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
... [Show More] 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.
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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 [Show Less]