Exam 3 Genitourinary Disorders Flashcards Preview

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Flashcards in Exam 3 Genitourinary Disorders Deck (32):
1

Genitourinary Disorders (4)

UTI
Acute Glomerulonephritis
Nephrotic Syndrome
Wilm's Tumor

2

Urinary Tract Infection
1) Lower Urinary Tract (2)
2) Upper Urinary Tract (4)

1) Urethra, Bladder
2) Ureters, Renal Pelvis, Calyces, Renal Parenchyma

3

Upper UTI - AKA _____ _____ can lead to (3)

Acute Pyelonephritis
1) Renal Scarring
2) HTN
3) End-Stage Renal Disease

4

Bacterial causes of UTI's (6)

- E. coli (80%)
- Proteus pseudomonas
- Klebsiella
- Staph. Aureus
- Haemophilus
- Coagulase-negative staphylococcus

5

Single Most Important Contributing factor to UTI =

So we want to tell toddlers to do what?

Why are females more at risk?

= Urinary stasis (incomplete emptying of bladder)

= Double Void

= have a SHORTER URETHRA

6

UTI structural/functional causes

1) ____ (bladder urine into ureters)
2) ______ abnormalities
3) _____ of ____ ______
4) Bladder ______

1) Reflux
2) Anatomic
3) Dysfunction of Voiding Mechanism
4) Compression

7

Clinical Manifestations of UTI in infancy
P
P
P
F
F
F
F
V

- Poor feeding
- Pallor
- Persistent diaper rash
- Fever
- Foul-smelling urine
- Frequent urination
- Failure to thrive
- Vomiting

8

Clinical Manifestations of UTI in Childhood
1) Where is the pain located?
-____/____ of urination, D____, H____, E____, I_____
- ____ appetite, v____, excessive ____
- G____ failure, Facial _____
-P___, F____

1) Suprapubic (lower abdominal pain)
- frequency, urgency of urination, dysuria, hematuria, enuresis (bedwetting), incontinence
- Poor appetite, vomiting, excessive thirst
- Growth failure, Facial Swelling
- Pallor, Fatigue

9

Diagnostics of UTI
1) Urine Culture (3)
2) Urinalysis (3)
3) May need (2)

1) (sterile)
- Clean catch (not sterile) 1st choice bc least invasive
- Sterile catheterization
- Suprapubic aspiration (lidocaine to site first)

2) Leukocytes, Nitrates, Blood

3) Renal Ultrasound, or VCUG (Voiding cystourethrogram)

10

Tx for UTI =

- If < 2 yo what needs to happen? Risk for (2)

- If VUR = __________ may need?

= PO Antibiotics

- Hospitalization + IV antibiotics, Risk for bacteremia, sepsis

- Vesicoureteral Reflux, may need surgical correction bc indicates anatomical obstruction

11

Nephrotic Syndrome =

= most common presentation of glomerular injury in children

12

Causes of Nephrotic Syndrome (3)

1) Idiopathic
2) Congenital/Genetic
3) Secondary to Lupus

13

Characteristics of Nephrotic Syndrome (4)*

1) Proteinuria
2) Frothy and Foamy urine
3) Hypoalbuminemia
4) Hyperlipidemia

14

Nephrotic Syndrome
- ______* especially when?
- Weight ____ (___)
- Abdominal _____
- D______ (bc?)
- A______
- Easily ______
- _____ urine volume

- Facial edema (especially seen when you wake up, will go away once start walking for a bit)
- Gain (edema)
- Swelling
- Diarrhea - dt edema in intestinal mucosa
- Anorexia
- Fatigued (dt fluid overload)
- Decreased urine volume

15

Diagnostics for Nephrotic Syndrome
1) Urinalysis will show __+ of what?
2) 24 hour urine protein = > ___mg/kg/day = consistent with nephrotic syndrome
3) Serum albumin will be high or low?
4) Serum protein will be high or low?
5) Renal ____

1) 3+
2) > 50 mg/kg/day
3) low
4) low
5) Biopsy

16

Tx for Nephrotic Syndrome Goals
1) Reduce =
2) Reduce =
3) Keep child as ____ as they are comfortable with

1) Excretion of urinary protein
2) Fluid retention
3) active

17

Nephrotic Syndrome Dietary Restriction =

- ____ Restrictions = w ____ in severe cases

= Low Salt Intake

- Fluid, diuretics

18

Medication for Nephrotic Syndrome*

Dosage
- __ mg/kg/day for __ weeks followed by
- __ mg/kg/day for ___ weeks

SE (7) for long term steroid tx

Corticosteroids*

- 2 mg, 6 wks
- 1.5 mg, 4 wks

Weight gain, Infection, Growth Retardation, Increased Appetite, Rounding of Face, Hypertension, Hyperglycemia

19

Nursing Management for Nephrotic Syndrome
1) Monitor for ___ retention and excretion, strict ___'s
2) ____ examination for ___ via __ _____
3) Daily ____, measurement of ____ girth
4) Monitor ____ ___ (dt increased risk for infection)

1) Fluid, I/O's
2) Urine, protein, UA dipstick
3) Weights, abdominal
4) Vital Signs

20

Parent Education for Nephrotic Syndrome
1) ___/___ children will relapse -> ___ ___ minimizes damage to kidney
2) __/__ of nephrotic syndrome
3) urine ____ at home

1) 2/3, early detection
2) S/S
3) dipsticks

21

Acute Glomerulonephritis Causes- Post infection dt (3)

Most common type in children is?

1) Streptococcal*
2) Pneumococcal
3) Viral

Acute Post Streptococcal Glomerulonephritis (APSGN)

22

Acute Post Streptococcal Glomerulonephritis

Occurs __-__ days after strep infection/dental work in certain strains that cause __-___ to deposit in glomerular ___ membrane -> glomeruli become ____, ___ the c___ l___

Peak Age = __-__ y
Uncommon in < ___ y
What seasons?

- 10-21, immune complexes, basement, edematous, occludes the capillary lumen

6-7 yo
< 2 y uncommon
More common in winter and spring

23

Clinical Manifestations of AG
1) ______*** __+, due to?
2) E____ due to? How does it progress?
3) L____
4) D____
5) H_____
6) P_____

How do you know the severity of renal disease?

1) HEMATURIA** 3+ dt bleeding in upper urinary tract -> smokey, cola/tea colored urine
2) Edema - generalized edema dt decreased GFR, Begins w periorbita edema -> LE -> ascites
3) Loss of Appetite
4) Decreased Urine Output
5) Hypertension
6) Proteinuria

Severity increases with increased amount of protein

24

Dietary Restrictions for AG
- Moderate ____, fluid _____

- moderate salt, fluid restriction

25

Regular Measurements to assess progression of AG disease
- ___ signs, body ____, __/__'s

- vital, weight, I/O's

26

Teaching for AG
- Do children die from this often?
- Specific ____ is acquired -> reoccurances are ___

- almost all children w APSGN recover completely
- immunity, uncommon

27

Wilm's Tumor =

- ___ common renal malignancy in children
- Peak age of diagnosis is ___ yo
- more frequent in females or males?
- Associated with GU a_____ and s____

= AKA nephroblastoma - malignant renal and intra-abdominal tumor of childhood

-Most
- 3 yo
- males
- anomalies, syndromes

28

Clinical Manifestations of Wilm's Tumor
1) ____ abdominal girth
2) Abdominal ___/___ is ___ and ___ tender on ___ side*
3) H____*
4) H_____
5) F____
6) Weight _____

1) Increased
2) swelling/mass is firm and non tender on one side
3) Hypertension
4) Hematuria
5) Fatigue
6) Loss

29

Tx for Wilm's Tumor =

= Surgical removal followed by chemotherapy

+/- radiation

30

NEVER ____ Wilm's Tumor, why?

- PALPATE, bc manipulation of tumor may cause spread of cancer cells to adjacent sites

31

Pre/Post op Wilm's tumor, Monitor what? why?

BP closely! bc at increased risk for HTN

32

Child and Family Teaching for Wilm's Tumor
- How soon is surgery performed after diagnosis?
- ____ is started immediately after surgery

- 24-48 hours
- chemotherapy