrs (2-4). M>F
 Assessment
Four most common characteristics:
1. Massive proteinuria
2. Hypoalbuminemia (K+ normal, BP normal)
3. Edema – usually starts in periorbital area and
dependent areas of the body and progresses to
generalized, massive edema. Pitting edema of 4+.
Caused by hypo albumin which causes shift of fluids to
extracellular space. *There is an insidious weight gain-
shoes don't fit, etc
4. Hyperlipidemia
* Of note is that there is no
hematuria or hypertension
 Other signs and
symptoms
Fatigue

Anorexia

Weight gain

Abdominal pain – from large amount of fluid in abdominal

 Treatment of nephrotic
syndrome
• Varies with degree of severity
• Treatment of the underlying cause
• Prognosis depends on the cause
• Children usually have the “minimal
change syndrome” which responds
well to treatment
 Ask Yourself?

• Which of the following signs and

symptoms are characteristic of
minimal change nephrotic syndrome?
a. gross hematuria, proteinuria, fever
b. hypertension, edema, fatigue
c. poor appetite, proteinuria, edema
d. body image change, hypotension
Acute Glomerulonephritis

Immune-complex disease
which causes inflammation of
the glomeruli of the kidney as
a result of an infection
elsewhere in the body.
Acute Glomerulonephritis
 Etiology/Pathophysiology
• Usual organism is Group A beta-hemolytic
streptococcus

• Organism not found in kidney, but the antigen-

antibody complexes become trapped in the
membrane of the glomeruli causing inflammation,
obstruction and edema in kidney

• The glomeruli become inflamed

and scarred, and slowly lose their
ability to remove wastes and excess
water from the blood to make urine.
 AGN
• Treatment and nursing care:
• Bed rest may be recommended during
the acute phase of the disease
• A record of daily weight is the most
useful means for assessing fluid
balance
Nursing care specific to the
child with AGN
• Allow activities that do not expend
energy
• Diet should not have any added salt
• Fluid restriction, if prescribed
• Monitor weights
• Education of the parents
Therapeutic management
• Corticosteroids (prednisone)
• Dietary management
• Restriction of fluid intake
• Prevention of infections
• Monitoring for complications:
infections, severe GI upset, ascites, or
respiratory distress
 Nursing diagnosis for the
child with
glomerulonephritis
• Fluid volume excess r/t to decreased
plasma filtration
• Activity intolerance r/t fatigue
• Altered patterns of urinary elimination
r/t fluid retention and impaired filtration
• Altered family process r/t child with
chronic disease, hospitalizations
 Medical Nutrition
Therapy Objectives
• Reduce protein breakdown
• Avoid dehydration or excess hydration
• Correct acidosis
• Correct electrolyte imbalances
• Control fluid and electrolyte losses
• Maintain optimal nutritional status
• Maintain appetite and morale
• Control complications of hypertension, bone pain, nervous
system involvement
• Slow rate of renal failure
 Medical Nutrition
Therapy Principles
• Provide enough protein therapy to maintain tissue
integrity while avoiding excess
• Provide amino acid supplements for protein
supplementation
• Reserve protein for tissue synthesis by ensuring
adequate carbohydrates and fats
• Maintain adequate urine volume with water
• (Possibly) restrict sodium, phosphate, calcium
• Supplement diet with multivitamin