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Flashcards in Exam 3 Peds GU Deck (41)
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1

Anatomical and physiological differences between children and adults

Urinary concentration
Structural differences
Urine output
Reproductive organ maturity

2

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

Hypospadias

3

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

Epispadias

4

When is hypo/epispadias surgically repaired?

By 1 year

5

Assessment for hypo/epispadias

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

6

Routine post-operative care for hypo/epispadias

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

7

UTI

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

8

Who is at the highest risk for a UTI?

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

9

Presentation of UTIs in children

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

10

Presentation of UTIs in infants

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

11

UTI pathogens

E. Coli (80%)
Klebsiella
Staph
Pseudomonas

12

Causes of UTIs

#1 is urinary stasis
Decrease fluid intake
Alkaline urine

13

Lab and Diagnosis tests for UTIs

Urinalysis (UA)
Urine culture
Renal ultrasound
VCUG

14

Nursing interventions for UTIs

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

15

Vesicoureteral Reflux

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

16

Signs and symptoms for assessing Vesicoureteral reflux

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

17

Physical exam for Vesicoureteral reflux

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

18

Nursing interventions for Vesicoureteral Reflux

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

19

Goal of vesicoureteral reflux management

To prevent pyelonephrosis and renal scarring

20

When does vesicoureteral reflux require surgical intervention?

For grade 3-5

21

Obstructive uropathy

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

22

What can obstructive uropathy lead to?

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

23

Common signs and symptoms of obstructive uropathy

Recurrent UTI
Incontinence
Fever
Flank pain
Urinary frequency
Hematuria

24

Postop care for surgical correction of obstructive uropathy

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

25

What to monitor with obstructive uropathy

Palpate abdomen for masses
Monitor BP

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

Nephrotic Syndrome

27

3 forms of nephrotic syndrome

Congenital
Idiopathic (80%)
Secondary

28

Speculated Causes of Idiopathic nephrotic syndrome

Metabolic
Biochemical, physiochemical
Immune-mediated response

29

Patho of nephrotic syndrome

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

30

Common signs and symptoms of nephrotic syndrome

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