Pediatric Nursing Exam 3 Study Guide PDF

EXAM 3 TOPIC Guide Pediatric Nursing PPT: no questions specifically from a slide, but ALL concepts can be integrated into questions such as atraumatic care, etc. growth and development school-age (6-12 years old) ○ erikson: industry ca i inferiority...

EXAM 3 TOPIC Guide Pediatric Nursing PPT: no questions specifically from a slide, but ALL concepts can be integrated into questions such as atraumatic care, etc. growth and development school-age (6-12 years old) ○ erikson: industry ca i inferiority > - become specific things interested in ○ piaget: preoperational (ends); concrete operational (begins around age 7 ) classification > - understand and characteristics ○ meaningful activities in company of peers ○ physical growth and development more muscle mass , less baby fat growth long > - continued in bones growth regularly spurts- > NOT growing as ○ permanent teeth erupt floss daily - after meals/snacks , brush regular dental checkups and at bedtime , ○ cooperative play ○ school ○ safety keep firearms > - identify locked away , safe areas to play stranger danger safety gear , supervise , wear , smoke detectors , while swimming drugs/alcohol/tobacco sport safety latchkey kids -going home to an empty home ROUTINE AND SAFETY * ○ fears death of parent failing in school bullies losing friends ○ cognitive development > - still analytically cannot critically think or begins to find specific interests in school and out of school popular > - clubs become start collections cooperative play organized sports conservation CANNOT think abstractly ○ stressors bullying making decisions need for approval grades competition adolescent (12-18 years) ○ erikson: identity vs role confusion ○ piaget: formal operational stage (11-adulthood) ○ domains of adolescent development ○ rapidly changing body, great variability ○ puberty → tanner staging ○ change in interview and education ○ emotional well being (emotional development) swings/variations > - mood relationship with parents/family separate from parents > start to - family and and become more involved with peers self/body image > - comparison with peers sexuality experimentation - sexual driven by curiosity self-exploration (masturbation) , importance of peers ~interview with and without parents present ○ safety and risk reduction depression/suicide > - annual psychologic screenings identify depression anxiety to , , suicidal ideations and substance use violence substance abuse discuss > - emphasize the risks effects , short-term of substance use eating disorders injury ~don’t lecture, inquire about their knowledge learns to tell time · able to solve problems · see perspective *For the below body system topics, you will want to know general information given about the system and variations in anatomy/physiology in pediatric patients hematologic Infants - > all bones involved adults - > only flat bones involved ○ hematopoiesis: (early blood cell production) begins around 2 weeks gestation in the embryo yolk sac then around 8 weeks gestation, process moves to the liver and spleen until sometime in 3rd trimester then the bone marrow takes over ○ hemoglobin types Hgb F → fetal hemoglobin * fetus uses until 6 months of age A short life span  Hgb A → “adult” hemoglobin Hgb A2 → variant form of Hgb A * smaller amounts ○ present in iron newborns > - maternal stores ↓ iron = ↓ hemoglobin Infants - > breastmilk fortified formula or iron pre-term infant has increased risk for anemia physiologic adolescencee anemia 2-6 months of age = physiologic anemia around #growth spurts 2-4 months start testing for anemia ↑ growth + ↑ blood volume + ↓ maternal iron stores = anemia * menses * poor diet adolescence also increase time of growth = increase risk for anemia #iron supplements may be necessary for babies GI * Cognitive delays with bleeding disorders that prevents oxygen from getting to organs ○ mouth 4-7 months (as 3 months and as late as 10 erupt * teeth early months) as common entry for infectious agents children frequently put things in their mouths by putting objects > - kids learn in their mouths for * monitor hazards choking inspect > - ausculate > -> percusse palpate ○ esophagus -or cardiac spincter lower esophageal spinchter not fully developed until 1 month reflux > - "happy long spitters" they losing weight as as are NOT = No concern regurgitation and dysphagia * rotovirus &Gl bugs ○ stomach: small capacity 302 1 - babieshave increased metabolism 30-90 mL at 1 week feed frequently > - more ↓ feeding every 500 mL at 2 years 2-4 hours 1500 mL at 16 years ○ intestines hsmall e intestine re NOT functionally mature at birth absorption occurs small bowel loss in infancy can lead to problems with absorption and diarrhea as an adult ○ biliary system - eventually ↓ in size liver relatively large at birth, easily palpated, immature functions until 2 years ○ pancreatic enzymes reach adult levels around 2 years old - helpdigestion with ○ total body fluids disturbances in fluid/electrolyte balance occur more frequently and rapidly in infants and young children fluid requirements change with specific disorders ○ total body fluid by age infants = 70-80% of body weight by age 3 = 65% of body weight by age 15 = 60% of body weight oncology ○ effects tissues vs organs ○ embryonal vs epithelial ○ little known for prevention ○ detection from blood counts or obstruction of the tumor ○ metastasis typically @ diagnosis ○ more responsive to treatment  GU ○ infants tubules have less surface area = decreased water absorption more prone to excess fluid volume and dehydration (cannot concentrate urine very well) immature renal system = inability to handle increased protein intake > - cannot concentrate urine well sodium excretion is lower = less able to adapt to sodium loss or excess small bladder capacity UOP 1-2 mL/kg/hour less concentration ○ toddler/preschool control of bladder sphincters does not occur before the age of 2 autonomy > - vs. Shame/doubt renal system is maturing/GFR is almost at adult levels urethra is shorter in females vs males UOP 0.5 mL/kg/hour ↑ risk of UTI UOP 1-2 mL/kg/hour susecptible more to trauma ○ school age fluid and electrolyte balance is stable specific gravity is similar to adult bladder capacity increases UOP = 1-2 mL/kg/hour ○ adolescents renal function now same as adult bladder capacity same as adult UOP = 0.5-1.0 mL/kg/hour GI cleft lip and palate opening > - formationIn the of the lip that extends into the nose ○ development of cleft occurs early pregnancy, when the tissue that forms the lip and/or fails to fuse ○ may be unilateral (left > right) or bilateral ○ history and assessment pregnancy and history & #1breastfeeding (hipple shield) priorities = feeding and respiratory difficulties, speech development, otitis media - ↳ feed milk feeds the bacteria - In upright position , ○ management temperature monitor , observe for manifestations of infections airway maintenance ear ↑ risk for aspiration nutrition/fluid balance surgical repair (lip: 2-3 months; palate 9-18 months) -prevent infection (rag syringe) and squeeze Straining) NO post-op care and feeding or protect NO crying , touching sutures (NO , , the site & place side-lying facilitate drainage position prevent to aspiration and prevent injury to suture line after repair pain control monitor growth and development family * bonding processes -> dehydration - loss of body so they much fluid , longer are no able to maintain body function normal faster they bring loss then back in ○ varies based on underlying cause ○ occurs more quickly in infants and children ○ early recognition is essential → can lead to hypovolemic shock ○ isotonic isonatremic (70%) equal loss of water and electrolytes loosing > - water and sodium at the same rate major fluid loss involves extracellular components and circulating blood volume occurs when fluid loss NOT balanced by intake labs serum Na = normal, may decrease Cl = decreased K = normal, may decrease hypovolemic shock may occur most common cause is vomiting and diarrhea ○ hypertonic/hypernatremic (20%) primarily a loss of water excessive water loss compared to electrolytes → fluid shifts from intracellular to extracellular → neurologic disturbances (seizures) ↑ sodium concentration delay of onset s/s due to compensatory mechanisms labs Na = increases (>145) Cl = increases K = varies altered LOC, confusion, lethargy/dizziness causes → diabetes insipidus, administration of IV fluids or feeds with high electrolytes Or mixing formulas correctly not ○ hypotonic/hyponatremia (20%) primarily a loss of electrolytes water shifts from extracellular to intracellular in an attempt to compensate → further increase loss of ECF → can result in hypovolemic shock labs serum Na = decreases (< 135) Cl = decreases K = level varies causes → severe/prolonged vomiting/diarrhea, burns, renal disease, IV fluids without electrolytes ○ management find > - the cause and treat the cause # I: Obtain IV access restore appropriate fluid balance and prevent complications risk for overhydration replacement of fluids try - want toproduce first (parenteral least invasive therapy fluid intiated when child is unable to drink enough given when cannot maintain daily requirements or restore/replace oral fluids to correct fluid losses losses NS used to restore water and sodium loss; maintains Na and Cl at present levels (usually 1st choice)  ringer’s solution used to expand intracellular fluid and replace extracellular losses/LR used to replace fluid from burns, bleeding and severe diarrhea once imbalance corrected may change to lower Na level and add D5W (D51/4NS) D5W used to restore water loss, plasma volume and calories ○ lowers Na levels HOWEVER using glucose can lead to cerebral edemia * assess cap refill , must monitor electrolytes, glucose, bicarb and kidney function while on , VS maintain weight, monitor accurate 1/0s fluids for problems for signs of , monitor ICP severe dehydration needs immediate treatment through IV or intraosseous DO NOT ADD KCL UNTIL AFTER THE CHILD HAS VOIDED #3 bolus before Kidneys functioning > ensures - are Skin color , TBP , TUOP checking , energy ↑LOC, cap refill - ○ passage of gastric contents into the esophagus ○ occurs during episodes of transient relaxation of the les, such as swallowing, crying, valsalva maneuvers that increase intra-abdominal pressure ○ delayed gastric emptying ○ neurologic disease ○ assessment (frequent crying) burning/heartburn arching · coll , clawing throat , , very hungry n/v pain , at , past medical history and risk factors onset and progression of symptoms physical examination weight length, head circumference > - , ○ management protecting airway → risk for apnea or ALTE CPR If reflux baby > - stop breathing Initiate causes to maintaining/restoring fluid balance/nutrition frequent feeds > small - thicken bottle feeds with infant cereal (usually rice cereal) reflux precautions and family education spicy foods > - avoid sodas , alcohol , avoid pressure on stomach NO caffiene smoking , , , postoperative care, if the child requires a fundoplication · monitor IOs gradually increase feeding monitor daily weights ordered administer pain meds as  appendicitis > - inflammation appendix of the 10 average patient age * years is ○ obstruction occurs in the appendiceal lumen causes of obstruction include hard fecal mass, stenosis, parasitic infection, hyperplasia of lymphoid tissue, or a tumor ○ after obstruction, mucus continues to be secreted, bacteria proliferate, and intraluminal pressure increases ○ elevated pressure leads to lymphatic and venous congestion, impaired perfusion and eventual ischemia management - nurse : management therapy pain , IV fluid , ○ necrosis occurs tube NG suction , IV antibiotics ○ the appendix becomes gangrenous and ruptures fever i rutability > S/s = , , - ○ rupture can lead to bacterial contamination of the peritoneum, causing bacterial abdominal sudden relief from pain after perforation rigid , abdomen, peritonitis EMERGENCYMEDICAL tachycardia rapid/slow distention , , chills breathing pallor , , ○ history and assessment intial pain > low-grade - cramping around umbilicus, decreased appetite, nausea, fever mmm often present with RLQ abdominal pain rebound tenderness at mcburney’s point CT scan is standard rovsing's sign → pushing on the LLQ elicits pain in the RLQ gold the pain becomes more intense and constant guarding and abdominal rigidity occur laying > - with Knees bent sudden, spontaneous relief of pain usually means rupture monitor for signs of sepsis and shock ○ management NPO until surgery; NG tube to decompress stomach monitor VS , maintain advanceIV and then therapy diet as tolerated · * avoid heat to the pain relief abdomen , laxatives and enemas promote comfort maintain hydration administer fluids > - IV as ordered administering antibiotics (pre- and post-op) PICC line may be inserted CBC , drainage > - monitor , cultures administer analgesics assess site post-operative care respiratory airway provide supplemental oxygen > assess status maintain , obtain VS , , , - , for bleeding function , assess bowel sounds and bowel · post-op teaching pre and patient family to and pyloric stenosis pylorus - food blocks entering from small intestine ○ elongation and thickening of the pylorus leading to hypertrophy blocks food reaching of cells - > from small intestine ○ may progress to merely complete obstruction of gastric outlet ○ history and assessment usually > - occurs the first few weeks of life sudden onset of forceful (projectile) vomiting immediately after eating weight > - los dehydration, metabolic alkalosis peristaltic waves on inspection olive-shaped mass in RUQ familial; males 4x more affected than females can happen at 1-12 weeks, but most common around 3-5 weeks failure extremely to thrive lethargic Irritable · ○ management , , * IV prevent dehydration/hypovolemic access - want to electrolytes shock - Isotonic solution and added NPO after surgical correction; NG tube to decompress stomach meet fluid, electrolyte, nutritional needs prevent infection, promote comfort, support parents num mmm foods slowly provide pacifier reintroduce emotional support reassurance , after for surgery monitor bleeding ·  hirschsprung’s blockage > - of the intestine because of segment a lack of nerves in the bottom of the colon ○ congenital aganglionic megacolon ○ a portion of the intestinal traction (usually the rectum or sigmoid colon) is missing neuronal ganglion cells ○ aganglionosis causes absence of peristalsis and motility ○ history and assessment can occur at any age digital rectal exam reveals an empty rectal vault if untreated, enterocolitis can develop ○ management surgical correction → determined by the child’s health and comorbidities short-term colostomy may be necessary nursing care: pre and post-operative care, pain control, prevent infection > - establish IV therapy for fivid electrolyte and balance antibiotic therapy no rectal temps , · low-fiber , high-protein high, calorie diet hematology sickle cell anemia RBCs carry less effective form called hemoglobin infarction S- causes cells to sickle - obstructs blood flow-tissue Ischemia and - sickle cells can ○ autosomal recessive disease where hemoglobin SS partially or completely replaces permenatly damage Vessels, and bones organs normal hemoglobin ○ found predominantly in African-Americans ○ sickle cell trait: 1 in 13 ○ sickle cell disease: 1 in 365 ○ sickle cell crises test to whether the Infant cell disease of sickle cell trait · hemoglobin electrophoresis distinguish has sickle vaso-occlusive crisis > - obstruction of blood flow causing hypoxia tissue and necrosis acute pain crisis occurs when statsis of blood causes tissue hypoxia leading to ischemia and possible infarction * silent stroke severity dependent on the site of the occlusion manifestations: pain, fever, tissue engorgement, joint swelling, tachycardia, pain in joints, hands, feet and abdomen enuresis is common  splenic sequestration when blood pools in the spleen > - infarctions and obstructions extremities thready pulse , hypotension Irritability tachycardia pallor d Urine output , tachyphea , cool , , , , profound anemia, hypovolemia, shoch, # splenomegaly can lead to atrophy acute chest syndrome > - most common cause of death clumping of the sickle cells in the lungs leads to hypoxia hypoxia = further sickling aplastic crisis increased destruction of fragile RBCs typically triggered by infection - an leads to temporary cessation of RBC production ○ treatment > - When symptomatic #high risk bone marrow transplant (only cure) blood transfusion > - of treatment anemia hydroxyurea Cytotoxic > - frequency that is used to reduce painful reduce of for crises and need blood transfusions in patients with recurrent, moderate-to-severe crises new biologics > - expensive , must be at least 6 years old new gene therapy - one time treatment genes that edits high in stem cells , risk , must be at least 12 ○ management full physical assessment - VS /especially temperature) > lung , neuro , heart , labs Hgb/Hc > - elevated in crisis platelet count ESR education I do NOT overexert , hydration yourself signs , for infection prophylactic penicillin produces , for dental , diet (meats, dried pain management to believe their pain fruits , green leefy vegetables legumes, breathing , * helps to improve their helpful most analgesics (NSAIDs, acetaminophen, narcotics) egg yolks seafood, , nuts ↳ whole grains , distraction, relaxation not as useful oxygen if hypoxia present fluids (PO, IV) heat packs  characterized by difficultly controlling bleeding - hemophilia deficiency of factor > - VIII , produced by a substance the liver that assists with thromboplastin formation in blood coagulation ○ group of chronic hereditary bleeding disorders ○ deficiency of a specific blood clotting factor CURE > - NO ↳ present diminished capacity ○ manifestations but easy bruising prolonged bleeding from wounds epistaxis hemarthrosis joint Into the cavities of the knees , ankles and elbows , hematoma with limited motion , spontaneous hematuria swelling and · pain , ○ 3 main types , mom is the carrier - males at risk > - lack of von Willebrand factor protein characterized by inability of platelets to aggregate beta-thalassemia ○ disorder of hemoglobin synthesis square-shaped > - ○ autosomal recessive > - parents gene) Inherited /both need to have ○ most common in Mediterranean, Africa, Asian, and Middle Eastern descent ○ increased bone marrow with thinning of bony cortex ○ manifestations failure to thrive -growth retardation pallor and/or jaundice severe anemia hemosiderosis hepatosplenomegaly bone deformities-frontal and maxillary bone bossing forehead > - becomes flat ○ treatment > - low life expectancy and NO CURE chronic transfusion tx given every > - 3 months chelation therapy infusion > - hours I done sleeping takes several at home while get * iron levels splenectomy education > - understand process disease A gentle counseling disseminated intravascular coagulopathy (DIC) ○ acquired process involving abnormal activation of body’s thrombin mechanisms and fibrinolytic system bleeding > - clotting and at the same time ○ secondary illness ○ severe and life-threatening  ○ increased, uncontrolled bleeding → anemia from excess bleeding → organ damage → excess bleeding tissue hypoxia and necrosis ○ precipitating factors cancer hypoxia burns trauma sepsis shock liver disease NEC ○ assessment excessive bruising petechiae hematuria oozing injection sites constantly > - assess mild GI bleeding ○ management constant assessment especially circulation and neurologic status administer clotting factors, platelets administer anticoagulation therapy helps erupt coagulation > - process apply pressure and elevate if possible areas of acute bleeding * injections avoid iron deficiency anemia > - typemost common of enough healthy anemia , where thereoxygen body's are not RBCs to carry to the tissues ○ manifestations fatigue, lethargy · might newborns not wake up to eat pallor of oral mucosa and skin nail spooning tachycardia splenomegaly -specific iron levels decreased Hgb, Hct, serum Fe, ferritin levels growth retardation · ○ management moms breastfeeding need to t iron Intake when dietary intervention - limit only 2402/day for whole milk to year Kids I and older too much calcium blocks to hydration get I helps to body fluid around the absorption of iron promote safety Don foods = red meats, fish (tuna salmon) eggs, dried beans , , , leafy greens iron supplementation iron supplements are usually liquid can stain teeth > - behind the teeth straw good oral hygiene , administer , use administer on empty stomach (1 hour before meals OR 2 hours after meals milk , antacids) Education or ↑ vitamin c = helps Increase absorption ADRs = constipation , GI complaints kept out of reach idiopathic thrombocytopenia purpura ↳ response autoimmune to virus where the body produces too much ○ immune response → produces antiplatelet antibodies anti-platlet antibodies ○ typically secondary to viral infection ○ neonatal d/t maternal platelet issues, placental insufficiency and fetal hypoxia ○ manifestations petechiae ecchymoses  purpura platelets less than 50,000 ○ typically acute but can become chronic ○ management observe and document reassurance education avoid trauma > - sports avoid contact avoid aspirin, NSAIDs, and antihistamines -platelet adhesiveness severe cases → corticosteroids IVIG chronic cases → splenectomy lead poisoning/anemia -chronic ingestion or of materials that contain by physical inhalation lead , characterized and mental dysfunctional ○ lead causes inability to synthesize heme ○ manifestations typical anemia symptoms fatigue, lethargy pallor of oral mucosa and skin nail spooning tachycardia splenomegaly decreased Hgb, Hct, serum Fe, ferritin levels ○ complications learning disabilities behavior issues seizures encephalopathy brain damage ○ testing blood levels > 5 mcg/dL = exposure ○ treatment intravenously oral or chelation therapy heavy > - excretes system metals via the venal ○ screening family > - assess toys hx , parent's hobbies/profession , home , ↓ any child whose parents answer yes on lead assessment questionnaire only test if answered yes on one of the questions OR regular intervals depending on negative or positive results any at risk child should have a level done at least by age 3 If parent specifically requests starts at 6 months every 3 months until , I I every 6 months until 3 once a year until l oncology nursing interventions for the oncology patient ○ admin chemo aide in minimizing complications of chemo, radiation, and/or bone marrow transplants ○ monitor for hyperleukocytosis, septic shock, SIADH, DIC, anemia/quick interventions if present blood ,headaches clots- , dizziness  ○ prevent/monitor for infection by using aseptic technique, limit interactions to infected persons; NO live plants/flowers and NO raw foods, be sure UTD on inactivated vaccines · ANC monitor - want around 1500 ○ encourage fluids, administer IV fluids, strict IO’s ○ encourage to eat when hungry, allow favorite foods if tolerated, provide appealing looking food - prior and after chemo ○ administer antiemetics, provide pleasant atmosphere-avoid bad smells essential oils ○ minimize painful procedures, analgesics regularly and prn, nonpharmacologic pain relief for -check bleeding ○ assess mmbs, provide and teach oral care, lip balm ○ age-appropriate activities, allow to participate in self-care, maintain contact with school, assist with child’s coping of body image disturbances ○ encourage child and family to verbalize feelings, ask questions assist child with coping skills provide education to both child and family re: disease, treatment, adverse effects, long term effects, along with providing information on resources the family may need ○ assist the child/family with the process of grieving establish trusting relationship with family and child assist with family planning for terminal stage including palliative care provide any and all resources including spiritual support leukemia malignant > - disease of the bone marrow ○ cancer of blood-forming tissue ○ issue is with the immature and/or abnormal WBCs deliberately destroy - do not attack and normal cells but compete for metabolic elements ○ most common malignancy of childhood ○ ALL (acute lymphoblastic) and AML (acute myelogenous) ○ majority of cases are now curable · develop another form of cancer later ○ ALL children * most common type in unrestricted proliferation of immature lymphocytes (WBCs) classification is based on type of WBC that becomes neoplastic AND immaturity of neoplastic cell cure rate = greater than 70%  peak age of 4 years exact cause unknown manifestations ○ fatigue ○ pallor ○ petechiae ○ bleeding (bruising) ○ fever ○ lymphadenopathy glands - swollen ○ hepatosplenomegaly ○ weight loss ○ bone pain/abdominal pain ○ headache ○ nausea/vomiting ○ papilledema swelling > - of optic nerve AML arrest of bone marrow cells resulting in the proliferation of immature granulocytes (WBC) classification: french-american-british classification cure rate = about than 50% peak age is adolescence exact cause unknown manifestations ○ fatigue ○ pallor ○ petechiae ○ bleeding (bruising) ○ fever ○ lymphadenopathy ○ hepatosplenomegaly gums from nose and/or sob bleeding ○ management skin · , rash , corticosteroids > - ADRs of minimize treatment chemotherapy different agentsused depending type on the age of leukemia and , administered via central l e or , control port platelet transfusion prevent and manage complications pain management > - nonpharmacologic use pharmacologic and interventions emotional support (family and child) osteosarcoma ○ most common bone cancer ○ arises from the osteoblasts ○ peak incidence = puberty > seen - during growth spurts ○ metastasis to lungs  ○ and inability to lift aheavy main symptoms is pain/swelling may report decreased > - also weakness , movement, limping weight , loss object ○ metaphysis of long bone often > - most in the femur ○ management surgical removal of tumor chemotherapy agents singly > various - for Infection , and/or used or breakdown , nutritional combination before after surgery control n/V , monitor deficiency good hygiene Skin bleeding precautions · , , limb sparing surgery prosthesis ambutation > - sometimes need fitting emotional support (family and child) rhabdomyosarcoma ○ soft tissue tumor ○ very fast growing ○ peak incidence = 2-5 years of age malignancy t most common soft tissue in childre ○ prognosis based on staging ○ metastasis is common to lung, bone, and CNS ○ survival rate = 39% if metastasized ○ symptoms if present based on tumor location phanteum > - pain ○ management frequent * punctures scans and lumbar radiation surgery and biopsy chemotherapy emotional support (family and child) wilm’s tumor ○ nephroblastoma-intra renal cancer abdomen/waistband > - lump is evident in the are a ○ usually unilateral * genetic can be ○ peak incidence 2-4 years of age ○ cause unknown ○ survival = about 90% ○ prognosis dependent on staging and metastasis ○ usually asymptomatic may have..abdominal pain, hematuria, HTN, fever & 25 % of patients seen ○ DO NOT PALPATE in rupture/causes > can - metastasis ○ management nephrectomy -surgical removal and Kidney after diagnosis Cusually of the tumor soon within 48 hours) chemotherapy preoperative and/or postoperative decrease > - of tumors and potentially to size preserve one Kidney radiation preoperative and/or postoperative for > - large children with tumors , metastasis , recurrence and residual disease emotional support (family and child) neuroblastoma ○ abnormal proliferation of neuroblast in the sympathetic nervous system > - most often found on the abdomen ○ most common outside the cranium ○ solid tumor ○ usual onset ~22 months of age ○ unknown cause  ○ typically a late diagnosis ○ prognosis based on staging of tumor, location of tumor and location of metastasis ○ manifestations abdominal fullness fatigue and fever weight loss bowel and bladder dysfunction neurological symptoms dyspnea limp malaise ○ management biopsy and surgical resection of tumor > - removal chemotherapy for > - residual metastasis and disease radiation for > - metastasis and residual disease palliation emotional support (family and child) GU bladder control achieved at which is enuresis uncontrolled e or after beyond unintentional urination that occurs age a child is an ○ bed wetting ○ primary most common child has never had a dry night (NEVER control had bladder d/t maturational delay and small functional bladder NOT associated with stress or psychiatric issues ○ secondary child begins bedwetting after has being relatively dry for 3-6 months is associated with stress and psychiatric issues also can be d/t infection or sleep disorders ○ diurnal daytime incontinence usually d/t holding urine can be secondary to constipation, stress, UTI and laughing RULE OUT PHYSICAL CAUSES behavior training set voiding schedule increase fluids during day to increase frequency ○ nocturnal nighttime bedwetting typically subsides on its own by 6 years of age can be secondary to increase of fluid intake at night, sleep apnea, UTI, constipation, emotional stress, sexual abuse  RULE OUT PHYSICAL CAUSES limit fluid intake after dinner limit caffeine and chocolate urge ↑ > - wake to void at 11pm medications pull-ups when away from home bed alarms glomerulonephritis ○ infection → post skin or pharynx infection with group A strep antigen-antibody complex gets into filter of glomer los ○ immune response → inflammation of glomeruli AND obstruction ○ increased vascular permeability → protein, RBCs and red cell casts excreted ○ manifestations sudden onset → hematuria, proteinuria and RBC cast oliguria cola-colored urine mild-mod edema mild-severe HTN abd pain fever malaise ○ diagnostics UA (+ protein, RBC, WBC) urine specific gravity (> 1.020) serum ESR (high) BUN/creatinine (high) antistreptolysin-O test (positive) ○ treatment bedrest give kidneys > - time to rest antibiotics (7-10 days) antihypertensives diuretics corticosteroids stop inflammation > - diet → LOW SODIUM maintain fluid volume * resolves after 6 months usually ○ follow-up UA 2, 4, 6 weeks and 4, 6, 12 months or until UA returns to normal serum creatinine 2, 6, 12 months or until UA returns to normal ○ complications hypertensive encephalopathy pulmonary edema > - ↑ fluid backs lungs into congestive heart failure renal failure destruction > - of nephrons  hemolytic uremic syndrome (HUS) #very deadly Shiga ○ ingestion of e. coli → bloody diarrhea illness → toxin attaches to glomeruli → hemolytic feces unpasterized dairy or fruit , undercooked meats anemia thrombocytopenia → acute renal failure , ○ most common cause of acute renal failure ○ manifestations > - of symptoms (microangiopathic hemolytic triad thrombocytopenia AKI anemia , , mild proteinuria bloody diarrhea decreased platelets