CMC MODULE 30

• Enuresis


  Involuntary passage of urine past the age when a child should be expected to have attained bladder control
• Types of enuresis


  • Nocturnal (occurs only at night)
  • Diurnal (occurs during the day)
  • Both
• Primary enuresis


  Bladder training was never achieved
• Acquired/secondary enuresis


  Control was established but has now been lost
• Assessment of enuresis

  1. History taking

  2. Assess for family stresses

  3. Assess timing of wetting (only when exceptionally tired/troubled, or when engrossed in activity)

  4. Assess for other symptoms (abdominal pain, burning, frequency) to check for UTI

  5. Assess for small bladder capacity
• Polycystic kidney


  Large, fluid-filled cysts have formed in place of normal kidney tissue
• Types of polycystic kidney

  • Autosomal recessive trait
  • Autosomal dominant trait
• Polycystic kidney


  • Kidneys grow large and feel soft and spongy
  • Newborn can have flattened nose or micrognathia (small jaw)
• Prune Belly Syndrome (PBS)


  Syndrome with a broad spectrum of severity, mainly affecting boys, with the most common abnormalities being cardiac, pulmonary, orthopedic, and urologic
• Prune Belly Syndrome


  • Bilateral undescended testes, dilated faulty development of the bladder and upper urinary tract, and renal dysplasia
  • Infant's abdomen appears wrinkled (like a prune) because of the poorly developed abdominal muscles
• Acute poststreptococcal glomerulonephritis


  Inflammation of the glomeruli of the kidney, usually occurring in children as an immune complex disease after infection with nephritogenic streptococci
• Chronic glomerulonephritis


  Follows acute glomerulonephritis or nephrotic syndrome, or occurs as a primary disease, resulting in diffuse or local nephron damage
• Systemic Lupus Erythematosus (SLE)

  Autoimmune disease where autoantibodies and antigens cause deposits of complement in the kidney glomerulus
• Nephrotic Syndrome (Nephrosis)


  Altered glomerular permeability due to autoimmune process or T lymphocyte dysfunction, resulting in abnormal loss of protein in urine
• Types of nephrotic syndrome

  • Congenital (autosomal recessive)
  • Secondary (progression of glomerulonephritis or systemic diseases)
  • Idiopathic (primary)
• Hemolytic-Uremic Syndrome


  Inflammation and occlusion of glomerular arterioles, leading to damaged red blood cells and platelets
• 90% of children with hemolytic-uremic syndrome have recently experienced an E. coli gastrointestinal infection
• A child has been seen by the school nurse for dizziness since the start of the school term. It happens when standing in line for recess and homeroom. The child now reports that she would rather sit and watch her friends play hopscotch because she cannot count out loud and jump at the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this history, the nurse suspects that she has

  A. Ventricular septal defect (VSD). B. Aortic stenosis (AS). C.Mitral valve prolapse.

  D. Tricuspid atresia.
• A heart transplant may be indicated for a child with severe heart failure and

  A. Patent ductus arteriosus (PDA). B. Ventricular septal defect (VSD). C.Hypoplastic left heart syndrome. D. Pulmonic stenosis (PS).
• A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as

  Patent ductus arteriosus (PDA). Ventricular septal defect (VSD). Hypoplastic left heart syndrome. Pulmonic stenosis (PS).
• A 3-month-old has been diagnosed with a ventricular septal defect (VSD). The flow of blood through the heart is

  Patent ductus arteriosus (PDA). Ventricular septal defect (VSD). Hypoplastic left heart syndrome. Pulmonic stenosis (PS).
• 5. A child born with Down syndrome should be evaluated for which associated cardiac manifestation?

  A. Congenital heart defect (CHD). B. Systemic hypertension. C.Hyperlipidemia. D. Cardiomyopathy.
• 6. A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. She is rubbing her eyes when she is looking at the lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory finding?

  A. Hypokalemia. B. Hypomagnesemia. C.Hypocalcemia. D. Hypophosphatemia.
• 7. A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF) is:

  A. Feeding formula that is supplemented with additional calories. B. Allowing the infant to nurse at each breast for 20 minutes. C.Providing large feedings every 5 hours.

  D. Using firm nipples with small openings to slow feedings.
• 8. During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. The nurse’s first action should be to:

  A. Lay the child flat to promote hemostasis. B. Lay the child flat with legs elevated to increase blood flow to the heart. C. Sit the child on the parent’s lap, with legs dangling, to promote venous pooling.

  D. Hold the child in knee-chest position to decrease venous blood return.
• During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which position?

  A. Sitting. B. Supine. C.Squatting. D. Standing.
• 10. For the child with hypoplastic left heart syndrome, which drug may be given to allow the patent ductus arteriosus (PDA) to remain open until surgery?

  A. Furosemide B. Apresoline C.Indomethacin D. Penicillin
• 1. To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?

  A. Abdominal Circumference B. Urine for protein C.Blood pressure D. Bowel sounds
• 2. You care for a 6-year-old boy with acute glomerulonephritis. When planning care for him, you should be aware that glomerulonephritis usually follows an infection of what organism?

  A. Group B Streptococci B. Staphylococcus viridans C.A Beta-hemolytic Streptococcus D. One of the rhinoviruses
• 3. A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include which of the following as a nursing diagnosis for this patient?

  A. Risk for infection B. Deficient fluid volume C. Constipation D. Overflow urinary incontinence
• Which patient below is NOT at risk for developing nephrotic syndrome?

  A. An 8 year old male with diabetes mellitus. B. A 5 year old female diagnosed with minimal change disease. C.A 10 year old male with Lupus. D. A 7 year old male recently diagnosed with Alport’s Syndrome.
• 5. You’re providing education to a group of nursing students about nephrotic syndrome. A student describes the signs and symptoms of this condition. Which signs and symptoms verbalized by the student require you to re-educate the student about this topic?

  A. Slight proteinuria B. Hypoalbuminemia C. Edema D. Hyperlipidemia
• 6. You’re providing care to a 6 year old male patient who is receiving treatment for nephrotic syndrome. Which assessment finding below requires you to notify the physician immediately?

  A. Frothy, dark urine B. Redden area on the patient’s left leg that is swollen and warm C. Elevated lipid level on morning labs D. Urine test results that shows proteinuria
• 7. As the nurse, you know that it is important to implement a low sodium diet for a patient with nephrotic syndrome. However, it is important to implement what other type of diet due to another complication associated with this syndrome?

  A. Low-phosphate B. Low-fat C. High-carbohydrate D. Low-potassium
• 8. A client has been admitted to the hospital with a diagnosis of acute glomerulonephritis. During history- taking the nurse first asks the client about a recent history of:

  A. bleeding ulcer B. deep vein thrombosis C. myocardial infarction D. streptococcal infection
• 9. A nurse is assigned to care for a patient with nephrotic syndrome. The nurse assesses which important parameter on a daily basis?

  A. weight B. albumin levels C. activity tolerance D. blood urea nitrogen (BUN) level
• 10. A child with minimal change nephrotic syndrome (MCNS) has generalized edema. The skin appears stretched, and areas of breakdown are noted over the bony prominences. The child has been receiving Lasix twice daily for several days. Which does the nurse expect to be included in the treatment plan to reduce edema?

  A. An increase in the amount and frequency of Lasix. B. Addition of a second diuretic, such as mannitol. C. Administration of intravenous albumin. D. Elimination of all fluids and sodium from the child’s diet.
• The treatment of enuresis can be complex because the cause is often unknown.

  • Help limit fluids during the 2 hours before bed.

  
  

  Bladder-stretching exercises-drinking a large quantity of water and then refraining from voiding as long as possible to increase the functional size of the bladder are contraindicated and can cause both dysfunctional voiding and renal damage.

  antidiuretic hormone (desmopressin [DDAVP]) administered orally is the drug of choice to reduce urinary output and nocturnal enuresis in cases of primary nocturnal enuresis