GU Dysfunction Flashcards
filtration of the kidney is dependent upon
adequate blood pressure - therefore any change in BP can cause a loss in kidney function
Loop of Henle and convoluted tubules reduce fluid by
90%
ROS
Rule out sepsis
Differences Between Pediatric and Adult GU System
-loop of henle in children is not long enough yet, so infant cannot concentrate urine as efficiently
by what age is kidney function of a child like that of an adult
6-12 months
what increases the risk of UTIs in children
short urethras
Children with acute renal failure will often…
regain full kidney function.
how do we get a urine sample from an infant
straight cath
how do we get a urine sample from a toddler/preschooler
clean catch with parents help since they are potty trained
how do we get a urine sample from a school-aged child
child can take instruction well, so clean catch
how do we get a urine sample from an adolescent
give instructions and provide privacy
labs and diagnostics for GU
urinalysis
creatinine clearance: asses GFR
radioisotopes :given IV and kidneys scaned to watch filtration
urine culture
blood studies
ultrasound/MRI
xray
Intravenous Pyelogram (IVP) looks at the
UPPER urinary tract with radiopaque dye injected into a vein
when doing an Intravenous Pyelogram (IVP) what needs to be assessed
if the child has an iodine allergy
during an Intravenous Pyelogram (IVP) the child may experience
flushing of face, salty taste
voiding cystourethrogram is a study of
LOWER urinary tract
what are the steps to a Voiding cystourethrogram
-Dye inserted via catheter into bladder,
-X‐ray taken during void
-Void may be painful
-Test is not done if child has UTI
clinical manifestations of UTI
-Fever!!!!
-Vomiting
-Abdominal pain, back pain, flank pain
-Dysuria, frequency, urgency
-Hematuria
-Jaundice
a subtle fever alone in a child can indicate
a UTI
why are UTIs often seen in ages between 2 and 6
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
UTI diagnostic studies
-Urinalysis: nitrates, leukocyte, esterase
-Urine culture
-Renal US
-Voiding cystourethrogram (VCUG)
UTI treatments
-antibiotic specific to organism
-FLUIDS
-tylenol for pain
Conditions that Predispose Infants and Children to UTIs
-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
teaching for prevention of UTI
-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
enuresis
Bed wetting, Continued incontinence of urine past the age of toilet training (UTI can cause temporary urinary control problems)
when does nocturnal enuresis usually subside by
6 years (further investigation is needed if its later)
interventions for enuresis
-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
what is Vesicoureteral Reflux (VUR)
abnormal retrograde (backward) flow of urine from bladder into the ureters
primary VUR is caused by
incompetence in the valve
risk factors for VUR
-Recurrent UTI in the female
-Single episode of UTI in the male
-Congenital defect
-Family history of VUR
treatment for Vesicoureteral Reflux (VUR)
-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
surgery for vesicouretal reflux
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
Hypospadias
urethral defect with the opening is on the ventral(bottom) surface of the penis rather than at the end
Epispadias
urethral defect with the opening is on the dorsal(front) surface of the penis