Quiz 5 Tutoring Notes for quiz 3 PDF

Preview

Summary

Notes for quiz three in caring for pediatrics...

Description

Quiz 5 Tutoring Notes:

● Kahoot Qs: ○ 1. Complication of obstruction – Infection ■ 3 kinds of obstructions: decreased urination would occur ■ Right bx the renal pelvis and the ureter – ureteropelvic junction ○

○

obstruction – know the three of them 2. Cause of acute renal failure – aminoglycoside use – prerenal cause – dehydration, bleeding, hypovolemic shock, less profusion to the kidneys – once corrected dehydration then the acute renal failure should be corrected too ■ Aminoglycosides – antibiotics the ones that end w mycin – gentamicin, vancomycin, tobramycin, NSAIDS, ace inhibitors, chemotherapy, diuretics – if nephrotoxic then it affects babies ears so it is ototoxic – OD on NSAIDs side effects is the ears being affected ■ Post renal causes – obstruction – ureteropelvic, ureterovesical (bladder and ureter) , posterior urethral valve 3. Chronic renal failure – hypocalcemia

■ Sodium – can be high or low – depending on fluid retention or dehydration

■ ■ ■ ■

Potassium– hyper – bc its not being excreted Calcium – low – bc calcitriol isn't being made (vitamin d) – less than 8 Phosphorus – high – can’t be secreted Know the ranges!

○ 4. Bed wetting more common in males ■ Enuresis – after age of 5 at least 2x a week for 3 months even when they have been potty trained – desmopressin given !!!!!

○ 5. Common cause of UTI – constipation ■ When constipated build up of stool in rectum and the intestine as it gets bigger it pushes on the bladder so even when urinating it doesn't full empty so when sleeping you can pee ■ Stagnant urine is a cause of infection as well as constipated

■ Back to front is a risk factor as well ■ Drink lots of water ■ Avoid bubble baths ! ○ 6. Nephrotic syndrome s/s - gross proteinuria ■ grOss prOteinuria = nephrOtic syndrOme ■ Albumin – is low !!! ■ Edematous, ascites, bp is low or normal ■ Fluid back into cells – give albumin infusion !! Diuretic !! acute tx – long term tx – steroids

■ Hyperlipidemia – prone to fatty clot ○ 7. Glomerulonephritis common symptom: gross hematuria ■ Coke colored pee !!! ■ Hypertension !!!! ○ 8. Hemolytic uremic syndrome – GI Infection ■ Recent GI infection – shigella or e coli – goes to red blood cells, platelets, kidneys and destroys or causes inflammation ■ s/s: thrombocytopenia, concern w bleeding, hemolytic anemia, acute kidney injury, diarrhea ■ Help thrombocytopenia – vitamin K to clot, platelet transfusion,

■ ■ ■ ■ ■ ■ ■ ● ● ● ●

Anemia – blood transfusion, sucrose IV Acute kidney injury – play out infection, tx symptoms Hyponatremia – low sodium, dietetic Hyperkalemia – kayexalate, sodium bicarbonate Hypocalcemia – vitamin d, calcium itself Hyperphosphatemia – phosphorus meds given w meals to get rid of it Metabolic acidosis for pts w renal failure – tx – sodium bicarbonate

Easiest test is the skeletal one when we get back Chronic renal failure – polycystic kidney disease – born w it it's a genetic disorder Diabetes complications – eyes, kidneys damages Nephrotic syndrome:

○ Cause: idiopathic ○ Inflammatory response in nephrons ○ s/s: inflammation, esr increased, proteinuria, urine is frothy, ascites, swelling,

○ ○

edema of body and face, decreased urine output/oliguria, metabolic panel little protein in blood (albumin/low albumin)-- liver creates more lipids/lipogenesis – clot formation, BP is not affected or low, weigh every morning Tx: albumin infusion, diuretics – acute — steroids for long term (months) methotrexate for severe pts Kidney biopsy if not responding to steroid tx, mri UA 24 hour urine collection

● Glomerulonephritis: ○ Cause: untreated strep (group a hemolytic whatever) ○ Test: throat culture (negative then titer, antistreptolysin titer) ○ s/s: inflammation, esr increased, gross hematuria, urine is tea colored or coke

○

○

colored, low hemoglobin, anemic, tachycardia, pallor, fatigue, fluid retention and edema/dependent edema, oliguria, high BP Tx: if throat culture is positive then tx symptoms – diuretics like lasix and antihypertensives – fluid restriction – if throat culture is negative then no antibiotics

● RENAL TEMPLATES: ● Renal assessment: ○ Renal system is working ○ Filter waste, take fluid balance, maintain electrolyte balance, calcitriol production, ○

erythropoietin, maintain RBC production Any abnormality or retention there will be problems with all these things

● Structural defects: obstructions

● ○ Ureteropelvic Junction: ■ Can lead to urine accumulation into pelvis of the kidneys leading to infection, most commonly UTI/pyelonephritis. ■ This isn’t going to allow the filtered urine the kidney has produced to move into the ureter and into the bladder to be excreted. Instead, it backs up and stays within the renal pelvis ○ Ureterovesicular Junction: ■ Urine can travel down from the kidney to the ureter but once it tries to get into the bladder it is not all able to because there is narrowing. ■ hydronephrosis (fluid in the ureter), we can see this with an ultrasound. ■ Can lead to infection ■ Common symptoms are infection and oliguria ○ Posterior Urethral Valve: ■ Fast decrease in amniotic fluid – oligohydramnios ■ Can cause preterm labor. ■ Stent ○ Baby born w one of these obstructions the urine won't flow so it backs up and ○ ○

fluid in the ureters is hydronephrosis – VUR Biggest complication is infection and not being able to fully excrete urine, toxins and fluids Stent to open those valves

○ Dx tests: renal bladder ultrasound to look at structure, comprehensive metabolic panel (electrolytes and measure kidney function, creatinine less than 1 if over 1 there’s dysfunctions), I&O, daily weights for retention ○ Hydronephrosis is in the ureteropelvic, if posterior than urine can’t be excreted they need surgery ● Renal failure types

○ Acute renal failure — reversible ■ s/s don't last more than 3 months ■ Prerenal – hypovolemic shock, ■ Intrarenal / acute kidney injury – nephrotoxic meds ■ Postrenal – obstruction ○ Chronic renal – irreversible ■ s/s more than 3 months ■ Structural defect or chromosome genetic abnormality ○ Electrolyte imbalances ■ Hypo or hypernatremia ■ Hyperkalemia ■ Hypocalcemia ■ Hyperphosphatemia ○ Except pt to have anemia - pallor, fatigue ○ s/s: low calcium – muscle cramps, chovek sign (cheek), trousseau – renal osteodystrophy can affect bones and teeth

■ ○ ○ ○ ○

Hyperkalemia – arrhythmias or dysrhythmias Hyponatremia – Seizures Hypernatremia – neuro problems, kayexalate to correct Know how to correct then (it's on top)

○ If cant manage or pee – DIALYSIS ■ Hemodialysis – vein and artery, infusion center or hospital, 2-3 hours ■ Peritoneal dialysis – in the abdomen, grabs toxins, done at home, more for children, 10-12 hours

● Causes of acute renal failure - Problems regulating blood pressure, electrolytes, acid-base balance - Not enough blood to kidney (pre-renal)-lack of perfusion & dehydration o It occurs before the kidneys o Usually caused by dehydration or hemorrhage - Kidney damage (intrarenal) o Caused by ▪ Infection such as pyelonephritis ▪ Trauma ▪ Nephrotoxic meds ● aminoglycosides (vancomycin, gentamicin, tobramycin), ● ACE inhibitors (do not use when creatinine is elevated) ● Acyclovir, contrast, Thiazide or loop diuretics, chemotherapy ● NSAIDS ▪ Most nephrotoxic meds are also ototoxic because the kidneys and the ears develop at the same time in utero. - Blockage of urine (post-renal) o The 3 types of obstructions o Diminish kidney functions o Stagnation of urine o Increase or promote infection o Congestion so function diminishes ● Enuresis – ○ bed wetting, at least 5 y/o, male, bed wetting every week 2x a week for 3 months, ○

already body trained – emotional stressor Pee before bed, decrease fluids 2 hours before bed, void frequently, potty breaks, decrease high carbonated fluids, caffeine and sugar, nightlight so they can pee

○ If nothing helps – desmopressin ● UTI ○ More common in girls ○ s/s: dysuria, urgency, frequency, abdominal pain, flank pain, fever, n/v, appetite ○ ○

low, irritable Dx: UA w urine culture, urinary bag for little ones – high nitrites, hematuria, high WBC, leukocyte esterase, cloudy and concentrated and foul smelling pee Broad spectrum antibiotic until know the bacteria – bactrim

○ Reason for male to have UTI is uncircumcised ● Hemolytic uremic syndrome: ○ Cause: recent GI infection, diarrhea containing shigella ○ The toxin as it dies it goes into the blood and kidneys – THROMBOCYTOPENIA, ○

HEMOLYTIC ANEMIA, ACUTE KIDNEY INJURY Thrombocytopenia s/s: bleeding !!! bruising, petechiae, purpura, bleeding gums tx – vitamin k Blood in stool

○ ○ Anemia – fatigue, tachycardia, pallor – blood transfusion ○ Injury – acid base imbalance – tx electrolyte imbalance ○ If not urinating for 24 hours – dialysis !

● NEURO TEMPLATES: ● Increased intracranial pressure: ○ s/s infants: bulging fontanels, sunset eyes, increased head circumference, irritability/high pitched shrill cry, decreased appetite

○ s/s child: headaches, photosensitivity, N/v, change in LOC, change in behavior, changes in glasgow coma scale (motor response, verbal response, eye response 3-15, less than 8 the pt is brain dead, less than 8 intubate)

■ ■ ■ ■

Meningitis Cerebral edema Head injury Hydrocephalus

● Structure assessment – imaging (CT scan, MRI) ○ CT scan – soft tissue ○ MRI – vessels and activity ○ Electrical brain waves – EEG ● Seizures: ○ Risk factors – fever/hyperthermia, low sodium, family hx, lead poisoning, meds ○

(ATI BOOK), infection Biggest goal !! – turn on side, seizure precautions, o2 at bedside, suction at bedside, lowest position and side rails NOTHING IN THEIR MOUTH

○ ○ SUCTION OUTSIDE ! ○ Document and time the seizure and remove anything that can cause airway ○

obstruction – more than 2 mins benzodiazepine (rectal or IV only) Infantile spasms:

■ Very small seizures 5-10 seconds ■ About 150 spasms a day ■ Dx at 4-7 months of age

■ Doesnt allow to develop appropriately – head lag, not babbling ■ Antiepileptics daily tx ■ They will have delays developmentally ● Head injury ○ Brain can swell – intracranial pressure ○ Assess for increased intracranial pressure and can worsen over time – consistent monitoring q 2 hours Rest, decrease stimuli but assess them at least q 2 hours

○ ○ If they vomit, vision changes like double vision, changes in behavior, fluid coming from nose or ears then they are worsening

○ Position in low semi fowlers – head of bed elevated !!! ○ No suctioning, chest physiotherapy, straining, not bending forward, no sneezing or coughing, dont dust the room

● -

Interventions for increased intracranial pressure (ICP): Avoid deep breathing, coughing, and blowing the nose Low fowler’s Therapeutic cooling Use log rolling to reposition the client. Avoid flexion of neck and hips

● Hydrocephalus ○ Fluid in brain ○ CSF not taken out and circulated ○ Head is battling space w brain and the CSF ○ Cause damage to the ventricle – hypoxia during birth, mom during drugs while pregnant

○ Head circumference bigger, fontanels bulging, sunset eyes, irritable, hard time gaining weight, high pitched shrill cry

○ Caused by a brain bleed as well ○ Infections can cause it too ○ Tx: VP shunt ● Meningitis ○ Viral or bacterial ○ Dx: lumbar puncture (local anesthetic) test the CSF ○ Bacterial – CSF increased WBC, cloudy, glucose low, protein is high, positive gram stain ■ Vaccines ! HIB, pneumo and meningococcal

■ Kernig's sign – straighten knee and they get pain in the spinal cord they have to flex neck to release tension

■ Brudzinski sign – both legs flexed causes flex head and the knees ○ ○ ○ ○

become flexed – older than toddlerhood Photosensitivity, dim lights, lower excess sound, no read, no tv, rest Monitor LOC often Isolation first 24 hours Droplet precautions

○ ● PKU: ○ Genetic testing, both mom and dad have, test all babies when they're born at least 24 hours after born so they can eat !

○ Lower phenylin in diet – AVOID ARTIFICIAL SWEETENERS, diet coke, high protein food items like milk,meat, wheat, yogurt, ice cream, aspartame Special formula NO REG FORMULA

○ ○ Autosomal recessive trait

● Hyperbilirubinemia ○ Physiological: after 24 hours and common, immature liver ○ Pathological: within 24 hours of life ■ Due to ABO incompatibility – mix of blood ○ TX: photolight therapy – if not kernicterus can happen ! ○ s/s: jaundice of skin and sclera ○ Dressed: diaper, goggles, turn every 2 hours, increase feeding ○ VS: monitor temp bc hyperthermia ○ Avoid lotions, ointments, and powder - can cause increase risk for burn ○ Normal levels of unconjugated bilirubin range from 0.2 to 1.4 mg/dl ○ Bilirubin will be excreted in the stool and sweat ○ Do not apply powder or lotion – increase risk for burns ● ABO incompatibility: ○ B+ = O-, O+, B-, AB+ ○ O- = O○ O+ = O- O+

○ ○ ○ ○ ○ ○ ○

AB- = O-, A-, B-, ABAB+ = everyone Negative can only get from negative If positive can get from both O universal donor AB can receive from everyone Acid base q ■ Partial comp everything messed up

■ Uncompensated - bicarb or o2 is normal ■ Compensated - ph is normal ● Reye's Syndrome: ○ An acute encephalopathy – cerebral dysfunction caused by a toxic, inflammatory or anoxic insult or injury may result in permanent tissue damage but can improve over time. Secondary mitochondrial hepatopathy

○ ○ Aspirin ○ S/S: abrupt change in LOC, cerebral edema, liver (AST, ALT) and ammonia ○ ○ ○ ● Labs ○

levels are elevated, hypoglycemia Dx: liver dysfunction, CSF have WBC Vitamin K to help w coagulation Mannitol to decrease intracranial pressure

Creatinine (best measure) ■ Should be less than 1 ■ Males - 0.6-1.2 mg/dL ■ Females- 0.5-1.1 mg/dL ■ Depends on age. ○ BUN ■ Dehydration can also altered BUN ■ Normal levels: 10-20 mg/dL ○ Potassium ■ Normal: 3.5-5.0 mEq/L ○ Sodium ■ 135-145 mEq/L ○ Calcium ■ 9.0-10.5 mg/dL ● Hemoglobin – ○ Males 14-18 g/dL ○ Females 12-16 g/dL ○ Anemia

○ Azotemia – high nitrogen ● Hematocrit ○ Males 42-52% ○ Females 37-47%...