The nurse has provided teaching to the caregiver of a child with hemolytic uremic syndrome (HUS). Which statement by the client indicates an understanding of the information?

Alright, now first, let’s quickly review the physiology behind hemostasis or clotting. Hemostasis starts as a response to an injury of the endothelium, which is the inner lining of blood vessels, and it can be divided into primary and secondary hemostasis. In primary hemostasis, platelets form a “plug” at the site of the damaged blood vessel to stop the bleeding. In secondary hemostasis, proteins called coagulation factors start to activate each other eventually leading to formation of a fibrin mesh around the platelet plug to stabilize it.

Now, the causes of HUS vary, so it can be classified as typical or atypical. Typical HUS is caused by bacterial toxins, including Shiga-like toxin which is produced by some strains of Escherichia coli, most commonly enterohemorrhagic E. coli or EHEC, serotype O157:H7, and Shiga toxin which is secreted by Shigella dysenteriae. These bacteria typically affect children, who become infected through contaminated food or drink, like contaminated beef, raw leafy vegetables, or unpasteurized milk from an infected cow; or by swimming in pools or lakes contaminated with feces. Rarely, typical HUS may also be caused by other bacteria, such as Streptococcus pneumoniae.

On the other hand, atypical HUS is typically non-infectious. It is caused by dysregulation of the complement system, which is part of the immune system, and can be genetic or acquired. The main risk factors for atypical HUS are being above 65 years of age, or having a weakened immune system.

HEMOLYTIC UREMIC SYNDROME
	KEY POINTS	NOTES
DEFINITION	Triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury
PHYSIOLOGY	Hemostasis Response to an injury of the endothelium Primary Platelets form plug at site Secondary Coagulation factors activate each other Fibrin mesh formed to stabilize platelet plug
CAUSES AND RISK FACTORS	Causes Typical Bacterial toxins Atypical Dysregulation of complement system
PATHOPHYSIOLOGY	Typical Bacteria enters body Attaches to intestinal wall Secretes toxins Toxins absorbed by intestinal blood vessels Enter bloodstream Attach to immune cells which carry toxin to capillaries in kidney Toxin causes cell death Hemostasis triggered Many tiny blood clots form in kidney Platelets are used up Thrombocytopenia occurs Red blood cells break down as they run into clots Hemolytic anemia occurs Renal capillaries are blocked Acute kidney injury occurs Complications Seizures Stroke GI bleeding Colitis Bowel inflammation Bowel necrosis or perforation Chronic kidney disease Hypertension
SIGNS AND SYMPTOMS	Typical Blood diarrhea Atypical Lack of diarrhea Both Weakness Fatigue Vomiting Jaundice Pallor Easy bleeding or bruising Petechiae Purpura Oliguira or anuria Electrolyte imbalances Edema
DIAGNOSIS	History Physical assessment Laboratory tests
TREATMENT	Hydration Transfusions Hemodialysis
MANAGEMENT OF CARE	Goals of care Prevent spread of infection Monitor for complications Institute contact precautions Assess kidney function Review laboratory results Monitor vital signs, heart and lung sounds, intake and output, and weight Notify HCP Decreased urine output Elevated potassium Uremia Hypertension Administer medications as prescribed Monitor hemoglobin and hematocrit Watch for manifestations of clotting problems Notify HCP Decreased hemoglobin or hematocrit, RBCs, or platelets Shortness of breath Pallor Petechiae Ecchymosis Notify local health department as indicated
PATIENT AND FAMILY TEACHING	Explain condition, plan of care, and how to administer medications Keep all follow-up appointments Provide rest Encourage fluids Follow diet high in iron and folic acid Review infection control measures Avoid raw meat, eat pasteurized airy, and wash fruits and vegetables Keep raw foods separate Avoid swallowing water from recreational sources Notify HCP Poor appetite Abdominal pain Vomiting Diarrhea Fever Decreased or dark urine Swelling

Hemolytic uremic syndrome: Nursing

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