Exam 2: GU Flashcards
(31 cards)
Kidneys function thorough:
filtration, reabsorption, and secretion
Kidney function
Nephrons
Filtration occurs at the glomerulus, bowman’s capsule, and the basement membrane
as the child grows concentration of urine becomes more effecient
Under 2 years old, kidneys less efficient
Ureters
carry waste fluid from kidneys to bladder
bladder
stores urine
bladder capacity in ounces estimated by adding 2 to child’s age
muscular organ
Urethra
excretes urine
urine excretion occurs around the 12th week of gestation
Clinical Manifestations of GU Problems
Symptoms/Assessment of: Urine Characteristics Edema Genitalia Sexual development
Urine Output: Infants, Children, Adolescents
Infants: 2ml/kg/hr
Children: 0.5-1kg/hr
Adolescents: 40-80ml/hr
Diagnostic Tests
urine culture
intravenus pyelogram
renal or bladder ultrasound
voiding cystourethrogram
Lab Tests (BUN, creatinine, Cr. Clearance, electrolytes, UA)
Urinanlysis
Color: pale yellow, clear
Odor: Ammonia like smell
Spec. Gravity: = 1.010
pH: 4.5-8
Protein: Negative <150mg/24hr
Glucose: <130mg/24hr
Ketones/Bilirubin/Heme: Negative
Structural Defects of the Urinary System
Hypospadias and epispadias
Nursing Care: Postop hypo/epi spadias repair
double diapering to protect stent
dont bathe child until stent is removed
restrict activities that put pressure on surgical site (2 weeks)
fluids
antibiotics
s/s infection
urine will be blood tinged for several days. Call dr if urine is leaking from any other area than penis
Pediatric Nephrosis S/S
edema
massive proteinuria
hypoalbuminemia
hypoproteinemia
hyperlipidemia
altered immunity
Primary vs secondary nephrotic syndrome
primary: disease that directly affects only the kidney
Secondary: results from a systematic disease, drugs, or toxin
MCNS (Minimal Change Nephrotic Syndrome)
Most common
90% of cases under age of 10 years and more than 50% in older children
MCNS (Minimal Change Nephrotic Syndrome)
Most common
90% of cases under age of 10 years and more than 50% in older children
Nephrotic Syndrome: Edema
primarily related to proteinuria
Nephrotic Syndrome: Altered immunity
related to loss of immunoglobulins
Nephrotic Syndrom: Hypoalbuminemia
related to:
insufficient albumin production in the liver
a decreased albumin concentration in kidneys due to retention of Na and H20
Nephrotic Syndrome: Hypercoagulability
related to alterations in coagulation factors
Nephrotic Syndrome: hyperlipidemia
related to increased synthesis of lipoprotein due to an “over” stimulation of liver synthesis from hypoalbuminemia
MCNS: Clinical manifestations
comes on fairly fast (over days)
1st thing noticed: puffy eyes in the morning
As the child is up and around and the day goes on, gravity pulls that fluid down, and the abdomen seems big and the feet swell (edema)
Hematuria - blood in urine
Malnouishment due to loss of protin in urine can be masked by swelling
Further complications of MCNS
respiratory distress r/t pleural effusion
thrombosis
heart failure: r/t pulmonary edema
renal failure
MCNS: Peds Assessment
Focus On:
Signs of fluid volume excess
Complications
Psychosocial impact on child and family
Key Points:
Hydration status and edema
I/Os
Daily weight
Measure abd. girth
VS Q4h (resp distress/htn/circulatory overload)
Urine tests Qshift (protenuria, specific gravity)
Assess for hypervolemia during periods of diuresis
Skin breakdown!
Monitor dietary intake
MCNS: Parents should look for
Sung fitting clothing/shoes
anorexia
pallor
hematuria
htn
decreased UO
irratibility
malaise
frothy/foamy urine
malnurishment
