Pediatric Renal & Urinary Disorders | Saunders NCLEX-PN Review Chapter 34

Chapter 34 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri delivers a comprehensive overview of renal and urinary disorders in children. This chapter equips nursing students with essential skills for assessment, intervention, and family education across acute and chronic pediatric nephrology conditions.

Watch the full chapter summary and explore NCLEX-PN content on the Last Minute Lecture YouTube channel:

Urinary Tract Infection (UTI) in Children

• Risk factors: Shorter urethra in girls, poor hygiene, vesicoureteral reflux, constipation.
• Symptoms: Fever, irritability, foul-smelling urine, dysuria, enuresis, vomiting.
• Nursing care: Encourage fluids, teach proper wiping and perineal care, medication adherence, monitor for complications (pyelonephritis).

Nephrotic Syndrome

• Patho: Increased glomerular permeability leads to proteinuria, hypoalbuminemia, edema, hyperlipidemia.
• Classic signs: Massive edema, weight gain, periorbital swelling, frothy urine.
• Management: Corticosteroids, diuretics, fluid/salt restriction during edema, daily weights, prevent infection, teach home urine protein monitoring.

Acute Poststreptococcal Glomerulonephritis

• Triggered by: Group A strep infection 1–2 weeks prior.
• Key findings: Hematuria (“tea/cola urine”), mild edema, hypertension, oliguria, proteinuria.
• Nursing priorities: Monitor BP, limit sodium/fluids if needed, daily weights, seizure precautions for severe hypertension, support recovery (most children fully recover).

Acute & Chronic Renal Failure in Pediatrics

• Acute Renal Failure (ARF): Sudden decrease in renal function, causes include dehydration, toxins, or sepsis. Key priorities: fluid balance, electrolyte monitoring (especially hyperkalemia), supportive care, and prevention of infection.
• Chronic Renal Failure (CRF): Progressive loss of function, often from congenital or acquired disease. Major interventions: diet modification (low sodium, low potassium, fluid restriction), growth and development support, psychosocial care, prepare for dialysis or transplant.

Enuresis & Structural Disorders

• Enuresis: Involuntary urination beyond expected age; managed with bladder training, scheduled voiding, and sometimes medication (desmopressin).
• Other disorders: Hypospadias/epispadias (urethral opening malposition), phimosis, cryptorchidism. Nursing care focuses on post-op site care, infection prevention, and family education.

Pediatric Dialysis & Transplant Care

• Hemodialysis/Peritoneal Dialysis: Indications, access device care, infection control, dietary management, and fluid restriction education for families.
• Transplant: Immunosuppressive therapy, infection risk reduction, life-long follow-up, support for child and family adjustment.

Key NCLEX-PN Priorities in Pediatric Nephrology

• Strict I&O, daily weights, monitor for hypertension, electrolyte imbalance, and fluid overload.
• Prevention of infection (UTI, peritonitis), patient and family education on chronic illness management, emotional support.

Conclusion:
Pediatric renal and urinary disorders require focused assessment, prevention of complications, and strong family education. Mastery of these conditions is essential for NCLEX-PN success and high-quality pediatric care.

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