Nursing Care Needs for Childhood Conditions

High-Yield Examination Topics for Childhood Urinary Conditions

1. Urinary Tract Infection (UTI)

  • Causative Agent: Escherichia coli (E. coli) from the gut is the most common cause of UTI in children.

  • Diagnostic Gold Standard:

    • Urine Culture: Significant bacteriuria is defined as >100,000 CFU/mL (clean-catch) or >50,000 CFU/mL (catheterized).

    • Invasive Procedures: Suprapubic Aspiration (SPA) is the most sterile method for non-toilet-trained children.

  • Clinical Signs by Age:

    • Infants: Often present with nonspecific symptoms like poor feeding, jaundice, or irritability.

    • Children: Present with localized signs like dysuria, urgency, and suprapubic pain.

  • Prevention (Critical for Education):

    • Wipe from front to back (especially in females).

    • Avoid tight clothing and use cotton underwear.

    • Ensure frequent voiding and complete bladder emptying.

2. Acute Glomerulonephritis (AGN)

  • Etiology: Most commonly follows a Group A hemolytic streptococcal infection (Post-streptococcal glomerulonephritis).

  • Classic Presentation Triad:

    1. Hematuria: Often described as "tea-colored" or "smoky" urine with RBC casts.

    2. Edema: Primarily periorbital (around the eyes).

    3. Hypertension: Requires frequent monitoring (2-4 hourly) to prevent seizures.

  • Nursing Management: Maintain strict intake-output (I/O) records, daily weights, and sodium-restricted diets.

3. Nephrotic Syndrome

  • Defining Characteristics:

    • Massive Proteinuria (>3 to 3.5 g/day).

    • Hypoalbuminemia (low serum protein).

    • Generalized Edema and Hyperlipidemia.

  • Primary Treatment: Corticosteroids (e.g., Prednisone) are the first-line therapy to reduce glomerular permeability.

  • Fluid Assessment: Daily weight at the same time and on the same scale is the most accurate indicator of fluid status.

4. Nephroblastoma (Wilm’s Tumor)

  • Epidemiology: Most common renal cancer in children, typically aged 2-5 years.

  • Key Finding: A firm, non-tender abdominal mass or swelling.

  • Staging and Treatment:

    • Multimodal Approach: Involves surgical nephrectomy, chemotherapy, and sometimes radiation.

    • Staging: Ranges from Stage 1 (localized/fully removable) to Stage 5 (bilateral involvement).

  • Safety Note: During assessment, excessive palpation of the abdominal mass should be avoided to prevent tumor rupture or seeding (metabolization).