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Pediatrics > Alterations in Genitourinary Function > Flashcards

Alterations in Genitourinary Function Flashcards

1
Q

Genitourinary Function

A

All nephrons present at birth (but continue to enlarge)
Most renal growth occurs in first 5 years of life
Efficiency of kidneys increases with age (increases markedly at age 2 years)
Urine output/kg higher in infancy
Bladder capacity at birth approx. 20-50 mL
Shortness of urethra may contribute to UTI
Reproductive system functionally immature until puberty

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2
Q

Hypospadias & Epispadias

A

Failure of urethral folds to fuse completely over urethral groove
Diagnosis made at birth - careful assessment!
Do not circumcise (not up to us to decide. If wanted, don’t initially circumcise because they need the foreskin for the surgery to correct the urinary stream)
Repaired surgically (usually in 1st year of life)
(placement of urethral meatus at end of glans penis to correct urinary stream. Improve physical appearance, preserve sexually adequate organ by release of chordee to straighten penis)

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3
Q

Hypospadias

A

Urethral meatus anywhere on ventral side (underside)
Often occurs with congenital chordee

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4
Q

Epispadias

A

Meatal opening on dorsal surface
Often occurs with exstrophy of bladder

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5
Q

Nursing Management of Hypospadias and Epispadias - Post-op

A

Protect surgical site from injury (pressure dressing); maintain urethral stent
Fluid intake to maintain urine output & patency of stent; accurate I&O
Pain management; may have bladder spasms
Looking for urine output!

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6
Q

Medications for Hypospadias and Epispadias

A

Analgesics, anticholinergics, antibiotics

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7
Q

Discharge teaching for Hypospadias and Epispadias

A

Avoid tub bath until stent removed; antibiotic ointment; catheter care

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8
Q

Bladder Exstrophy

A

Posterior bladder wall extrudes through lower abdominal wall. Upper urinary tract usually normal.
Bladder mucosa appears as mass of bright red tissue & urine continually leaks from open urethra
this is an emergency

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9
Q

Bladder Exstrophy: Treatment is surgical reconstruction in several stages

A
  • Bladder closure (within 48 hours)
  • Esispadias repair (9 months)
  • Reconstruction of bladder neck & ureteral reimplantation (3-5 years)
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10
Q

Bladder Exstrophy: Goals of Treatment (5)

A

Preservation of renal function
Attainment of urinary control
Adequate reconstructive repair for psychologic benefit
Prevention of UTI
Preservation of external genitalia with continence & sexual function

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11
Q

Bladder Exstrophy: Pre-Op Care

A
  • prevention of infection & trauma to exposed bladder
  • cover bladder mucosa in sterile plastic wrap
  • clean surrounding area & protect from leaking urine
  • fluid management is critical!
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12
Q

Bladder Exstrophy: Post-Op Care

A
  • manage pain & agitation
  • immobilize wound & pelvis (traction)
  • avoid abduction of legs
  • maintain proper alignment, monitor peripheral circulation, provide meticulous skin care
  • monitor renal functioning
  • offer emotional support
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13
Q

Obstructive Uropathy

A

Structural or functional abnormalities of urinary system that interfere with urine flow
Often causes hydronephrosis which results in:
- cessation of glomerular filtration
- metabolic acidosis
- inability to concentrate urine (polyuria, polydipsia)
- urinary stasis (bacterial growth) -
- restriction of urinary outflow (progressive renal damage)

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14
Q

Most common site of obstruction

A

UPJ (ureteropelvic junction) is most common site of upper obstruction
Early diagnosis & treatment essential to prevent permanent renal damage
Transient or permanent urinary diversion may be required

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15
Q

Obstructive Uropathy: Surgery to correct or divert urine flow

A

Pyeloplasty (removal of obstructed segment of ureter & reimplantation into renal pelvis) or valve or reconstruction

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16
Q

Obstructive Uropathy: Post- op

A

May have urinary incontinence
Monitor for urine retention
Discharge teaching re: dressings, catheters, stents, signs of obstruction or infection, urinary diversion systems
Avoid contact sports

17
Q

Urinary Tract Infection

A

Involves lower or upper urinary tract
Acute or chronic (recurrent or persistent)
Uncircumcised males < 3 months & females < 12 months have highest prevalence
Incidence increases in teenage girls who are sexually active
E. coli, Staphylococcus aureus, Klebsiella Proteus, Pseudomonas, Haemophilus

18
Q

Clinical manifestations of UTI: Infants (11)
(PPUFFR HIVSS)

A
  • poor feeding
  • persistent diaper rash
  • unexplained fever
  • failure to thrive
  • fever
  • renal tenderness
  • hypothermia
  • irritability or lethargy
  • vomiting & diarrhea
  • strong-smelling urine
  • sepsis
19
Q

Clinical Manifestations of UTI: Older Children
(DUI FHEAPS)

A
  • Dysuria
  • Urgency or hesitancy
  • Increased Frequency
  • Fever
  • Hematuria
  • Enuresis or new-onset incontinence
  • Abdominal tenderness or lower abdominal pain
  • Poor appetite
  • Strong-smelling urine
20
Q

Etiology and Patho of UTI

A

Urinary stasis: abnormal anatomic structure or abnormal function. infrequent voiding
Vesicoureteral reflux: back flow of urine from bladder into ureters which creates reservoir for bacteria. Structural anomaly

21
Q

Kidney Damage

A

May result from vesicoureteral reflux & recurrent UTIs
Risk increases if:
- < 1 year of age
- delay in effective antibiotics for upper UTI
- anatomic or neurologic obstruction
- recurrent episodes of upper UTI

22
Q

Diagnosis and Management of UTI

A

Urine specimen: Dipstick. C&S, midstream, catheter, suprapubic, urine bag
Radiologic studies: renal ultrasound (soon after diagnosis). Voiding cystourethrogram (3-6 weeks after infection cleared if renal ultrasound abnormal or 2nd infection) DMSA
Antibiotic therapy: follow-up cultures - 48-72 hours, monthly for 3 months, q3 months for 6 months and then annually

23
Q

Nursing Management UTI

A

Antibiotics & antipyretics
Encourage fluid intake; Document I&O
- infants 2-3 ml/kg/hr; children 1-2 ml/kg/hr
Encourage frequent voiding; post-void catheterization
Child may regress & become incontinent
Prevention (especially girls)
- wear cotton underwear, avoid tight-fitting pants, wipe from front to back after BM, avoid “holding” urine, generous fluid intake

24
Q

Nephrotic Syndrome

A

Clinical entity produced by loss of urinary protein
Kidney’s release protein inappropriately that causes a shift in fluid and causes edema

25
Q

Clinical manifestations of Nephrotic Syndrome (HHEPA)

A

Proteinuria
Hypoalbuminemia
Edema (periorbital edema)
Hyperlipidemia
Altered immunity

26
Q

Etiology of Nephrotic Syndrome

A

Congenital: autosomal recessive. extremely rare.
Primary: kidney is main or only organ involved. Results from disease (glomerulonephritis)
Secondary: caused by systemic disease (diabetes, lupus, sickle cell anemia), drugs, or toxins

27
Q

Minimal Change Nephrotic Syndrome (don’t see any changes in the kidneys)

A

80% of cases
Predominantly seen in preschool child
- rare if < 6 months
- uncommon in < 1 year
- unusual if > 8 years
Boys > girls in childhood; equal in adolescence
Glomeruli appear normal or show minimal changes
Nonspecific illness, usually URTI precedes manifestations by 4-8 days
- precipitating factor rather than a cause

28
Q

More Manifestations of Nephrotic Syndrome

A

Perioribital edema or waking that resolves during the day (moves to abdomen, genitalia, or lower extremities)
Weight gain
Urine decreased; foamy or frothy
Edema - ascites, pleural effusion, labial or scrotal swelling
BP may be increased
Sign of malnutrition (protein loss) -> hair changes, pallor, shiny skin with prominent veins
Irritable, lethargic, fatigues, susceptible to infections

29
Q

Diagnostic test for Nephrotic Syndrome

A

History, physical, characteristic symptoms, lab (serum albumin, urinalysis, BUN, creatinine)

30
Q

Treatment of Nephrotic Syndrome

A

Generally treated as outpatient
Diet - normal for age
- do not restrict protein intake unless renal failure
- “no added salt” if massive edema during corticosteroid period
Medications
- corticosteroid therapy (95% have complete remissions)
- IV albumin
- Immunosuppressant therapy
- diuretics

31
Q

NS: Prognosis is related to response to steroid therapy

A

Steroid responsive: amount of protein in urine decreases to negative or trace within 10-15 days. relapses may occur following illness
Frequent relapse: respond but relapse at least 2x within 6 months; 4+ relapses within 12 months
Steroid-dependent: 2 consecutive relapses while on steroid therapy or within 2 weeks after steroid therapy discontinued
Steroid-unresponsive: no remission after 4 weeks of prednisone

32
Q

Nursing Management of NS

A

Strict I&O
Urine dip for protein
Daily weight
Vs - watch BP
Medications (side effects of corticosteroids. hypertension & volume overload (albumin))
Prevent infection
Prevent skin breakdown
Nutritional & fluid needs
Promote rest
Emotional support

33
Q

Hemolytic-Uremic Syndrome: Hamburger Disease
Triad of signs (HIGHLIGHTED)

A

Hemolytic anemia
thrombocytopenia
acute renal failure - may progress to chronic renal failure

34
Q

Hemolytic-Uremic Syndrome

A

Rare acute renal disease
6 months to 3 years
usually follows mild gastroenteritis with diarrhea, URI, or UTI
Linked to E coli

35
Q

Clinical Manifestations of HUS: Prodromal (1-7 days)

A

upper respiratory illness
abd pain with nausea, vomiting, blood diarrhea
pallor
fever
irritability
lymphadenopathy
skin rash
edema
severe gastro with bloody diarrhea

36
Q

Clinical Manifestations of HUS: Acute Stage

A

hemolytic anemia
hypertension
purpura (purple and nonblanching rash)
neurologic involvement (seizures, lethargy, stupor, coma, cerebral edema)
hematuria & proteinuria
oliguria or anuria
edema & ascites

Pediatrics (25 decks)

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