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Pediatrics > Genitourinary Disorders > Flashcards

Genitourinary Disorders Flashcards

1
Q

Assessment Parameters for GU Disorder

A
  • burning
  • changes in voiding pattern
  • foul-smelling urine
  • discharge
  • pain, irritation, discomfort
  • blood in urine
  • edema
  • masses
  • flank/abdominal pain; cramps
  • n/v, fever, trauma
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2
Q

What is the bladder capacity of a newborn?

A

30 mL

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3
Q

At what age does a child’s bladder become adult sized?

A

1 year

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4
Q

At what anatomic location would a dull sound indicating a full bladder be heard?

A

above the symphysis pubis

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5
Q

Important Past Medical Hx for GU Disorder

A
  • maternal polyhydramnios
  • oligohydramnios
  • diabetes
  • hypertension
  • alcohol/cocaine ingestion
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6
Q

Important Neonate hx for GU

A
  • presence of single umbilical artery
  • abdominal mass
  • chromosome abnormality
  • congenital malformation
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7
Q

Important Family hx for GU

A
  • renal disease or uropathology
  • chronic UTI’s
  • renal calculi
  • history of parental enuresis
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8
Q

Lab/Diagnostic Tests for GU

A
  • urinalysis
  • urine culture
  • renal ultrasound
  • VCUG
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9
Q

VCUG’s are not usually performed until when?

A

Until the child has been treated w/ antibiotics for at least 48 hours

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10
Q

What is the expected urine output in the infant and child?

A

0.5-2 mL/kg/hr

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11
Q

What is necessary for accurate urine culture results?

A

obtaining a clean or sterile urine specimen

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12
Q

What is a critical component of nursing care related to renal disorders?

A

Close monitoring of serum blood counts and electrolytes

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13
Q

What is Suprapubic Aspiration used for?

A

obtaining a sterile urine specimen from the neonate or young infant

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14
Q

Anticholinergic Agents

A
  • used for UT spasms or contractions; control nocturnal enuresis
  • increase fluid intake
  • avoid in febrile child
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15
Q

Desmopressin

A
  • decreases volume of urine in child w/ nocturnal enuresis
  • nasal spray
  • administer at bedtime; alternate nares
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16
Q

Desmopressin may cause what?

A

Nasal irritation
Nausea
Flushing
Headaches

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17
Q

Corticosteroids

A
  • administer w/ food
  • may mask signs of infection
  • do NOT stop abruptly
  • monitor for Cushing syndrome
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18
Q

Furosemide (Lasix):Diuretics

A
  • administer w/ food or milk do decrease GI upset
  • monitor BP, renal function, and electrolytes
  • may cause photosensitivity
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19
Q

Bladder Exstrophy

A

congenital defect resulting in bladder being open and exposed outside of the abdomen

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20
Q

Postop Care for Bladder Exstrophy

A
  • prevent infection
  • keep infant supine
  • quickly change diapers
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21
Q

Catheterizing if Bladder Tissue is present

A

If tissue is present, surgery reconstruction of bladder w/in pelvis and reconstruction of urethra-INDWELLING catheter and medications for bladder spasms

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22
Q

What medications are used for bladder spasms?

A

Oxybutynin
Belladonna
Opioid suppository

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23
Q

Catheterizing if Bladder Tissue is NOT present

A
  • Bladder is removed and a continent urinary reservoir is created
  • Stoma is created on abdominal wall w/ access to reservoir
  • Catheterization about 4x/day
  • urine is often cloudy due to location
  • HIGH RISK for latex allergy
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24
Q

Hypospadias

A

urethral defect in which the opening of the penis is on the ventral surface

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25
Q

Epispadias

A

urethral defect where opening is on the dorsal surface of the penis

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26
Q

When is Hypospadias/Epispadias usually repaired?

A

by 1 year of age

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27
Q

Complications of Hypospadias/Epispadias if not corrected

A
  • not capable of aiming correctly when standing
  • infertility
  • body image/self esteem issues
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28
Q

What to assess for w/ Hypospadias/Epispadias?

A
  • Chordee
  • Cryptorchidism
  • hydrocele
  • inguinal hernia
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29
Q

Chordee

A

fibrous band causing the penis to curve downward

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30
Q

Cryptorchidism

A

undescended testicles

  • can lead to sterility and increased risk of testicular cancer
  • requires surgery
  • if not descended by 6 months-surgery
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31
Q

Hydronephrosis

A

condition in which the pelvis and calyces of the kidneys are dilated

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32
Q

What are some causes of Hydronephrosis?

A
  • congenital defect
  • result of obstructive uropathy
  • secondary to vesicoureteral reflux
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33
Q

S/S of Hydronephrosis reported in Health History

A
  • failure to thrive
  • intermittent hematuria
  • abdominal mass
  • s/s of UTI
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34
Q

Vesicoureteral Reflux

A

condition in which urine from the bladder flows back up the ureters

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35
Q

If the urine if infected and the kidney’s are exposed to bacteria then vesicoureteral reflux could lead to?

A

Pyelonephritis

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36
Q

Primary VUR results from what?

A

Congenital abnormality at the vesicoureteral junction that results in incompetence of the valve

37
Q

Secondary VUR is related to what?

A

Other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction

38
Q

How is VUR graded?

A

according to severity

39
Q

The goal of therapeutic management for VUR is what?

A

preventing pyelonephritis, renal scarring, and development of HTN later in life

40
Q

Which grades of VUR usually warrant surgery?

A

III, IV, V

41
Q

Teaching for Preventing Infection for VUR

A
  • empty bladder completely
  • perineal hygiene
  • toileting hygiene
  • antibiotic therapy as prescribed
  • give meds at bedtime b/c of urinary stasis overnight
42
Q

UTI

A

infection of the urinary tract most commonly affecting the bladder

43
Q

What is most often the cause of an UTI?

A

Most often occurs as a result of bacteria ascending to the bladder via the urethra

44
Q

UTI is most often cause by which bacteria?

A

E.coli

45
Q

S/S of UTI

A
  • jaundice
  • increased RR
  • perineal redness/irritation
  • blood,dark, cloudy, mucus, foul odor in urine
  • pallor
  • edema
  • elevated BP
  • distended bladder
  • abdominal mass
  • tenderness
46
Q

Lab/Diagnostic Tests for UTI

A
  • urinalysis
  • urine culture
  • renal ultrasound
  • VCUG
47
Q

Enuresis

A

continued incontinence of urine past the age of toilet training

48
Q

Nocturnal Enuresis usually resolves by what age?

A

6

49
Q

Enuresis may occur secondary to what physical disorders?

A
  • diabetes mellitus or insipidus
  • sickle cell anemia
  • ectopic ureter
  • urethral obstruction
50
Q

What are the most frequent causes of daytime enuresis?

A

dysfunctional voiding or holding of urine

51
Q

What are the most frequent causes of nocturnal enuresis?

A
  • high fluid intake in evening
  • obstructive sleep apnea
  • sexual abuse
  • family hx
  • inappropriate family expectations
52
Q

Nephrotic Syndrome

A

occurs as a result of increased glomerular basement membrane permeability, which allows abnormal loss of protein in the urine

53
Q

What is key to look for in nephrotic syndrome?

A

periorbital edema

54
Q

Nursing Management of Nephrotic Syndrome

A
  • promote diuresis; administer corticosteroids/furosemide
  • watch for hypokalemia
  • weigh daily
  • prevent infection
  • monitor temp
  • administer PCV vaccine
  • notify if exposed to chickenpox
55
Q

How long do you have to wait to deliver live vaccines if child is taking corticosteroids?

A

2 weeks

56
Q

Acute Post-streptococcal Glomerulonephritis

A

immune processes injure the glomeruli

  • occurs following an infection
  • occurs b/t ages 5-12
  • progresses to uremia and renal failure
57
Q

What will urine reveal w/ APSG?

A

proteinuria and hematuria

  • tea colored or cola colored or even dirty green
  • elevated ASO titer
58
Q

Hemolytic-Uremic Syndrome is defined by what 3 features?

A
  • hemolytic anemia
  • thrombocytopenia
  • acute renal failure
59
Q

Therapeutic Management for Hemolytic Uremic Syndrome

A
  • maintain fluid balance
  • correct HTN, acidosis, electrolyte imbalances
  • replenish circulating RBC
  • provide dialysis
60
Q

S/S of Hemolytic Uremic Syndrome

A
  • pallor
  • toxic appearance
  • edema
  • oliguria
  • anuria
61
Q

Causes of HUS

A
  • antecedent diarrheal illness
  • idiopathic
  • inherited
  • drug related
  • malignancies
  • transplantation
  • malignant HTN
62
Q

Renal Failure

A

condition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products
-acute or chronic

63
Q

Acute Renal Failure

A
  • sudden, often reversible, decline in renal function that results in the accumulation of metabolic toxins as well as fluid/electrolyte imbalance
  • when it continues to progress it becomes chronic
64
Q

End-Stage Renal Disease (ESRD)

A

chronic renal failure requiring long term dialysis or renal transplantation

65
Q

Nursing Goals for Child w/ ESRD

A
  • promoting growth and development
  • removing waste products and maintaining fluid balance
  • encourage psychosocial well-being
  • supporting/educating family
66
Q

Peritoneal Dialysis

A

uses abdominal cavity as a semipermeable membrane to help remove excess fluid and waste products

67
Q

Hemodialysis

A

removes toxins and excess fluid from the blood by pumping the child’s blood through a hemodialysis machine and then reinfusing the blood into the child

68
Q

Female Reproductive Organ Disorders

A
  • labial adhesions
  • vulvovaginitis
  • pelvic inflammatory disease
  • menstrual disorders
69
Q

Labial Adhesions

A

“Labial fusion”

partial or complete adherence of the labia minora

70
Q

Vulvovaginitis

A

inflammation of the vulva and vagina

71
Q

Causes of Vulvovaginitis

A
  • bacterial or yeast overgrowth
  • chemical factors: bubble baths, soaps, perfumes
  • poor hygiene
  • tight clothing
  • persistent scratching
72
Q

Pelvic Inflammatory Disease (PID)

A

inflammation of the upper female genital tract and nearby structures

73
Q

What are the 2 most common causes of PID?

A

gonorrhea and chlamydia

74
Q

Phimosis

A

foreskin of the penis cannot be retracted

  • normal in the newborn
  • topical steroid BID x 1 month
75
Q

Paraphimosis

A

more serious disorder characterized by retraction of the phimotic prepuce which causes a constricting band behind the gland of the penis and results in incarceration if left untreated

76
Q

Treatment for Paraphimosis

A
  • reduction of the prepuce of a small dorsal incision to release foreskin
  • circumcision
77
Q

What is considered a medical emergency for males?

A

swollen reddened penis and can quickly result in necrosis

78
Q

Hygiene for Uncircumcised Male

A
  • foreskin does NOT normally retract in newborn
  • change diaper frequently and wash penis daily
  • older infant foreskin retracts clean around glans once a week
  • dry area prior to replacing foreskin
  • always replace foreskin
  • teach preschool age to retract foreskin and clean during bath
79
Q

Benefits of Circumcision

A

decreased incidence of UTI’s, STI’s, AIDS, and penile cancer and in female partners a decreased occurrence of cervical cancer

80
Q

Complications of Circumcision

A

alterations in meatus, unintentional removal of excessive amounts of foreskin, or damage to the glans penis

81
Q

Hydrocele

A

fluid in the scrotal sac

  • benign/self limiting
  • spontaneously resolves by age 1
82
Q

Variocele

A

venous varicosity along the spermatic cord

  • swollen scrotal sac
  • mass on one or both sides and bluish discoloration
  • spermatic veins feel worm-like
83
Q

Testicular Torsion

A

a testicle is abnormally attached to the scrotum and twisted

  • requires immediate surgery
  • most common in boys ages 12-18 yrs
84
Q

Testicular Torsion can result in what if left untreated?

A

ischemia leading to infertility

85
Q

Epididymitis

A

inflammation of the epididymis

  • caused by infection w/ bacteria
  • rarely occurs before puberty
86
Q

What is the most common cause of pain in the scrotum?

A

Epididymitis

87
Q

If Epididymitis occurs before puberty it may be a result of what?

A

urethral or bladder infection related to urogenital anomaly

88
Q

Therapeutic Management of Epididymitis

A

directed toward eradicating bacteria

  • encourage rest w/ scrotum elevated
  • ice packs
  • analgesics/antibiotics
89
Q

What can Epididymitis cause if left untreated?

A

Scrotal abscess
Testicular infarction
Infertility

Pediatrics (24 decks)

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