GU Dysfunction Flashcards

1
Q

filtration of the kidney is dependent upon

A

adequate blood pressure - therefore any change in BP can cause a loss in kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Loop of Henle and convoluted tubules reduce fluid by

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ROS

A

Rule out sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differences Between Pediatric and Adult GU System

A

-loop of henle in children is not long enough yet, so infant cannot concentrate urine as efficiently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

by what age is kidney function of a child like that of an adult

A

6-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what increases the risk of UTIs in children

A

short urethras

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Children with acute renal failure will often…

A

regain full kidney function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how do we get a urine sample from an infant

A

straight cath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how do we get a urine sample from a toddler/preschooler

A

clean catch with parents help since they are potty trained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do we get a urine sample from a school-aged child

A

child can take instruction well, so clean catch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how do we get a urine sample from an adolescent

A

give instructions and provide privacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

labs and diagnostics for GU

A

urinalysis
creatinine clearance: asses GFR
radioisotopes :given IV and kidneys scaned to watch filtration
urine culture
blood studies
ultrasound/MRI
xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Intravenous Pyelogram (IVP) looks at the

A

UPPER urinary tract with radiopaque dye injected into a vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when doing an Intravenous Pyelogram (IVP) what needs to be assessed

A

if the child has an iodine allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

during an Intravenous Pyelogram (IVP) the child may experience

A

flushing of face, salty taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

voiding cystourethrogram is a study of

A

LOWER urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the steps to a Voiding cystourethrogram

A

-Dye inserted via catheter into bladder,
-X‐ray taken during void
-Void may be painful
-Test is not done if child has UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

clinical manifestations of UTI

A

-Fever!!!!
-Vomiting
-Abdominal pain, back pain, flank pain
-Dysuria, frequency, urgency
-Hematuria
-Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

a subtle fever alone in a child can indicate

A

a UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

why are UTIs often seen in ages between 2 and 6

A

play is important in toddler and preschool age so they may not want to stop playing to urinate, or they may not want to pee in an unfamiliar place

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

UTI diagnostic studies

A

-Urinalysis: nitrates, leukocyte, esterase
-Urine culture
-Renal US
-Voiding cystourethrogram (VCUG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

UTI treatments

A

-antibiotic specific to organism
-FLUIDS
-tylenol for pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Conditions that Predispose Infants and Children to UTIs

A

-Urinary tract obstructions
-Voiding dysfunction resulting in urinary stasis
-Anatomic differences
-Individual susceptibility to infection
-Reflux
-Urinary retention while toilet‐training
-Bacterial colonization of the prepuce of uncircumcised infants
-Sexual activity in adolescent girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

teaching for prevention of UTI

A

-Wear cotton underwear
-Avoid bubble baths (esp. girls)
-Urinate frequently (at least 4 times/day)
-Drink plenty of liquids (amount varies with age)
-Change diapers often
-Wipe front to back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

enuresis

A

Bed wetting, Continued incontinence of urine past the age of toilet training (UTI can cause temporary urinary control problems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

when does nocturnal enuresis usually subside by

A

6 years (further investigation is needed if its later)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

interventions for enuresis

A

-limit fluids in the evening, give rewards
-set alarm to get child up to pee in the middle of the night
-behavior modification and positive reinforcement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is Vesicoureteral Reflux (VUR)

A

abnormal retrograde (backward) flow of urine from bladder into the ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

primary VUR is caused by

A

incompetence in the valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

risk factors for VUR

A

-Recurrent UTI in the female
-Single episode of UTI in the male
-Congenital defect
-Family history of VUR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

treatment for Vesicoureteral Reflux (VUR)

A

-Antimicrobials if UTI is present
-Increased fluids
-Hygiene/voiding practices to prevent UTI
-Prophylactic antibiotics may also used to prevent UTI
-Serial urine cultures
-Severe cases, require surgical interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

surgery for vesicouretal reflux

A

ureters are resected from the bladder and replanted elsewhere in the bladder wall;
often we hold off on surgery because sometimes it can clear up on its own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Hypospadias

A

urethral defect with the opening is on the ventral(bottom) surface of the penis rather than at the end

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Epispadias

A

urethral defect with the opening is on the dorsal(front) surface of the penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

treatment for Hypospadias & Epispadias

A

-Do not circumcise at birth
-Surgery is usually done by 18 months of age

36
Q

why do we not circumcise if an infant has Hypospadias or Epispadias

A

so that surgeon can use this skin when correcting problem (may possibly be able to perform after repair surgery)

37
Q

post op for Hypospadias & Epispadias

A

-Urethral drainage catheter temporarily
-Oxybutynin (Ditropan)

38
Q

why is Oxybutynin (Ditropan) given after Hypospadias or Epispadias surgery

A

given to relieve bladder spasms

39
Q

what can happen if Hypospadias & Epispadias is left untreated

A

-may not be able to aim urine stream
-Interferes with deposition of sperm - sterile
-Affects self-esteem and body image

40
Q

oxybutynin action

A

works directly on the smooth muscles of the urinary tract by blocking parasympathetic nerve impulses

41
Q

oxybutynin use

A

urinary incontinence, neurogenic and overactive bladder

42
Q

oxybutynin Side effects

A

drowsiness, tachycardia, anticholinergic effects (constipation and urinary retention), insomnia

43
Q

Phismosis

A

Narrowing or stenosis of prepubital opening of the foreskin, FORESKIN IS NOT ABLE TO BE RETRACTED

44
Q

Phismosis is a …

A

Normal finding in infants - usually resolves as the child grows

45
Q

treatment for Phismosis

A

-Steroid cream may be applied twice/day for 1 month
-Circumcision in severe cases (rare)

46
Q

why do we not force retraction in Phismosis

A

it could cause scarring and possible paraphismosis

47
Q

Paraphosmosis

A

retracted foreskin cannot be replaced to its normal position - edema and venous congestion created by CONSTRICTION of the tight band of foreskin - a urologic EMERGENCY

48
Q

Hydrocele

A

Peritoneal fluid in the scrotum

49
Q

communicating hydrocele

A

-opening between
scrotum and peritoneum
*Can change in size during the day

50
Q

Noncommunicating hydrocele

A

-no opening between scrotum and peritoneum
-No change in size

51
Q

hydrocele is common in newborns and usually resolves by

A

12 months of age

52
Q

Cryptorchidism

A

Undescended testicle (one or both)

53
Q

interventions for Cryptorchidism

A

-Use warm hands to examine infant
-Exam can be done in parents lap to aid comfort and cooperation in infant
-Testes will retract normally if infant is cold or upset

54
Q

If testes do not descend:

A

surgery may be required (between the ages of 6 months and 2 years)

55
Q

Nephrotic Syndrome

A

Increased glomerular membrane permeability causing an abnormal loss of protein in the urine

56
Q

Nephrotic Syndrome incidence

A

more boys 70% before age 5, peak incidence between 2 yrs and 7 yrs.

57
Q

clinical manifestions of nephrotic syndrome

A

-Weight gain
-Massive proteinuria
-Hypoalbuminemia
-Edema around eyes, hands and face
-Growing waistline (ascites)
-Nausea or vomiting (may be related to ascites)
-Pale tight skin from progressing edema
-Weakness or fatigue
-Irritability or fussiness
-Hypertension

58
Q

intervention for ascites

A

sit in upright position so that it does not compress the lungs

59
Q

intervention fro N/V

A

may need to give calorie supplementation to increase caloric intake because the child is still growing, SMALL FREQUENT FEEDING of fav foods

60
Q

diagnostic testing for nephrotic syndrome

A

-Urinalysis
-Serum protein, electrolytes
-Renal US

61
Q

nursing care for nephrotic syndrome

A

-Elevate head of bed and change positions often to decrease edema and to allow better breathing
-May need to restrict fluids acutely, diuretics
-Daily weights
-Measure abdominal circumference
-Strict I&O
-Skin care due to edema‐lotion, good hygiene
-Give IM in non‐edematous skin (usually higher on body)
-Restrict sodium intake

62
Q

where do you measure abdominal circumference

A

belly button

63
Q

medications for nephrotic syndrome

A

-Prednisone (to initiate remission)
-Diuretics
-Antibiotics

64
Q

when is a child considered tl be in remission from nephrotic syndrome

A

when urine is zero to trace for protein for 5‐7 days

65
Q

Acute Glomerulonephritis

A

Inflammation of the glomeruli in response to a preceding illness

66
Q

causes of Acute Glomerulonephritis

A

Streptococcal -causes strep throat, impetigo

67
Q

manifestations of Acute Glomerulonephritis

A

-Dark brown color of urine from old blood
-Proteinuria (mild to moderate)
-Abdominal pain
Hypertension
-Mild edema
-Lung congestion - crackles
-Decreased urine output
-Lethargy

68
Q

Acute Glomerulonephritis diagnostic testing

A

-Serum urea and creatinine
-Serum protein
-Serum WBC count
-Urinalysis
-Renal biopsy
-Throat culture

69
Q

treatment for acute glomerulonephritis

A

-Antihypertensives and diuretics
-Antibiotics
-Maintain sodium and fluid restrictions during initial edematous phase
-Weight daily, strict I & O
-Bed rest d/t fatigue during acute phase
-Emergency care - hemodialysis for renal failure

70
Q

Hemolytic Uremic Syndrome

A

The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia

71
Q

Hemolytic Uremic Syndrome caused by

A

E. Coli

72
Q

clinical manifestations of Hemolytic Uremic Syndrome

A

-GI symptoms: diarrhea
-Anemia
-Fever
-Abdominal pain
-Low hemoglobin

73
Q

isolation precautions for e. coli

A

Contact isolation

74
Q

diagnostics for Hemolytic Uremic Syndrome

A

-Hematuria
-Mild proteinuria
-Increased blood urea nitrogen (BUN)
-Increased creatinine

75
Q

treatment for Hemolytic Uremic Syndrome

A

-Blood products (for low hemoglobin)
-May require peritoneal dialysis

76
Q

what is the triad for Hemolytic Uremic Syndrome (HUS)

A

decreased RBC, decreased platelet count, renal failure

77
Q

Hemolytic Uremic Syndrome is contagious..

A

up to 17 days after the resolution of diarrhea; contact precautions

78
Q

Acute Renal Failure

A

A sudden, often reversible, decline in renal function that results in the accumulation of metabolic toxins (particularly nitrogenous wastes) as well as fluid and electrolyte imbalance.

79
Q

causes of acute renal failure

A

-Dehydration
-Hemorrhage
-Shock
-Severe diarrhea
-Traumatic injury
-Prolonged anesthesia after heart surgery
-Antibiotics

80
Q

clinical manifestations of acute renal failure

A

-Oliguria and/or anuria
-Azotemia (blood urea nitrogen [BUN] elevated)
-Creatinine elevated
-Hyperkalemia (weak irregular pulse, lower BP, abdominal cramps)
-Increased phosphorus levels
-Fluid retention and edema
-Hypertension, cardiac arrhythmias

81
Q

treatment for acute renal failure

A

-Support body systems: cardiovascular, respiratory
-Treat cause
-Give insulin and glucose to help move potassium into cells to lower circulatory level
-Aluminum hydroxide gel to bind with phosphorus and prevent absorption of it
-Prevent infection
-Support nutrition

82
Q

Dietary modifications in acute renal failure

A

-Restrict protein intake if chronic failure
-Restrict potassium and sodium intake
-Restrict phosphorus intake
-Provide maximum calories within fluid restrictions to help with growth
-Fluid restriction - as much as 1/3 of daily maintenance fluid requirement

83
Q

Dialysis

A

diffusion through a semi-permeable membrane

84
Q

if you get a cloudy return on dialysis…

A

peritonitis, use antibiotics

85
Q

Hemodialysis

A

Blood is removed from the body, an external membrane is used to diffuse out urea and electrolytes before blood is returned to child.

86
Q

3 hours of hemodialysis is equal to ___ hours of peritoneal dialysis

A

12