GI

Question 1

Cryptorchidism

Answer 1

Undescended teste or testes

Question 2

Hydrocele

Answer 2

Fluid in scrotum; enlarded scrotal sac, spontaneously resolves or surgical repair if not resolved by 1 year

Question 3

Hypospadias

Answer 3

Opening of urethra on dorsal surface(top) of penis
Female: wide urethra
Repair is during first year of life

Question 4

Hypospadias with chordee

Answer 4

Causes penis to curve downward
cobra-head appearance
Surgical release of band causing deformity

Question 5

How would you manage hypospadias with chordee?

Answer 5

Surgical repair

Question 6

At what age would you perform surgical repair for hypospadias with chordee? Why?

Answer 6

12-18 months or 3-4 years old

The penis needs growth prior to repair

Question 7

Enuresis

Answer 7

child is unable to control bladder function;
must happen 2-3 week for 3 months
common in children 5-7 years old

Question 8

Nocturnal(nighttime) enuresis

Answer 8

bedwetting in a child who has never been dry for extended periods.. the child is unable to sense a full bladder and does not awaken to void

Question 9

Daytime(diurnal) enuresis

Answer 9

Wetting that occurs during the day

Question 10

Primary enuresis

Answer 10

Wetting that occurs in a child that has not fully mastered toilet training

Question 11

Secondary enuresis

Answer 11

Onset of wetting after a period of established urinary continence

Question 12

Causes of enuresis

Answer 12

Unclear etiology: family hx, disorders associated with bladder dysfunction, males, emotional stress

Question 13

Diagnosis of enuresis

Answer 13

Clean catch urine specific gravity

Question 14

Enuresis Treatment

Answer 14

Decrease stress, limit fluids, alarm bells, bladder stretching and meds

Question 15

Enuresis meds

Answer 15

**Desmopressis acetate - helps reduce urine volume, given orally or nasally

Imipramine hydrochloride(TCA) - Risks for suicide; Give for 6-8 weeks and gradual withdrawal; give with food one hour before bed

Oxybutynin chloride(anticholinergic)- reduce bladder contractions and increase bladder capacity; can cause low self-esteem

Question 16

Encopresis

Answer 16

Involuntary loss of feces(stool)

Primary - If never toilet trained
Secondary - If already toilet trained

Question 17

Causes of encopresis

Answer 17

Functional - stress and regression

Question 18

Encopresis managment

Answer 18

Focused on route cause ; teach parents - Do not punish and praise when child is successful

Question 19

Vesicoureteral Reflex(VUR)

Answer 19

It is the backflow/retrograde flow of urine from bladder into ureters ; heterogeneous disorder ; leads to bladder in fection

Question 20

S/S of VUR

Answer 20

FREQUENT UTI***
Suprapubic pain
Incontinence
Family hx
enlarged bladder

Question 21

Diagnostic VUR

Answer 21

Voiding cystourethrogram - rates/grades the VUR(I-V), V is most serious

CT scan, Cystoscopy w/without contrast

Question 22

Therapeutic managment of VUR

Answer 22

Teach double voiding - prevents bacteria from reaching the kidneys

Low-dose abx therapy, urine culture every 2 to 3 months or any time a child has a fever

VCUG to assess the status

Question 23

Treatment of VUR

Answer 23

Cystoscopy, Laparoscopic surgery

Question 24

After VUR surgery care

Answer 24

Have to make sure urine collection bags are below child’s bladder at all times

Aseptic techinique

Question 25

Acute Poststrep Glomerulonephrisitis(APSGN)

Answer 25

An immune complex response; occurs after antecedent strep infection and strains of group A beta-hemolytic streptococcus

Question 26

What is the latent period of APSGN?

Answer 26

10 to 21 days between the infection and onset of manifestations

Question 27

Most common age for APSGN?

Answer 27

6 to 7 years old, more common in boys

Question 28

Patho for APSGN

Answer 28

*Inflammation of the glomeruli of kidney* Tissue damage from the glomeruli being plugges or clogged by proteins --> Ischemic damages leads to decreased function --> Reduction in glomerular filtration rate --> build up of sodium and water in bloodstream

Question 29

S/S of APSG

Answer 29

Oliguria Edema - facial edema in the morning which laters spreads to extremities and abd throught the day Hypertension Painless hematuria - tea colored, cola colored or bright red Abd. Pain, headaches, pallor, lethargy, anorexia, il apprearing, pulmonary congestion

Question 30

Lab asessment of APSGN

Answer 30

*Inability to filter properly* ``` Increase serum urea and creatinine Decresed serum protein WBC elevated ESR elevated Increase BP ``` Encephalopathy from HTN

Question 31

Nursing management of APSGN

Answer 31

Monitor for acute HTN Manage edema - monitor I&Os, daily weights Nutrition - low sodium, FR, low potassium Susceptibility to infections Monitor neuro status and behavior changes

Question 32

Medications for APSGN

Answer 32

Abx - For only those with evidence of perisistent strep infections Diuretics - furosemide Antihypertensives - Nifedipine every 4-6 hours orally or sublingual