NCMA 219 FINALS

• Dehydration


  Excessive loss of water from the body tissues, common in infants and children when fluid output surpasses intake
• Causes of dehydration

  • Fever
  • Hyperventilation
  • Vomiting
  • Diarrhea
  • Decreased fluid intake
  • Diabetic ketoacidosis (DKA)
  • Burns
• Mild dehydration


  (Infants: <5%, Older children: <3% of body weight lost)
• Moderate dehydration


  (Infants: 5-10%, Older children: 3-6% of body weight lost)
• Severe dehydration


  (Infants: >10%, Older children: >6% of body weight lost)
• Signs and symptoms of dehydration


  • Increased heart rate
  • Dry skin
  • Sunken eyes
  • Decreased skin elasticity
  • Altered consciousness
  • Prolonged capillary refill
• Diagnostic tests for dehydration

  • Urinalysis
  • CBC
  • Electrolyte studies
  • ABG
  • Specific blood tests
• Management of dehydration


  1. Restoring and maintaining hydration through weight monitoring

  2. Accurate fluid intake and output measurement

  3. IV fluids

  4. Oral rehydration therapy

  5. Medications like ondansetron and zinc supplements
• Gradual reintroduction to a regular diet is recommended after hydration is stabilized
• Vomiting


  Forceful expulsion of gastric contents, often accompanied by nausea and retching, controlled by the central nervous system
• Bilious vomiting


  Vomiting containing bile
• Non-bilious vomiting


  Vomiting not containing bile
• Vomiting is usually self-limiting, requiring no specific treatment
• Causes of vomiting


  • Infectious diseases
  • Increased intracranial pressure
  • Toxic ingestions
  • Food intolerances
  • Allergies
  • GI tract obstruction
  • Metabolic disorders
  • Psychogenic issues
• Complications of vomiting


  • Dehydration
  • Electrolyte imbalance
  • Malnutrition
  • Aspiration
  • Mallory-Weiss syndrome
• Treatment of vomiting


  1. Identifying the cause

  2. Managing symptoms with fluids and antiemetic drugs
• Nursing interventions for vomiting

  • Determining the cause
  • Monitoring thirst for fluid needs
  • Providing carbohydrates to spare protein and prevent ketosis
  • Promoting small, frequent feedings
  • Positioning to prevent aspiration
  • Brushing teeth or rinsing mouth after vomiting to dilute stomach acid
• Diarrhea


  Stemming from disorders in digestive, absorptive, and secretory functions, arises due to abnormal intestinal water and electrolyte transport
• Mild diarrhea


  Based on stool consistency and associated symptoms
• Moderate diarrhea


  Based on stool consistency and associated symptoms
• Severe diarrhea


  Based on stool consistency and associated symptoms
• Assessment and diagnostic studies for diarrhea

  • History-taking
  • Physical examination
  • Stool analysis
  • Serum electrolyte tests
  • Urinalysis
  • ABG
• Nursing management of diarrhea

  1. Maintaining adequate hydration through oral rehydration therapy or IV fluids

  2. Monitoring intake and output along with weight

  3. Ensuring proper nutrition, especially through breastfeeding for infants and early nutrient reintroduction

  4. Preventing infection through enteric precautions and handwashing

  5. Promoting skin care by exposing diaper area to air, frequent changes, and keeping the area clean and dry
• Nephrotic syndrome


  A condition characterized by increased glomerular permeability, allowing larger molecules to pass into the urine, leading to proteinuria, hyperproteinemia, edema, and hyperlipidemia
• Nephrotic syndrome is more prevalent in boys than girls (2:1)
• Most common cause of nephrotic syndrome in children (85%)

  Minimal change disease
• Other causes of nephrotic syndrome

  • Mesangial proliferation
  • Focal sclerosis
• The pathophysiology of nephrotic syndrome involves the loss of negatively charged glycoproteins in the capillary walls, increasing basement membrane permeability
• Key features of nephrotic syndrome

  • Massive proteinuria (>3.5g/24hrs)
  • Hypoalbuminemia (<3g/dl)
  • Edema
  • Hyperlipidemia
  • Lipiduria
  • Increased coagulation
  • Renal insufficiency
  • Hyponatremia
  • Orbital edema
  • Thromboembolism
  • Increased infection risk due to the loss of immunoglobulins and antithrombin III in urine
• Diagnostic findings of nephrotic syndrome

  • Significant proteinuria (3+ to 4+)
  • Low serum albumin (<2.5gm/dl)
  • Elevated serum cholesterol and triglycerides
  • Renal function anomalies such as a spot UPC ratio >2.0 or UPE >40 mg/m2/hr
• Treatment of nephrotic syndrome

  1. Steroids for immunologic causes

  2. ACE inhibitors to decrease proteinuria

  3. Cholesterol-lowering drugs

  4. Heparin

  5. Dietary adjustments depending on GFR status

  6. Mild diuretics

  7. Sodium restriction for edema and hypertension
• Therapeutic management of nephrotic syndrome

  1. Salt restriction

  2. Steroid therapy

  3. Diuretics
• Nursing care for nephrotic syndrome

  • Monitoring intake and output
  • Managing signs of low plasma volume
  • Educating patients on medications like steroids or cyclosporine
  • Advising on a high-protein diet with restricted cholesterol and fat intake
• Early stage management of nephrotic syndrome resembles that of acute glomerulonephritis, while advanced stages are managed similarly to chronic renal failure
• Acute glomerulonephritis (AGN)


  A kidney condition involving damage and inflammation of the glomeruli, most frequently affecting children (especially boys aged 6-7) and young adults
• AGN typically occurs 2-3 weeks after an upper respiratory infection with group A β-hemolytic streptococci, presenting suddenly and predominantly affecting children aged 2-12
• Most patients with AGN recover spontaneously or with minimal therapy without long-term consequences
• Pathophysiology of AGN


  Deposition of antigen-antibody complexes in the glomerulus following infection, leading to increased epithelial cell production, leukocyte infiltration, thickening, scarring, and reduced glomerular filtration rate (GFR)
• Causes of AGN


  • Streptococcal throat infections
  • Impetigo
  • Viral infections (mumps, hepatitis B, HIV)
  • Lupus
  • Diabetes
  • High blood pressure
  • Endocarditis
• Assessment findings in AGN

  • Convulsions
  • Congestive heart failure (CHF)
  • Oliguria
  • Anuria