NURSING CARE OF CHILDREN WITH HYDRONEPHROSIS - CASE REPORT

Hidronefroza označava dilataciju bubrežne nakapnice i čašica uz stanjenje bubrežnog parenhima zbog suženja pijeloureteričnog vrata i nemogućnosti normalnog otjecanja. Težina oštećenja ovisi o visini, stupnju i trajanju opstrukcije. Hidronefroza je podjednako zastupljena u oba spola i otkriva se uglavnom prenatalno između 18. i 20. tjedna i u prvoj godini života. Najčešće mjesto urođene zapreke pasaži mokraće je pijeloureterični spoj. Infekcija mokraćnog sustava najčešće dovodi bolesnika na pretrage, osobito u prve dvije godine života. Ultrazvuk je osnovna pretraga za procjenu i praćenje hidronefroze. Dinamička scintigrafija je metoda izbora za procjenu funkcije i opstrukcije bubrega. Prepoznavanje i razrješavanje opstrukcije normalnoj struji mokraće je primarni zadatak dječjeg urologa, a klinički pristup ovisi o kliničkoj prezentaciji. Mogući su sljedeći terapijski postupci: konzervativno liječenje, privremena derivacija mokraće na razini bubrega (perkutana nefrostomija), uklanjanje opstrukcije otvorenim kirurškim ili endoskopskim postupkom, te u konačnici nefrektomija. Najpoznatiji klasični operacijski postupak je zahvat po Hynes – Andersonu. U Kliniku za dječju kirurgiju zaprima se jednogodišnje dijete koje se operira zbog hidronefroze. S obzirom na dob djeteta neophodna je pratnja roditelja ili skrbnika koji je uz dijete 24 sata na dan. Medicinska sestra uz adekvatnu psihofizičku pripremu djeteta i roditelja svojim radom i profesionalnošću stvara osjećaj povjerenja. Najčešći problemi koji se javljaju u prijeoperacijskom i posljeoperacijskom zdravstvenoj skrbi su: strah roditelja u/s hospitalizacijom i operacijskim zahvatom, akutna bol u/s kirurške rane, VR za krvarenje u/s operativnog zahvata, VR za razvoj infekcije u/s redon-drenaže, VR za razvoj infekcije u/s urinarnog katetera, strah roditelja u/s postoperativnog tijeka djetetova operacijskog zahvata, VR za razvoj hospitalizma u/s dobi djeteta. Individualizirani pristup, adekvatna psihološka priprema djece i roditelja, te određeni sestrinski postupci za koje je zadužena medicinska sestra, pomažu u lakšem prihvaćanju bolesti, čine potrebnu hospitalizaciju manje stresnom, sprječavaju hospitalizam i ubrzavaju oporavak djeteta što nam je svima cilj i zadovoljstvo.Hydronephrosis denotes the dilatation of the renal pelvis and renal calyx with renal reduction parenchyma due to pelviureteric junction narrowing and the inability of normal draining. The damage heaviness depends on the amount, stage and duration of the obstruction. Hydronephrosis is equally present in both sexes and it is mainly prenatally discovered between the 18th and 20th week and in the first year of life. The most common place of inborn urinary tract obstructions is the pyeloureteral junction. Urinary tract infections are the most common reason why the patients come to the examination, especially in the first two years of life. Ultrasound is the basic diagnosis procedure for the evaluation and monitoring of hydronephrosis. Dynamic scintigraphy is a method chosen for evaluating kidney function and obstruction. Recognizing and solving the problem of normal urine fluency obstructions is the primary task of pediatric urologist. Therefore, the clinical approach depends on a clinical presentation. Possible therapeutical procedures are as folows: conservative treatment, temporary urine derivation on the kidney level (percutaneous nephrostomy), removal of the obstruction via surgical or endoscopic procedures, and finally nephrectomy. The most famous classical surgical procedure is the Anderson‐Hynes. A one-year-old child is, due to the need for a hydronephrosis surgery, admitted to the department of pediatric surgery. Considering the age of a patient, a child should be accompanied 24 hours a day by his parents or a guardian. The nurse creates a sense of trust through work and professionalism together with the adequate psycho-physical preparation of the child and his parents. The most common problems occurring in preoperative and postoperative health care are: parents' fear related to hospitalization and surgical intervention; acute pain related to surgical wounds; risk of bleeding related to surgery; risk of infections related to redon drainage; risk of infection related to urinary catheter; parents’ fear related to the postoperative procedure of the child's surgery; risk of developing hospitalism in child's age. Individualized approach, adequate psychological preparation of children and parents as well as certain nursing care procedures help to accept illness, make the necessary hospitalization less stressful, prevent hospitalization and enhance the recovery of the child, which is our goal and satisfaction