[Exam 4] Chapter 43 – Alteration in Urinary Elimination/Genitourinary Disorder

Question 1

Bladder capacity in newborn?

Answer 1

30 mL, 270 mL by year 1.

Question 2

What size catheter will lbe used based on <2 years old, 2-5 years, 5-10 years, 10-16years

Answer 2

< 2 = 6 French
2-5 Years = 6-8 French
5-10 Years = 8-10 French
10-16 = 10-12 French

Question 3

Bladder Exstrophy: what is this?

Answer 3

congenital defect resulting in the bladder being open and exposed outside of the abdomen.

Question 4

Bladder Exstrophy: Nursing management involves what?

Answer 4

Preventing infection and skin breakdown

Question 5

Bladder Exstrophy, Providing PostOp Care: What will be done after surgery to prevent infection?

Answer 5

Keep the infant supine and quickly change soiled diapers.

Question 6

Bladder Exstrophy, Providing PostOp Care: What is done during surgery?

Answer 6

Surgical reconsturction of the bladder within pelvic cavity and reconstruction of urethra.

Question 7

Bladder Exstrophy, Providing PostOp Care: What will be done to allow for urinary drainage?

Answer 7

Indwelling urethral cather or suprapubic tube .

Question 8

Bladder Exstrophy, Providing PostOp Care: How to manage bladder spasms?

Answer 8

With oxybutynin or belladonna and opioid suppositories.

Question 9

Bladder Exstrophy, Providing PostOp Care: When will blood tinged urine disappear?

Answer 9

Within hours to day of surgery

Question 10

Bladder Exstrophy, Catheterizing of Stoma: What happens if bladder tissue is insufficient for repair?

Answer 10

Bladder is removed and a continent urinary resovior created. Urters connected to portion of small intestine. Stoma created on abdominal wall.

Question 11

Bladder Exstrophy, Catheterizing of Stoma: How often is stoma catheterized?

Answer 11

About 4x per day to empty the reservoir of urine. Urine appears mucus like and often cloudier.

Question 12

Hypospadias/Epispadias: What is hypospadias?

Answer 12

Urethral defect in which the opening is on the ventral surface of the penis rather than the end

Question 13

Hypospadias/Epispadias: What is epispadias?

Answer 13

Urethral defect in which the opening is on the dorsal side ofthe penis (up)

Question 14

Hypospadias/Epispadias: When is this repaired?

Answer 14

By about 1 year of age

Question 15

Hypospadias/Epispadias: What happens during surgery?

Answer 15

Meatus is moved to the glans penis and the urethra is reconstructed as needed.

Question 16

Hypospadias/Epispadias, Nursing Assess: What else may occur with hypospadias?

Answer 16

Cryptorchidism (undescended testicles)

Question 17

Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: When will circumscision occur?

Answer 17

After the surgery, as the excess skin may be needed

Question 18

Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: How to prevent strain on urethral incision?

Answer 18

Ensure that the urinary drainage tube remains carefully taped with penis in upright posiiton..

Question 19

Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: What is double diapering?

Answer 19

Method used to protect the urethra and stend or catheter after surgery. Alsokeeps area clean from infection.

Question 20

Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: What should the child not do for three weeks?

Answer 20

Roughhousing, ride-on toys or any activity involving straddling

Question 21

UTI: What symptoms will infants display?

Answer 21

Fever, irritability, vomiting, failure to thrive, or jaundice.

Question 22

UTI: What symptoms will children display?

Answer 22

Fever and vomiting, but also dysuria, frequency, hesistancy, and urgency

Question 23

UTI - Patho: What normally causes this?

Answer 23

E. Coli

Question 24

UTI - Patho: What contributes to bacterial grwoth?

Answer 24

Decreased fluid intake, and also having urine remain after voiding.

Question 25

UTI - Therapeutic Mx: How is this treated?

Answer 25

Oral or IV antibiotics. 7-14 day course is often prescribed.

Question 26

UTI - Health Hx: What signs may be shown?

Answer 26

Fever, N/V, Chills, Abdomen Lethargy, Jaundice, Poor Feeding

Question 27

UTI - Health Hx: RF for this?

Answer 27

Previous UTI, VUR, Constipation, Urine Holding.

Question 28

UTI - Health Hx: Observe for what signs in neonate or young infant?

Answer 28

Jaundice or increased respiratory rate.

Question 29

UTI - Health Hx: How will urine appear?

Answer 29

Visible blood, cloudiness, dark color, sediment, mucus, or foul odor

Question 30

UTI - Labs: Which ones may be done?

Answer 30

Urinalysis Urine Culture Renal Ultrasound.

Question 31

UTI - Nursing Mx, Eradicating Infection: When would IV Antibiotics be prescribed?

Answer 31

For child who has protracted vomiting or suspected pyelonephritits.

Question 32

UTI - Nursing Mx, Eradicating Infection: What is used to reduce fever and relieve abdomen paink?

Answer 32

Antipyretics like acetaminophen or ibuprofen for fever Heating pad or warm compress for flank pain.

Question 33

Enuresis: What is this?

Answer 33

Continued incontinence of urine past age of toilet training. Usually gone by 6 years.

Question 34

Enuresis: This may occur secondary to which disorders?

Answer 34

Diabetes mellitus, sickle cell anemia, ectopic ureter, or urethral obsturction.

Question 35

Enuresis: Most common cause of daytime enuresis?

Answer 35

Dysfunctional voiding or holding of urine

Question 36

Enuresis: Nocturnal enuresis may be realted to what

Answer 36

high fluid intake in the evening, obstructive sleep apnea, or sexual abuse

Question 37

Enuresis, Nursing Assess: What questions should you ask parents?

Answer 37

ABout urine holding behaviors like squatting/dancing And amount of fluid consumed before bedtime

Question 38

Enuresis, Nursing Assess: Risk factors of this?

Answer 38

Family disruption Chronic constipation Excessive famly demands rt toileting patterns

Question 39

Enuresis, Nursing Mx: Child should be encouraged to increase what?

Answer 39

Amount of fluid consumed during the day in order to increase frequency to void. Set schedule of when to void.

Question 40

Enuresis, Nursing Mx, Educating about Nocturnal Enuresis: Encourage parents to limit what

Answer 40

Chocolate and caffeine, and to limit fluids beofre going to bed.

Question 41

Enuresis, Nursing Mx, Decreasing Nighttime Voiding: Teach family to use what?

Answer 41

Enuresis alarm system . Work by sounding an alarm when first few drops of urine appear. Child awakens and stops the urine flow.

Question 42

Enuresis, Nursing Mx, Decreasing Nighttime Voiding: What medications can be prescribed?

Answer 42

Oxybutynin, imipramine, and desmopressin

Question 43

Nephrotic Syndrome: What is this?

Answer 43

Occurs as result of increased glomerular basement membranes permeability, which allows abnormal loss of protein in the urine.

Question 44

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS): When is the onset?

Answer 44

By 6 years

Question 45

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS): Complications of this?

Answer 45

Anemia, infection, poor growth, peritonitis, thrombosis and renal failure

Question 46

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Why is there increased glomerular permeability?

Answer 46

Because of passage of larger plasma proteins through glomerular basement membrane. Excess loss of protein in urine and decrease protein and albumin in blood stream

Question 47

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Hypoalbuminemia results in what?

Answer 47

Change in osmotic pressure, and fluid shifts from the bloodstream into the interstital tissue (causing edema). Triggers kdiineys to respond by conserving sodium, leading to edema.

Question 48

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: What does liver do?

Answer 48

Liver senses protein loss, and increases lipoproteins. Hyperlipidemia then develops as excess lipids cannot be excreted in urine.

Question 49

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: These children are at increased risk for what

Answer 49

clotting because of decreased intravascular volume.

Question 50

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Increased risk for what?

Answer 50

development of serious infection

Question 51

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Steroid resistant nephrotic syndrome results in what

Answer 51

acute renal failure

Question 52

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Therapeutic Mx: What does this usually involve use of?

Answer 52

Corticosteroids.

Question 53

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Therapeutic Mx: What is used in severely edematous child?

Answer 53

IV Albumin, along with diuretics.

Question 54

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Therapeutic Mx: What type of immunosuppressive therapy may be needed?

Answer 54

Cyclophosphamide, cyclosporina A

Question 55

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Common signs of this?

Answer 55

N/V, Recent Weight Gain, History of Periorbital Edema, Weakness/Fatigue

Question 56

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Rf for this?

Answer 56

Intrauterine growth retardation, young age, male sex

Question 57

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Observe the child for what?

Answer 57

Edema. (periorbital, generalized). Edema becomes more generalized as disease progresses.

Question 58

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: How will blood pressure be?

Answer 58

May be elevated. May be normal or decrease when progressing to renal failure.

Question 59

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Urine dipstick will reveal what?

Answer 59

Proteinuria.

Question 60

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What is adminsitered to promote diuresis??

Answer 60

Corticosteroids. Make sure to taper or weaning doses.

Question 61

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What diuretic usually adminsitered

Answer 61

Furosemide.

Question 62

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What electrolyte imbalance may occur?

Answer 62

Hypokalemia.

Question 63

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: Measure pulse rate and BP every 4hours why

Answer 63

to detect hypovolemia, resultign from excesive fluid shifts.

Question 64

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What happens in servere hypoalbuminemia?

Answer 64

IV Albumin may be adminsitered. Causes it to shift back into blood stream. Adminsiter with furosemide.

Question 65

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Prevent Infection: What is done?

Answer 65

Administer pneumoccocal vaccine. Administer prophylactic antiiotics. Don't admiinister live vaccines until at least 2 weeks after corticosteroid use ceases.

Question 66

Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Encouraging Nutrition: What restrictions will occur?

Answer 66

Fluid restriction for children wtih massive dema. Especialyl sdoium. Eat foods high in protein

Question 67

Acute Post-Streptococcal GLomerulonephritis (APSGN): What is this?

Answer 67

Immune process injures the glomeruli. Causes inflammation, which alters glomerular structure and function. Occurs ifter infection.

Question 68

Acute Post-Streptococcal GLomerulonephritis (APSGN): What is this caused by?

Answer 68

Antibody-antigen reaction secondary to infection.

Question 69

Acute Post-Streptococcal GLomerulonephritis (APSGN): Complication of this?

Answer 69

Progression to uremia and renal Failure.

Question 70

Acute Post-Streptococcal GLomerulonephritis (APSGN): treatment?

Answer 70

No specific treatment. Must maintain fluid volume and manage hyertension

Question 71

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: Signs can include?

Answer 71

Fever, Lethargy, Headache, Decreased Urine Output, Abdominal Pain.

Question 72

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: How will BP be?

Answer 72

Elevated.

Question 73

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: What to inspect physically?

Answer 73

Edema, and increased work of breathing.

Question 74

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: Urine dipstick will reveal what

Answer 74

proteinuria as well as hematuria.

Question 75

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: How will gross hematuria appear?

Answer 75

tea colored, cola covered, or even dirty green colored.

Question 76

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: What should be administerd?

Answer 76

Antihypertensives like nifedipine and diuretics

Question 77

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: What restrictions will occur during initial edematous phase?

Answer 77

Maintain sodium and fluid restrictions. Weight them daily.

Question 78

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: How will child act during acute phase?

Answer 78

Are generally faituged ad choose bed rest.

Question 79

Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: What may happen if this doesnt get fixed?

Answer 79

Dialysis may be necessary

Question 80

Cryptorchidism: What is this?

Answer 80

Undescended testicles, occurs when one or both do not descent into scrotal sac. Usually descend in 7th month.

Question 81

Cryptorchidism: What may cuase this?

Answer 81

Mechanical, hormonal, chromosomal, or enzymatic

Question 82

Cryptorchidism: Complciations of this?

Answer 82

Sterility and increased risk for testicular cancer.

Question 83

Cryptorchidism: How to fix this?/

Answer 83

Surgical management. Orchiopey performed to realse spermtic cord, and testes pulled into scrotum.

Question 84

Cryptorchidism: Risk factors for this?

Answer 84

Prematurity, first-born child, cesarean birth and low birth weigiht

Question 85

Cryptorchidism, Nursing Mx: When should they descend by?

Answer 85

By 6 months of age, and if not, they should be referred for surgical repair

Question 86

The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child’s future care? “Care will be no different than that of any other infant.” “My infant will only need this one surgery.” “My child will wear diapers all his life.” “We will need to care for the urinary diversion.”

Answer 86

“We will need to care for the urinary diversion.”

Question 87

A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action? Obtain a sterile urine sample after completion of antibiotics. Teach appropriate toileting hygiene. Prepare the child for surgery to reimplant the ureters. Administer antibiotics intramuscularly.

Answer 87

Teach appropriate toileting hygiene.

Question 88

When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention? Test urine for specific gravity. Weigh child daily. Weigh the wet diapers. Measure abdominal girth daily.

Answer 88

Weigh the child daily