the nurse is assigned to care for a 6 year old child with chronic kidney failure

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Situation

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1. What are some of the major causes of CRF the nurse could identify in the children?

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Major Causes:

Developmental abnormalities of the kidney, with malformation of the urinary tract Glomerular disease Congenital structural abnormalities of the urinary tract, including blockage of the kidneys at various levels Metabolic abnormalities Inherited diseases
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2. What are the main goals of nursing care of this client with CRF?

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Main goals in clients with CRF:

Promote maximal renal function To maintain body fluid and electrolyte balance within safe biochemical limits To treat systemic complications To promote as active and normal a life as possible for a child for as long as possible Child will remain encouragement in his 3/8/13 or her normal growth and development,

3. What types of assessments will the nurse need to identify for this child with CRF?

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Assessment

First changes observed: growth failure, developmental delay, bone disease and hypertension.

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Health history elicit description of the full illness and complaint. Common signs and symptoms reported during the health history might include: headache, muscle cramps, nausea Obtain a detailed prenatal and antenatal history. Antenatal findings may include polyhydramnios, oligohydramnios , and abnormal antenatal ultrasound. Assess the childs current and past 3/8/13 medical history for risk factors

Physical examination and laboratory and diagnostic tests Early signs: loss of normal energy, increased fatigue on exertion, pallor, subtle (may not be noticed), elevated blood pressure (sometimes) As the disease progress: decreased appetite (especially at breakfast), less interest in normal activities, increased or decreased urine output with 3/8/13 compensatory intake of fluid, pallor more

other signs and symptoms: weight loss, facial edema, malaise, bone or joint pain, growth retardation, dryness or itching of skin, bruised skin, sensory or motor loss (sometimes), amenorrhea (common in adolescent girl) uremic syndrome (untreated): GI symptoms, anorexia, N&V, bleeding tendencies, bruises, bloody diarrheal stools, stomatitis, bleeding form lips and mouth, intractable itching, uremic frost (deposits of urea crystals on skin), unpleasant uremic breath odor, deep respirations, HPN, CHF, pulmonary edema, neurologic involvement (progressive confusion, dulled sensorium, coma, 3/8/13 tremors, muscular twitching, seizures

4. What nurse caring for the child with CRF should be using careful assessment for signs of infection. What symptoms of infection would the nurse assess for in this child?
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Children with CRF seem to be more susceptible to infection, especially pneumonia, urinary tract infection, and septicaemia, although reason for this is unclear. These children become extraordinary sensitive to changes in vascular volume that may cause pulmonary overload, central nervous system symptoms, hypertension and cardiac failure.
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Symptoms of infection

Changes in respiratory pattern Productive cough with yellow or other abnormal color Adventitious sounds Elevated temperature Cloudy, foul smelling urine Dysuria Urgency Frequency
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5. What are some of the major stressors should discuss with the family of this child?

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Because either CRF or ESRD is a chronic, lifelong problem, the family will have many learning needs, especially related to the need for meticulous follow up care. They need to understand the etiology of the problem and the course of treatment They will need to be taught about dietary restrictions, use and side effects of medications, signs of further 3/8/13 deterioration of the renal function, and

The side effects from steroids and immunosuppressive therapies include a depressed immune system so the child is more vulnerable to infection, growth retardation, and bone demineralization There is a greater risk for fractures Some children ill feel hyperactive with high doses of steroids. If they take the steroids for a long time, they may develop a moon face, fat deposits along 3/8/13 the shoulders, and generally gain

If the child is on diuretics, the individual may lose potassium and feel weak or faint or experience heart palpitations. The family need to know that these side effects are possible but do not always occur. They may also benefit from financial counseling, as these are costly problems and are not always covered by health insurance policies or manage care contracts. 3/8/13

They need to understand the impact that a chronic illness has on themselves and their child They should be encourage to take advantage of psychological counseling or participate in a support group. For the family whose child has undergone a transplant, additional teaching is needed. The family should be taught signs of rejection and kidney 3/8/13 infection. They must also understand the

Families also need to know that generally childhood immunizations should be given , and that there is no adverse effect on the kidney. The rationale is that while these children may be immunosuppressed, their immune system still can respond to the vaccines in the immunizations.

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Signs of rejection Laboratory signs of rejection weight gain, and Increasing BUN hypertension and creatinine

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In addition, the nurse is responsible for teaching the family about:

Disease, its implications, and the therapeutic plan The possible psychologic effects of the disease and the treatment Technical aspects of the procedure Body changes such as skin color, growth retardation, and lack of sexual 3/8/13 maturation.

Allowing children, especially adolescents , maximum participation in and responsibility for their own treatment
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