Study topic
Paediatric renal and musculoskeletal
NCLEX pediatric renal-MSK chapter: AGN versus nephrotic syndrome, UTI and hypospadias, cast neurovascular checks, Pavlik harness, and Gower sign.
This chapter pairs kidney patterns in children with the orthopedic devices that show up beside them on the exam: casts, harnesses, and the climb-up-the-legs sign that means muscle disease.
Nephrotic syndrome vs acute glomerulonephritis
| Feature | Nephrotic | AGN (post-strep) |
|---|---|---|
| Urine | Frothy; massive protein | Tea/cola; RBCs/casts |
| Edema | Often marked, periorbital then general | Milder; watch pulmonary fluid |
| BP | May be normal or varied | Hypertension common — priority |
| Big risk | Infection, thrombosis, skin breakdown | Hypertensive/encephalopathy cues |
Urinary structure and infection
- Infants cannot localize dysuria — fever and irritability matter.
- Teach front-to-back wiping, unfinished antibiotic courses, and hydration.
- Hypospadias: surgical repair uses foreskin tissue — hold routine circumcision until the plan is set.
Casts and congenital orthopedic disorders
- Check fingers/toes: color, warmth, capillary refill, movement, sensation.
- Pain out of proportion or pain with passive stretch: escalate for compartment risk.
- Keep cast clean/dry; never insert hangers or powder deep inside.
- Elevate the limb as ordered to limit swelling.
| Condition | Teaching point |
|---|---|
| DDH / Pavlik | Keep harness on per hours ordered; skin care under straps; do not adjust angles yourself |
| Clubfoot | Serial casting/bracing adherence |
| Scoliosis brace | Wear schedule as ordered for curve control |
| Muscular dystrophy / Gower | Hands walking up thighs to stand — refer for workup |
Safety
Cool, pale, numb toes distal to a cast are a now problem. Loosen restrictive coverings per protocol and notify — do not wait for the next clinic slot.
Priority map
| Picture | First move |
|---|---|
| Puffy child, frothy urine | Nephrotic map — infection/skin/weight |
| Tea urine + high BP after strep | AGN — BP/fluid priority |
| Hypospadias newborn | Delay circumcision |
| Cast + dusky toes | Neurovascular emergency |
| Boy climbs own legs to stand | Gower — evaluate MD |
Must know
- 1Nephrotic syndrome (often preschool/school-age): massive proteinuria, hypoalbuminemia, edema, frothy urine, infection risk from loss of immunoglobulins — protect skin, monitor weight/abdominal girth, steroids as ordered.
- 2Acute post-strep glomerulonephritis: tea/cola urine, oliguria, hypertension, mild edema after a strep infection — BP and fluid status are priorities.
- 3Infant UTI: fever, irritability, poor feeding, foul urine — culture pathway; teach hygiene and unfinished antibiotics.
- 4Hypospadias: delay circumcision until surgical repair plan is clear — foreskin may be needed for reconstruction.
- 5Cast care: report cool/pale/dusky toes, delayed refill, numbness, unrelieved pain, swelling — neurovascular emergency. Keep cast dry; do not stick objects inside.
- 6DDH: uneven gluteal folds, limited abduction, Ortolani/Barlow context; Pavlik harness keeps hips flexed/abducted — leave on as taught, skin checks.
- 7Clubfoot: serial casting/bracing pathway. Scoliosis brace: wear hours as ordered.
- 8Gower sign (uses hands to push up legs when rising): classic Duchenne muscular dystrophy cue in young boys — escalate evaluation.
Memory hooks
Frothy and puffy = nephrotic
Heavy protein loss makes foam and edema. Infection risk rides along.
Tea urine after strep = AGN
Cola-colored urine and hypertension days to weeks after strep point to acute glomerulonephritis.
Cold pale toes under cast = call
Neurovascular compromise beats “wait until morning clinic.”
How it's tested
Stems contrast nephrotic edema with AGN tea urine, ask cast red flags, Pavlik teaching, or hypospadias circumcision timing. Distractors circumcise before hypospadias repair or ignore numb casted toes.