Exam 1: Genitourinary Flashcards
(65 cards)
1
Q
Genitourinary System Differences
A
- Healthy infant, kidneys operate at functional level appropriate for body size (however function is reduced when the infant is under stress)
- By 6-12 months, kidney function is nearly that of an adult
- Young infant kidneys cannot concentrate urine as efficiently as those of older children and adults. Susceptibility to acemia.
- Neonates bladder, which is in lower abdominal cavity, gradually sinks into pelvic cavity during early childhood.
- Young children have shorter urethral, predisposing them to UTI’s.
- Unlike adults, most children with acute renal failure regain normal function.
2
Q
When do children gain complete bladder control?
A
4-5 y/o
3
Q
Why are young infant’s kidney not able to concentrate urine as efficiently as those of older children and adults?
A
- Because loops of Henle are not long enough to reach inner medulla.
- After few weeks of life, ability of kidneys to acidify urine reaches adult levels.
4
Q
Nephrotic Sydrome clinically includes
A
- Massive proteinuria
- Hypoalbuminemia
- Hyperlipidemia
- Edema
5
Q
Two Types of Nephrotic Syndrome
A
- Primary: restricted to glomerular injury
2. Secondary: Develops as a part of systemic illness
6
Q
What are clinical manifestations of nephrotic syndrome?
A
- Weight gain
- Puffiness in the face
- Edema → intestinal mucosa, abdominal
- Urine → decreased volume, darkly opalescent and frothy ( a lot of bubbles)
- Skin pallor
- Irritability
- Increased susceptibility to infection
7
Q
Diagnostic symptoms of nephrotic syndrome
A
- Massive proteinuria
- High specific gravity
- Elevated cholesterol & platelet count
8
Q
Treatment for Nephrotic Syndrome
A
Corticosteroid therapy
- PO for 3 months straight
- DO NOT STOP ABRUPTLY
- May become dependent
- Many side effects
9
Q
Nephrotic Syndrome relapses can occur if
A
Response to corticosteroid therapy is poor.
10
Q
Nursing care for nephrotic syndrome
A
- Monitor intake and output daily
- Monitor for skin breakdown → change diapers frequently and change positions frequently
- Susceptible to upper respiratory tract infections → steroids bring resistance down
11
Q
Vesicoureteral Reflux
A
- Retrograde of bladder urine into the ureters: the urine that is supposed to be stored in the bladder is now going back up through the ureters.
- Most common cause of pyelonephritis in children.
12
Q
Management of Grade I and II Vesicoureteral Reflux
A
- Conservative therapy with continuous low-dose ABT and frequent urine cultures (as long as they don’t have continuous UTIs).
- Usually high incidence of spontaneous resolution (children are small and the ureters may form a loop near the bladder but as they grow older the ureters will straighten out)
13
Q
Management of Grade III Vesicoureteral Reflux
A
Management conservatively unless complications
14
Q
Management of Grade IV and V Vesicoureteral Reflux
A
-Surgical correction is required: surgery will place ureters higher up on the bladder
15
Q
Hypospadius
A
- Urethral opening that is located below the glans penis.
- Can be anywhere along the ventral surface.
16
Q
Characteristics of Hypospadius
A
- Foreskin is usually absent ventrally.
- May have undescended testes.
- May be mistaken for female genitalia.
17
Q
Surgical Repair of Hypospadius
A
- Do not circumcise → the skin from the circumcision will be used in the repair
- Urinary diversion may be necessary after repair → avoid tub baths until recovered, never clamp together
- Avoid certain toys especially right after surgery (i.e ride along toys)
18
Q
HUS (Hemolytic Uremic Sydnrome) is an acute disease characterized by a triad of manifestations including:
A
- Acute renal failure
- Hemolytic Anemia
- Thrombocytopenia
19
Q
Hemolytic Uremic Syndrome (HUS) is caused by
A
- No causative agents identified -> many pathogens associated.
- Usually follows URI or GI disease.
20
Q
Clinical Manifestations of HUS
A
- Episode of diarrhea and vomiting
- Anorexia
- Irritable & Lethargic
- Pallor
- Bruising, purpura, rectal bleeding
- Anuria
- HTN
- Seizures
21
Q
How is HUS diagnosed?
A
- Triad is sufficient for diagnosis → proteinuria, hematuria, elevated creatinine and BUN
- Urinary casts
- Low Hgb and Hct
- High reticulocyte count
22
Q
Management of HUS
A
- Recognize what it is that is going on and counteract it. If this is done, there is 95% change of full recovery
- Fluid replacement
- HTN treatment
- Correction of acidosis and electrolyte imbalance
- Hemodialysis
- Blood transfusions
- TPN
- Symptom treatment
23
Q
Glomerulonephritis
A
- Immune complex disease
- Most cases are post infectious associated with pneumococcal, streptococcal and viral infections.
24
Q
Glomerulonephritis: Latent period
A
10-14 days after infection
25
Glomerulonephritis Incidence
- Primarily affects school-age children; peak onset 6-7 y/o; uncommon in <2 years.
- Most common in winter and spring.
- Second attacks are rare
26
Glomerulonephritis: The kidneys
- Appears normal to moderately enlarged.
- Decreased GFR
- Microscopic exam: diffuse proliferations and exudative process
27
Clinical Manifestations of Glomerulonephritis
- Facial puffiness
- Edema that is prominent in the face in the morning and spreads to the extremities and abdomen as the day progresses.
- Anorexia
- Urine that is cola-colored, cloudy and decreased in volume
- Paleness
- Irritability
- Headaches
- Abdominal discomfort
28
How long does glomerulonephritis persist for?
4-10 days
29
How can glomerulonephritis affect BP?
-Blood pressure may rise
30
What is a sign of improvement of glomerulonephritis?
-Increase in urine output
31
Evaluation of Glomerulonephritis
- UA
- Culture
- Labs
32
Major Complications of Glomerulonephritis
- Hypertensive enchepalopathy
- Acute cardiac decompensation
- Acute renal failure (Most children obtain complete recovery → recover spontaneously)
33
Treatment for Glomerulonephritis
- ABT only if infection is present
| - Antihypertensives
34
Management of Glomerulonephritis
- Sodium and water restriction is useful
- Monitor BP q4-6 hours
- Restrict foods high in K
35
Acute Renal Failure
- Usually reversible
| - Prevention is key
36
Most common cause of acute renal failure in children
- Dehydration
| - Other cause of poor perfusion that respond to fluid restoration
37
What are primary manifestations of acute renal failure?
- Oliguria
| - < 1mg/kg/hr
38
Management of Acute Renal Failure
- Avoid nephrotoxic drugs
| - Monitor/assess fluid and electrolyte balance
39
Chronic Renal Failure
Onset is gradual
40
Most common causes of chronic renal failure include
- congenital renal disease,
- urinary tract malformations
- vesicoureteral reflux
41
What is the most reliable indicator for chronic renal failure?
Creatinine
42
Treatment for Chronic Renal Failure
Dialysis or Transplantations
43
Consequences of Chronic Renal Failure
- Delayed growth or absent sexual maturation
- Risk for infection
- School may be difficult
- Social isolation
- Allow children to set their own activity limits
44
Nocturnal Enuresis
Occurs at nighttime during sleep
45
Diurnal Enuresis
Occurs during waking hours
46
Primary Enuresis
A child never having experienced a period of dryness (never able to potty train)
47
Secondary Enuresis
Onset of wetting after urinary continence is established
48
Enuresis Cause/Incidence
- No single cause
| - Occurs more frequently in boys
49
Evaluation of Enuresis
- H&P
- Urinalysis
- Urine Culture
- Glucose Test (looks for diabetes)
- Bladder ultrasound/VCUG (looks for structural issues)
50
Management of Enuresis
- Limiting fluids after dinner
- Avoid sugar and caffeine intake after 4pm
- Reward systems
- Behavioral conditioning
- Voiding frequently
51
Urinary Tract Infection
-May be present with or without symptoms
52
UTI: Incidence
-Peak incidence 2-6 yrs: Not caused by structural anomalies
53
Who has the highest risk for UTI’s?
- Uncircumcised males <3 months
| - Females <12 months
54
What organisms can cause UTI’s?
E-coli and other gram negative organisms
55
If the first urinary tract infection occurs during infancy, there is a
Greater chance for renal scarring
56
What can cause UTI’s?
- Dysfunctional voiding
- Urinary stasis
- Presence or absence in foreskin contributes
57
What increases the risk for UTI’s?
- Pregnancy
- Intermittent constipation
- Short-term indwelling catheters
- Tight clothing or diapers
- Poor hygiene
- Sexual intercourse
58
Clinical Manifestations of UTI’s in Neonates
- Irritability
- Poor feeding
- Respiratory distress
- Screaming with urination
59
Clinical Manifestations of UTI’s in Infancy
- Vomiting
- Persistent diaper rash
- Dehydration
60
Clinical Manifestations of UTI’s in Childhood
- Poor appetite
- Excessive thirst
- Frequent/painful urination
- Bloody urination
61
UTI: Diagnostics
- UA: cloudy/hazy; thick noticeable strands of mucous; fishy smell
- Culture: presence of bacteria (make sure a sterile specimen was collected)
62
Management Goals for UTI’s
- Eliminate current infection
- Identify contributing factors to reduce reoccurrence
- Prevent urosepsis
- Preserve renal function
63
Treatment for UTI’s
- ABT based on culture results
| - Surgical correction for anatomical defects
64
Management of UTI’s
- Collect specimen prior to starting antibiotics
- Ultrasound and VCUG
- Encourage fluid intake and avoid caffeine/carbonation.
65
Admission Criteria for UTI’s
- Age <60 days
- Patient is toxic or ill appearing
- Patient is dehydrated or unable to retain oral fluids
- Pain requiring parental narcotics
- Patient with known or suspected genitourinary anomalies
- Failure of outpatient management
- Uncertainty about outpatient compliance or primary care provider availability
