NSG 101 Nursing Care Of A Family When A Child Has A Renal Or Urinary Tract Disorder Study Guide 2021

NSG 101 Nursing Care Of A Family When A Child Has A Renal Or Urinary Tract Disorder Study Guide 2021 NURSING CARE OF A FAMILY WHEN A CHILD HAS A RENAL OR URINARY TRACT DISORDER Nephron • A nephron, the functioning unit of thekidney, consists of a glomerulus (a filtrating unit) and a complex set of tubules with accompanying blood supply Urine • The amount of urine excreted in a24-hour period depends on fluid intake, kidney health, and age. • OLIGURIA - significant decrease inurine production • ANURIA absence of urineproduction. • CRETININE is a product released during muscle cell metabolism. The amount excreted in urine normally remains constant, regardless of the amount of protein in the diet or body processes. When it is less in amount,therefore, it means that kidneys are not functioning as well as usual. - - - - Laboratory/Diagnostic TestsUrinalysis o One of the most revealing tests ofkidney function is also one of the simplest. Creatinine Clearance Rate o Glomerular filtration rate is the rate at which substances are filtered fromthe blood to the urine. o 24 hours as determined by a 24-hour urine sample. o normal creatinine clearance rate is100 mL/min. o A normal urine creatinine level is 0.7to 1.5 mg/100 mL; creatinine in blood serum rarely exceeds 1 mg/Dl Urine Culture o A urinary tract infection (UTI), thepresence of bacteria in urine, is diagnosed by a urine culture. Radioisotope Scanning o The administration of radioisotopes (a technetium scan) is a second wayto assess glomeruli filtration ability. o Radioactively tagged substances aregiven intravenously (IV); the rate at which these substances can be observed flowing through the kidney and excreted in urine is then determined. Ultrasonography and MagneticResonance Imaging o can detect differing sizes of kidneysor ureters and can differentiate between solid or cystic kidney masses. X-Ray Studies o A plain flat-plate abdominal xray film can provide information about the size and contour of the kidneys. This radiograph may be referred to as a KUB (kidney, ureters, and bladder). Computed Tomography o Computed tomography (CT) scans of the kidneys are used to show the size and density of kidney structuresand adequacy of urine flow. o PREPARATION:NSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS A RENAL OR URINARY TRACT DISORDER STUDY GUIDE 2021 - Conscious sedation may begiven before a CT - Contrast medium may be injected before the procedure to better outline urine flow. If this medium is iodine based, be certain to ask about allergy to iodine Intravenous Pyelogram o An intravenous pyelogram (IVP) is an x-ray study of the upper urinary tract. o It used to be a mainstay of diagnosisfor kidney disorders but now is used less frequently because ultrasounds, MRIs, or CT scans reveal so much information. o PREPARATION - a radiopaque dye is injected intoa peripheral vein, circulates through the bloodstream, and is almost immediately identified asa foreign substance by the kidney and filtered out into the urine by the glomeruli. - Explain the procedure as relatedas possible - Mention medicine instead of dyeto avoid misinterpretation. - When explaining the test, compare the x-ray machine to acamera - Caution children that they may experience flushing of the face, warmth, and a salty taste in theirmouth after the injection of medicine. - Ask the parents if the child has aknown allergy to iodine. Voiding Cystourethrogram o A voiding cystourethrogram (VCUG),a study of the lower urinary tract, reveals the structure of the urethra and bladder and the presence of reflux into the ureters. o PREPARATION: - Bladder catheterization is done and a radiopaque dye is injected. - Explain the procedure to the child and parents prior to the procedure that the child will beasked ro void into the bedpan while on the x-ray table.NSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS A RENAL OR URINARY TRACT DISORDER STUDY GUIDE 2021 - Caution the child that first urination after catheterization willbe painful. - Prepare warm water for perinealflushing to alleviate pain in urination. - A VCUG should not be done if achild has an active UTI because there is danger that the radiopaque material injected intothe bladder could spread, carrying bacteria from the infection into the ureters and kidneys. - Report any symptoms of UTI - A clean-catch urine specimen forculture may be ordered before the VCUG to rule out infection. Blood Studies o A blood urea nitrogen (BUN) test measures the level of urea in blood and is used to assess glomerular function, or how well the kidneys canclear this from the bloodstream. Cystoscopy o Cystoscopy, examination of the bladder and ureter openings by direct examination with a cystoscopeintroduced through the urethra, is done to evaluate for possible vesicoureteral reflux or urethral stenosis. o PREPARATION: - Radiopaque dye may be introduced into the bladder at thetime of cystoscopy so the bladder can be visualized on radiography (cystography). - Small catheters also can be threaded into the ureters for theintroduction of dye to outline them (retrograde pyelography). - Urge children to drink plenty of fluids so they urinate frequentlyto flush out any pathogens introduced at the time of the procedure. Renal Biopsy o Renal biopsy involves passing a thinbiopsy needle into the kidney through the skin over the kidney. o PREPARATION: - The kidney is located first by ultrasound to accurately locateNSG 101 NURSING CARE OF A FAMILY WHEN A CHILD HAS A RENAL OR URINARY TRACT DISORDER STUDY GUIDE 2021 the place of the biopsy. The childlies prone with a sandbag under the abdomen for firmness. - prepare children for the feel of a pinprick as the local anesthetic is injected; after this, they should not feel any further pain. What they will feel is pressure as the biopsy needle is inserted. Caution children that they need to lie still while the biopsy specimen is taken. - After the biopsy, press a sterile gauze square against the biopsy site for approximately 15 minutesto halt bleeding, and then apply apressure dressing. - Children can be discharged 2 to4 hours after the procedure if vital signs are stable and they have voided. o PREPARATION FOR RENAL BIOPSY - Measure vital signs and observe the biopsy site every 15 minutes for at least the first hour. - Do not lift the dressing to assess bleeding, because doing so destroys the protective- - - - -