Exam 3 Peds GU

Question 1

Anatomical and physiological differences between children and adults

Answer 1

Urinary concentration
Structural differences
Urine output
Reproductive organ maturity

Question 2

Opening of the urethra is on the ventral surface of the penis

Answer 2

Hypospadias

Question 3

Opening of the urethra is on the dorsal surface of the penis

Answer 3

Epispadias

Question 4

When is hypo/epispadias surgically repaired?

Answer 4

By 1 year

Question 5

Assessment for hypo/epispadias

Answer 5

Insepct penis for placement of urethre
Chordee
Palpate for presence of testicles

Question 6

Routine post-operative care for hypo/epispadias

Answer 6

Foley – be sure is secured in order to not place stress on incisions
Antibiotics, pain medications, anti-spasmodics
Double diaper

Question 7

UTI

Answer 7

Occurs due to bacteria ascending to the bladder from the urethra
Most common serious bacterial infection in children

Question 8

Who is at the highest risk for a UTI?

Answer 8

Infants and young children
Until age 1 more common in males than females
Then more common in females than males

Question 9

Presentation of UTIs in children

Answer 9

Poor appetite, enuresis, frequent urination, fatigue, blood in urine, painful urination, abdominal or back pain

Question 10

Presentation of UTIs in infants

Answer 10

Poor feeding or vomiting, screaming on urination, fever, strong smelling urine, persistent diaper rash, dehydration

Question 11

UTI pathogens

Answer 11

E. Coli (80%)
Klebsiella
Staph
Pseudomonas

Question 12

Causes of UTIs

Answer 12

#1 is urinary stasis
Decrease fluid intake
Alkaline urine

Question 13

Lab and Diagnosis tests for UTIs

Answer 13

Urinalysis (UA)
Urine culture
Renal ultrasound
VCUG

Question 14

Nursing interventions for UTIs

Answer 14

Administer antibiotics to eliminate infection
Surgery correction if cause is anatomic defect
Encourage PO intake or IVF – avoid cola or caffeine
Urinate frequently, empty bladder completely
Promote hygiene
No bubble baths, cotton underwear, to tight pants, wipe from front to back, wash area daily with soap and water
Teenagers  educate to void after intercourse
Administer antipyretics if needed, heating pad
Educate parents on how to prevent recurrent infection

Question 15

Vesicoureteral Reflux

Answer 15

Urine from the bladder flows back up the ureters
Occurs with bladder contraction during voiding
After voiding goes back into bladder is a great place for bacterial growth until next void  leads to kidney infections

Can lead to renal scarring and hypertension

Question 16

Signs and symptoms for assessing Vesicoureteral reflux

Answer 16

Fever
Dysuria or hematuria
Frequency or urgency
Nocturia
Back or abdominal pain

Question 17

Physical exam for Vesicoureteral reflux

Answer 17

Monitor BP (could be elevated)
Palpate abdomen for hydronephrosis
History of frequent UTIs? Congenital defects?

Question 18

Nursing interventions for Vesicoureteral Reflux

Answer 18

Antibiotic prophylaxis
Proper hygiene/voiding practices
Serial urine cultures (every 2-3 months and with fevers) and annual VCUG to assess progression of reflux
Many children will outgrow over a period of years

Question 19

Goal of vesicoureteral reflux management

Answer 19

To prevent pyelonephrosis and renal scarring

Question 20

When does vesicoureteral reflux require surgical intervention?

Answer 20

For grade 3-5

Question 21

Obstructive uropathy

Answer 21

An obstruction at any level along the upper or lower urinary tract that blocks the normal flow of urine

Question 22

What can obstructive uropathy lead to?

Answer 22

Dilation of the affected kidney (hydronephrosis) and ureter
Recurrent UTI
Renal insufficiency
Progressive damage to kidney

Question 23

Common signs and symptoms of obstructive uropathy

Answer 23

Recurrent UTI
Incontinence
Fever
Flank pain
Urinary frequency 
Hematuria

Question 24

Postop care for surgical correction of obstructive uropathy

Answer 24

Monitor UOP
Encourage PO or IVF
Pain meds or antispasmodics
Educate parents

Question 25

What to monitor with obstructive uropathy

Answer 25

Palpate abdomen for masses | Monitor BP

Question 26

A clinical state that occurs as a result of increased glomerular basement membrane permeability to plasma proteins Allows abnormal loss of protein in the urine

Answer 26

Nephrotic Syndrome

Question 27

3 forms of nephrotic syndrome

Answer 27

Congenital Idiopathic (80%) Secondary

Question 28

Speculated Causes of Idiopathic nephrotic syndrome

Answer 28

Metabolic Biochemical, physiochemical Immune-mediated response

Question 29

Patho of nephrotic syndrome

Answer 29

Increased glomerular permeability allows passage of larger plasma proteins through the glomerular basement membrane Results in an excess loss of protein (albumin) in the urine (proteinuria) Have a decreased amount of protein in blood (hypoalbuminemia) Causes a change in osmotic pressure and fluid shifts from bloodstream into interstitial fluid, edema (especially the abdominal cavity, called ascites) Lowers blood volume (hypovolemia) which “starves” kidneys, they hold on to Na and H2O, more edema Liver senses the protein loss and increases production of lipoproteins Results in hyperlipidemia because lipids cannot be excrete in urine At increased risk for clotting because of decreased intravascular volume Also at increased risk for infection or renal failure Diagnosis: Clinical manifestations (especially weight gain), labs

Question 30

Common signs and symptoms of nephrotic syndrome

Answer 30

Recent wt gain History of periorbital edema when awakening then generalized edema during day Abdominal swelling (ascites) Pleural effusion, labia or scrotal swelling Weakness or irritability Decreased urine volume, frothy Susceptible to infection

Question 31

Physical exam for nephrotic syndrome

Answer 31

Edema BP – normal or slightly decreased Heart and lung sounds Palpate skin and abdomen

Question 32

Lab and Diagnostic tests for nephrotic syndrome

Answer 32

Clinical manifestations: Urinalysis Marked proteinuria Mild hematuria, if any Serum protein and albumin levels low Serum cholesterol and triglyceride levels elevated Eventually BUN and Cr will become elevated Renal biopsy done if does not respond to treatment

Question 33

Management objectives for nephrotic syndrome

Answer 33

Reducing excretion of urinary protein Reducing fluid retention Preventing infection Minimizing complications related to therapies

Question 34

Diet for nephrotic syndrome

Answer 34

Low salt diet, possible fluid restriction

Question 35

Meds for nephrotic syndrome

Answer 35

If edema is severe – diuretics and albumin Infection - abx Corticosteroids – 1st line of therapy for NS Prednisone for 21 days then taper off About 2/3 will relapse Repeat course of steroid therapy or other immunosuppressive meds May last for many years

Question 36

Continued monitoring for nephrotic syndrome

Answer 36

``` Continuous monitoring of fluid retention or excretion Strict I & O Daily weight Measure abd girth In-depth skin assessment Monitor VS Protect against infection Promote adequate nutrition Protein rich snacks ```

Question 37

Parent education for nephrotic syndrome

Answer 37

``` Signs of relapse Urine dipstick at home Prevent infection but CAN go to school Mood swings related to steroids Emotional toll of relapse ```

Question 38

Acute Glomerulonephritis

Answer 38

Immune complexes are deposited in the glomerular basement membrane Causes inflammation and edema due to leukocytes Altered glomerular structure and function in both kidneys (cannot filter properly) Results in excessive amounts of water and retention of Na  expands plasma and interstitial fluid volumes  circulatory congestion (HTN) and edema

Question 39

When does Acute Glomerulonephritis usually occur?

Answer 39

After an infection Acute post streptococcal glomerulonephritis (Group A ß-hemolytic streptococcus) Latent period of 10-21 days after infection

Question 40

Acute Glomerulonephritis clinical manifestations

Answer 40

Edema – periorbital and then spreads to extremities and abdomen Gross hematuria – causes discoloration of urine (cloudy, smoky brown like cola or tea) Mild proteinuria Severely reduced urine volume Mild to moderately elevated blood pressure (HA) Pallor, irritability, lethargy, anorexia, child appears ill Diagnosed with + antistreptolysin O (ASO) titer Might have a CXR (cardiac enlargement, pulmonary congestion, pleural effusion) during the edematous phase

Question 41

Diagnosis and treatment of Acute Glomerulonephritis

Answer 41

Diagnosed with + antistreptolysin O (ASO) titer and clinical manifestations Might have a CXR (cardiac enlargement, pulmonary congestion, pleural effusion) during the edematous phase No treatment – just supportive measures Diet – moderate sodium restriction, possible fluid restriction if severe edema, K restriction during oliguric phase Measure VS, wt, strict I & O Determine HTN early and give antihypertensives or diuretics Give abx if strep is still positive Daily wt is the best way to assess fluid balance Bed rest during acute phase then allow frequent rest periods