Comprehensive Nursing care to the children with the various diseases and disorders (RENAL SYSTEM)
Nephrotic syndrome is a combination of two words.
Nephron Meaning Basic Structure of Kidney.
Syndrome meaning group of symptoms.
Nephrotic syndrome in children is a kidney disorder in which protein is excreted from the body through urine, mainly albumin, due to damage to the glomeruli, which are the filtering units of the kidney, or due to increased permeability of the glomeruli.
Due to the excretion of protein from the body through this urine, the amount of protein in the blood decreases, due to which the condition of edema occurs in the heel (swelling) particularly around the ice, ankle and abdomen. Due to which the lipid and cholesterol levels in the blood also increase.
Nephrotic symptoms are a collection of symptoms that occur primarily due to damage to the glomeruli in the kidney.
Four symptoms are mainly seen in nephrotic syndrome.
1) Body excretion of high levels of protein in urine (proteinuria).
2) Decreasing amount of protein in blood. (Hypoalbuminemia).
3) Increased amount of lipids in the blood (hyperlipidemia).
4) Swelling in body part (in heels).
These four main symptoms are seen in nephrotic syndrome.
Nephrotic syndrome affects people of all ages.
In children, it is mainly seen in children of 1 to 7 years.
Explain the etiology/cause of the nephrotic syndrome.
(State the cause of nephrotic syndrome.)
Due to glomerular disease,
Due to a hereditary condition,
Certain diseases such as collagen vascular disorder, due to damage to the small blood vessels of the kidney,
It is mainly seen in children due to certain disease conditions
Due to abnormal kidney function,
Due to diabetic kidney disease,
Due to certain types of infection,
Due to medication,
Focal Segmental Glomerulo Sclerosis (FSGS),
Scattered scarring of glomeruli,
Membranous nephropathy,
Due to heart failure, due to certain types of diseases like Hepatitis B, Hepatitis C, Malaria etc.
Explain the clinical manifestation / sign and symptoms of the child with the nephrotic syndrome. (State the signs and symptoms of a child with nephrotic syndrome.)
Swelling.
Weight gain in the child.
Swelling is mainly seen on the lining of the eye socket and around the eye (in the periorbital AD).
Swelling is mainly seen in feet and ankles due to prolonged sitting or standing.
The face is puffy.
Proteinuria.
Hypoalbuminemia.
Hypercholesterolemia.
Diarrhea.
Vomiting.
Anorexia.
Liver enlargement.
Blood pressure increases.
Anemia.
Infection of respiratory tract, peritoneum and skin.
Skin is pale.
Skeletal muscle wasting.
Sometimes swelling is also seen in the wall body which is called Anasarka.
ascites,
pitting edema,
Oliguria (decrease in urine output).
Weight gain.
Hematuria (blood in urine)
Respiratory distress.
Blood pressure increases.
Kidney failure.
Cholesterol level increases in the body.
feeling tired
Accumulation in the body
Getting infected immediately.
Loss of appetite.
feeling tired
Explain the diagnostic evaluation of the child with the nephrotic syndrome.
History taking and physical examination.
Urine test.
Blood test.
Kidney biopsy.
Blood pressure monitoring. Blood chemistry.
Imaging studies.
Ultrasound.
C-T scan.
Erythrocyte sedimentation rate (ESR).
Serum cholesterol level.
Explain the medical management of the child with the nephrotic syndrome.
(State the medical management of a child with nephrotic syndrome.)
Providing the child with corticosteroid medication to treat inflammatory conditions.
Ex:= Presnisolone
2 mg/ kg/ day in divided dose throwout 24 hrs
Providing immunosuppressive medicine to the child.
Ex:= Levamisole,
Methotrexate,
Cyclophosphamide,
Cyclosporine,
Chlorambucil.
If the child has any infectious condition, provide proper antibiotic medication.
Provide the child with diuretic medicine to treat the condition of edema.
Ex:= Frusemide 1 to 3 mg/ kg/ day in 2 divided doses with Spironolactone 2 to 3 mg/ kg/ day in 2 divided doses.
Also provide potassium supplementation along with diuretic medicine.
If the child has a condition of AD and ascites, give albumin infusion (1g/kg/day) due to which the fluid can shift from the interstitial space to the intravascular system.
Provide antihypertensive medicine to the child.
Providing medicine of statin group to decrease the cholesterol level of the child.
Advise the child to restrict salt.
Advise the child to reduce fluid intake.
Provide anticoagulant medicine to the child.
Advise the parents to provide the child with a well-balanced diet such as a protein-rich and sodium-restricted diet.
Providing renal transplantation if the child has end-stage renal failure.
Explain the nursing management of child with nephrotic syndrome.
(State the nursing management of a child with nephrotic syndrome.)
Proper assessment of the child.
To monitor the child’s vital signs.
Monitoring the child’s fluid balance.
Monitor the child’s weight regularly.
Monitoring child’s intake output chart.
Elevate the extremities if the child has a condition of edema.
If the child has a condition of edema, then diuretic medicine and fluid level monitoring.
Continuous maintenance of nutritional status of child.
Advise the child to avoid protein, salt.
Provide proper medication to the child.
To provide complete information to the child’s parents about the disease condition, its causes, symptoms and signs and diagnostic evaluation.
Advise the child’s parents to maintain personal hygiene to prevent infection.
Providing emotional support to the child’s parents.
To maintain a proper interpersonal relationship (IPR) with the child’s parents.
To provide complete education to the child’s family members.
To clear all the doubts of the child and his family members.
Encouraging the child to participate in different play activities.
To monitor the child’s vital signs frequently.
Providing properly prescribed medication to the child.
Continuous monitoring of the amount of fluid intake by the child or the amount of intravenous fluid provided to the child.
Providing a nutritious diet to the child.
Advise the child to take small frequent feedings.
Provide education to parents to provide sodium restricted diet to child.
Provide supplementary vitamins and iron to the child properly.
Giving advice to the child’s parents or taking regular follow up.
In acute glomerulonephritis infection and inflammation of the glomerular capillaries in the kidney is called glomerulonephritis.
Acute glomerulonephritis is mainly caused by streptococcal bacteria.
The most common symptoms of acute glomerulonephritis include swelling, increased blood pressure, and changes in urine output.
Glomerulai:=
Glomeruli are tiny ball-shaped structures located in the kidney that primarily play an important role in the filtration of blood and are responsible for the formation of urine. There are thousands of filtration units in a kidney. Capillaries are located in them and they are surrounded by membranes. Their main work is to filter waste products, excess water and electrolytes.
Glomerulonephritis :=
Infection and inflammation of the glomerular and its capillaries is known as glomerulonephritis.
Explain the Etiology/ causes of the glomerulonephritis.
Due to streptococcal infection.
Due to taking heavy doses of nonsteroidal anti-inflammatory drugs.
Due to bacterial, viral and parasitic infections.
Caused by group A beta streptococcus hemolyticus.
Having a history of upper respiratory tract infection.
Explain the clinical manifestation of the child with the acute glomerulonephritis.
Hematuria (blood in urine).
In AD. Proteinuria (increased level of protein in urine).
fever,
feeling cold,
weakness,
loss of appetite,
feel tired,
nozia,
vomiting,
Generalized, facial and periorbital swelling,
weight gain,
headache,
Hypertension,
fluid overload,
Abdominal pain,
palness,
Explain the diagnostic evaluation of the children with the acute glomerulonephritis.
history taking and physical examination.
Urine analysis.
Complete blood count test.
Swab culture.
Throat swab culture.
Chest X Ray
Electrocardiogram.
Anti-streptolysin O titer test.
Blood examination to assess blood urea nitrogen levels.
Erythrocyte Sedimentation Rate Test.
Kidney scan.
Explain the management of the children with the acute glomerulonephritis.
Medical management
Providing antihypertensive medicine to the child.
Ex:= Nifedipine, Atenolol.
Provide antibiotic medicine to the child.
Ex:= Cephalaxin 50 mg/ kg up to 10 days.
Providing corticosteroid medicine to the child.
Give diuretic medicine to the child.
Ex := Frisemide 1-2 mg/day.
Advise parents for peritoneal dialysis if child has high blood urea nitrogen level.
Providing an immunosuppressive agent to the child.
Advise the child to take complete rest.
Maintaining child’s fluid volume and recording daily weight.
Continuous monitoring of the child.
Properly administering medicine to the child.
To record vital sign of child regularly.
Explain the Nursing management of Children with the Acute glomerulonephritis.
Advise child to take salt and fluid restriction diet.
Ask the child to avoid fluid intake in excessive amounts.
To monitor the child’s vital signs.
Monitoring child intake output chart.
Advise the child to take proper rest.
Monitor child’s blood urea nitrogen, creatinine and blood pressure.
Properly monitor the child’s fluid balance.
Advise the child to take antihypertensive and diuretic medicine properly.
Advise child to avoid high protein diet.
Advise the child to take adequate amount of carbohydrates.
Advise the child to restrict potassium and sodium intake.
To fully monitor the child’s fluid balance care.
Monitoring the child for any signs and symptoms of heart failure.
If the child has any kind of infection, treat it immediately.
Monitoring the child’s weight daily.
Advising parents of child to take regular follow up.
Renal failure is also known as kidney failure.
Renal failure is a condition in which the kidneys lose their ability to filter and remove waste products from the body.
Due to this condition, toxic materials accumulate in the body and electrolyte imbalance occurs in the body.
Renal failure is a condition in which adequate kidney function fails.
There are two types of renal failure.
Acute renal failure is also known as acute kidney injury (AKI). In which kidney function declines suddenly and rapidly. Acute kidney failure is a condition in which the functional ability of the kidney is suddenly impaired.
Due to which kidney cannot perform proper filtration and urine output also decreases (less than 1ml/ kg/ hr) and cannot maintain electrolyte balance and fluid balance in the body. Acute kidney failure occurs within 7 to 90 days. In acute kidney failure, mainly the glomerular filtration rate decreases, the concentration of blood urea nitrogen increases, the amount of creatinine increases, the urine output decreases to less than 400ml throughout the day, the condition of hyperkalemia arises and retention of sodium in the body is observed.
Explain the Etiology/cause of the Acute Renal failure.
1) pre renal cause
Due to impaired blood supply to kidney.
Due to dehydration.
Diarrhea.
Vomiting.
Hemorrhage.
Burn.
Due to excessive use of diuretic medicine.
Due to decreased cardiac output.
due to congestive heart failure.
Due to cardiogenic shock.
due to acute pulmonary embolism.
Due to constriction of the blood vessels supplying blood to the kidney.
Due to dilation of the blood vessels supplying blood to the kidney.
2) Intrarenal
Intrarenal failure is mainly due to structural damage in glomeruli, kidney tubules, nephrons.
due to prolonged renal ischemia.
Blood clots, due to deposits of cholesterol around the veins and arteries.
Due to infection.
Due to hemolytic uremic syndrome.
Due to severe transfusion reaction.
Due to exposure to any nephrotoxic agent.
Like:=
NSAID Drug,
ACE inhibitors,
aminoglycoside lupus,
multiple myeloma,
3) Postrenal
Due to obstructed urine flow.
Due to enlargement of the prostate gland.
Being a kidney stone.
Being a cancer of the urinary tract organ.
Due to certain types of medication.
Being a bladder stone.
Due to enlargement of prostate gland.
Being bladder cancer.
Due to the occurrence of neurological disorders.
Explain the clinical manifestation / sign and symptoms of the children with the acute renal failure. (State the symptoms and signs of a child with acute renal failure).
Oligouria (decreased urine output),
Anuria (no urine output),
Fluid retention occurs.
To be in ED.
Electrolyte imbalance.
Muscle weakness.
Uremic symptoms.
Hyper tension.
Bruising and bleeding.
Respiratory distress.
Neurological symptoms.
Cardiovascular complications.
The child appears critically ill and lethargic.
Passing dark colored urine.
Dry skin and mucus membrane.
Azotimia.
Rapid heart rate.
Flank pain.
Shortness of breath.
Metabolic acidosis occurs.
Anemia and platelet dysfunction.
Increased susceptibility to secondary infections.
Generalize Malay.
feeling tired
Cardiac problem.
Increased susceptibility to secondary infections.
Fluid and electrolyte imbalance.
Fluid overload.
Hyperkalemia, hyponatremia, hypocalcemia, hypermanegnesemia.
Loss of appetite.
Nozia.
Vomiting.
Diarrhea.
Dryness of mucus membrane.
Metallic test coming from the mouth.
Abdominal pain.
headache.
Insomnia.
Irritability.
Confusion.
Peripheral neuropathy.
to be startled
Coma.
Explain the diagnostic evaluation of the child with acute renal failure.
(Write the diagnostic evaluation of a child with acute renal failure.)
history taking and physical examination.
Blood test.
Potassium test.
Electrolyte test.
Urine test.
ECG.
Kidney biopsy.
Imaging test.
Kidney biopsy.
Explain the medical management of the children with renal failure. (State the medical management of a child with renal failure).
Identify child-specific causes of renal failure.
Assessing whether the child has a urinary tract infection or not.
Assessing the child’s fluid level.
Provide proper diuretic medicine to the child.
Monitor child’s electrolyte levels.
Dialysis if child has severe renal failure.
Providing proper medicine to the child.
Providing nutritional support to the child.
Provide antihypertensive medicine to the child.
Provide medication to child to control anemia.
Continuously monitor the child’s renal function.
Continuously monitor child’s electrolyte levels.
Advising the child on life style modification.
Explain the nursing management of children with acute renal failure.
(State the nursing management of a child with acute renal failure).
To properly assess the child.
To properly monitor the child’s vital signs.
Properly monitor the child’s fluid level.
Properly monitoring the child’s intake output chart.
Monitor the child’s blood urea nitrogen level.
Assess the child for any signs and symptoms of fluid overload.
Collaborate with other health care members for the care of the child.
Monitor child’s electrolyte levels.
Provide proper medication to the child.
Provide antihypertensive medicine to the child.
Providing proper nutritional support to the child.
Advise the child on fluid restriction.
Providing proper dialysis care to the child.
Provide proper skin care to the child.
Child’s skin integrity properly
to monitor.
Advise child to take low sodium, low potassium, low phosphate diet.
Providing psychological support to the child.
Advising the child to maintain proper hygienic condition.
Monitoring child’s intake output chart.
Monitor child’s weight daily.
Properly monitor child’s blood pressure.
Monitor the child’s blood urea nitrogen level, creatinine and electrolyte levels.
Monitoring the nutritional status of the child.
High calorie for child,
Provide low protein, low sodium, low potassium diet and vitamin supplementation.
Provide food to the child in small and frequent amounts.
Maintain streak aseptic technique in child care.
Providing proper mouth care to the child.
Properly monitor the child’s heart activity.
Advise the child’s parents to provide proper medication to the child.
Advising the child’s parents to follow up regularly.
Explain/ define the chronic renal failure (CRF).
Chronic renal failure is also known as chronic kidney disease (CKD).
In chronic kidney failure there is a slow and progressive deterioration of kidney function leading to electrolyte imbalance and fluid imbalance leading to conditions like uremia and azotemia over a period of months and years.
Chronic renal failure results in slow, insidious, and irreversible impairment of renal excretory and regulatory function.
The final stage of chronic kidney disease is called end-stage renal disease (ESRD).
Chronic kidney disease is a condition in which the kidneys gradually become unable to filter the waste products and fluids in the body, thus toxin substances accumulate in the body.
This condition is mainly due to different causes like diabetes, hypertension, glomerulonephritis, polycystic kidney disease etc.
Explain the Etiology/cause of the chronic renal failure.
Due to diabetes mellitus.
Due to hyper tension.
Having a family history of kidney disease.
due to frequent episodes of acute renal failure.
Long-term infections such as chronic pyelonephritis
Due to infections like nephritis and tuberculosis.
Due to an autoimmune disorder.
Due to polycystic kidney disease.
due to nephrotoxic agents.
Due to certain chemicals.
Due to reflux nephropathy.
Due to any injury or trauma.
Due to kidney stone and infection.
Due to glomerulonephritis.
Being bilateral calculi.
Due to bi lateral pelvic ureteric junction obstruction.
Due to congenital anomalies.
Explain the clinical manifestation / sign and symptoms of the children with the chronic kidney disease. (State the symptoms and signs of chronic kidney disease).
feeling tired
Weakness.
Fluid retention.
Being in ED.
Changes in urination.
Urinary frequency increases.
Hypertension.
Electrolyte imbalance.
Anemia.
Bone pain.
Mineral imbalance.
Itching.
Difficulty breathing.
From Europe.
Numbness.
Tingling sensation.
Weakness.
Nozia.
Vomiting.
Loss of appetite.
Thrust increases
Weight loss.
Cognitive impairment.
Personality changes.
Confusion.
Inability to concentrate.
Disorientation.
A flapping hand.
Restlessness.
Burning sensation in feet.
Chest pain.
Hyper lipidemia.
Hyperkalemia.
Hypertension.
Progressive anemia.
Acidotic breathing.
Purpura.
Peripheral neuropathy.
Cardiomyopathy.
Pericarditis.
Impaired immune function.
Explain the diagnostic evaluation of the child with chronic kidney disease. (State the diagnostic evaluation of a child with chronic kidney disease).
history taking and physical examination.
Blood test.
Serum creatinine test.
Blood urea nitrogen test.
Urine test.
Albumin to creatinine ratio.
An imaging study.
Ultrasound.
X-ray of chest, spine and extremities,
ct scan.
MRI.
Kidney biopsy.
Glomerular filtration rate.
Assess the electrolyte level.
Assay the hemoglobin level.
Assess the hematocrit level.
Blood pressure monitoring.
Explain the medical management of the children with chronic kidney disease.
(State the medical management of a child with chronic kidney disease.)
If the child has a condition of high blood pressure, provide anti-hypertensive medicine.
If the child has a condition of diabetes, provide antidiabetic medicine.
Providing medicine of statin group to reduce the child’s blood cholesterol.
For treatment of anemia, provide iron and folic acid supplements to the child and treat with packed cell transfusion.
If the child has a condition of hyperphosphatemia, provide phosphate binder medicine.
Provide calcium and vitamin D supplements to the child.
Provide diuretic medication to prevent child from fluid retention.
Providing properly nutritious food to the child including adequate protein at list 1.5 gm/ kg/ day involves eggs, milk, meat, and fish etc.
Advise the child for adequate calorie intake.
Monitoring the child properly.
Giving advice to the child to make his life style modification.
Child No Adequate Weight Maintain
Advising his parents to do so.
To provide proper care to the child so that no other complications occur.
Advise the child to have adequate water intake to prevent dehydration.
If the child has a condition of acidosis, provide sodium bicarbonate tablets to treat the condition of acidosis.
If the child has any infectious condition, provide proper antibiotic medication.
If the child is itching, provide antihistamine medication to relieve it.
Explain the nursing management of child with chronic kidney disease. (State nursing management of child with chronic kidney disease).
Proper assessment of the child.
To properly monitor the child’s vital signs.
Properly monitor the child’s fluid level.
Assess the child for any other complications.
Providing prescribed medicine to the child.
Monitor the child’s fluid and electrolyte levels.
Advising parents to maintain proper nutritional status of child
Properly monitor the child’s hemoglobin level.
Properly monitor child’s blood pressure.
Assess the child for any other signing symptoms.
To provide proper psychological support to the parents of the child.
Advising the child on lifestyle modification to prevent other complications.
Collaborate with other health care personnel for proper care of the child.
To provide proper psychological support to the child and his family members.
To provide complete information to the child about his disease, its causes, its symptoms and signs, and its treatment.
Advising the child’s parents to provide regular medication.
Advising parents of child to take regular follow up.