Danny is 14 months old. He was admitted again following a second febrile convulsion thought to be induced by a urinary tract infection (UTI). On admission it has been noted that although his length is on the 75^th centile his weight is on the 50th centile. He was generally irritable, especially when voiding urine.

Urine testing on the ward revealed some proteinuria. He was prescribed a five-day course of antibiotics.

• What care will Danny require for this hospitalisation and why?

Answer:

• Danny will need to be given antibiotics which may be given intravenously initially, so he will need an intravenous cannula to be inserted
• He will need his temperature to be monitored at least every 4 hours for pyrexia
• He will need analgesia should dysuria occur manifested by pain on micturition
• Monitoring of his fluid input and output (weighing nappies after use)
• Danny’s growth will need to be monitored
• The ward should liaise with his health visitor so that this can be followed up at home

• Danny’s parents are worried.  What short- and long-term consequences might they be worried about?

Answer: Danny’s parents will be concerned about the planned surgery and his short- and long-term prognosis:

• The planned surgery and any potential risks to their son
• Whether this will be a recurring event

Danny’s renal function in later life

The consultant arranged for Danny (Scenario 21.1) to have a DMSA scan as a day case and this has revealed that he has vesico-ureteric reflux on his left kidney with some renal scaring. The consultant has decided that Danny will require surgery to re-implant his left ureter and has referred Danny to a paediatric renal surgeon.

• What can the nurse do to ally parental fears?

    Answer:

• The nurse should arrange for Danny’s parents to visit the surgical unit where he will have his operation
• The nurse could arrange for Danny’s parents to meet another parent whose child has had this surgery
• The nurse should ensure that these concerns are relayed to the paediatric renal consultant who can provide up to date evidence for the management of Danny
• Information leaflets should also be provided

Billy is 6 years old. Two weeks ago he had a sore throat and was given some antibiotics by his GP. Over the past few days his mother has noticed that when he wakes up his eyes are puffy and he doesn’t seem to be as energetic as he used to. He has mentioned that his head hurts sometimes. She was worried that he might have tonsillitis again and need to take more time off school, so she took him back to the GP who has asked for him to be admitted to hospital because he has ‘inflamed kidneys’. On admission to the ward a urine test shows that he has blood and protein in his urine. The medical staff have commenced intravenous antibiotics. What other treatment will Billy require?

Answer:

• Billy will need to have his temperature, pulse, respiratory rate and blood pressure monitored for pyrexia and hypertension.

• His urine should be tested daily for haematuria and proteinuria. Each day at the same time he should be weighed in similar clothing.
• His urine output and fluid and dietary input must be recorded accurately. He may also be thirsty and dislike being restricted in what he eats and drinks. The nurse should ensure that if his fluid intake is restricted, the volumes to be consumed are spread throughout the day and his food is presented attractively.
• His parents will need to be provided with information regarding his progress and renal function and ultimate prognosis.
• Billy may be reluctant to mobilise and be bored. The nurse should ensure that he has a variety of age appropriate toys to amuse him, but also allow time for rest. The hospital play specialist should also be involved in relieving his boredom and to distract during blood tests and cannulations.
• Billy may be concerned about his altered body image in that he has put on weight and looks and feels ‘bloated’ despite not feeling hungry.
• Billy may also be upset to see that his parents are worried about him and have concerns that his current ill health is due to previous naughty behaviour.

Becka is an 11-year-old girl who has enjoyed being a Brownie but has never been away on a weekend trip. She has recently moved up to be a Girl Guide and would like to be able to join in the Guide weekends and go on sleepovers with her friends. However, on occasions she has wet the bed at home, so her mother has refused to allow her to go until she ‘grows out of this habit’.

•           What help and support could be made available to enable Becka to participate in more independent activities?

Answer:

• Introduce Becka and her family to resources from the ERIC website
• Involve the paediatric renal specialist nurse
• Conduct a thorough assessment of Becka’s continence issues from her point of view as well as her family’s
• Contact social services who may be able to help with laundry