GU

Question 1

pre-op hypospadias care

Answer 1

should be detected in newborn assessment
increased risk of UTI until fixed
may interfere with procreation

Question 2

post-op care hypospadias care

Answer 2

no straddle toys or carrying infant on the hip
stent will be in place after surgery
double diaper wrap catheter to drain into second diaper
pressure dressing, check tip of penis frequently, do not change dressing

Question 3

surgery for hypospadias

Answer 3

skin removed during circumcision is used to repair penis

Question 4

goals of surgical care of hypospaidas

Answer 4

prevent body image problems
enable child to void in standing position
improve physical appearance of genitalia
preserve functionality of sex organ

Question 5

Vesicoureteral Reflux (VUR)

Answer 5

reflux of urine from bladder into uterus and kidneys
graded 1-5
can lead to HTN, renal insufficiency or failure
primary reflux is familial and usually outgrown

Question 6

how to treat VUR stage 1-3 (early)

Answer 6

prophylactic antibiotics related to urinary stasis

take all abx as prescribed

Question 7

how to treat VUR stage 3 (late)-5

Answer 7

surgical repair to fix reflux

Question 8

primary VUR

Answer 8

result of incompetent valvular mechanism at the ureterovesicular junction

Question 9

secondary VUR

Answer 9

result of a condition such a UTI

Question 10

diagnosis and treatment of VUR

Answer 10

VCUG
antibiotics until reflux resolves
surgery, necessary when abx dont work or severe reflux (3-5)

Question 11

pre-op nursing considerations for VUR

Answer 11

prevent infection (take all abx, empty bladder completely, good hygiene)
screen siblings
age appropriate prep for procedures

Question 12

post-op nursing considerations for VUR

Answer 12

catheter and stent care (no swimming, sandboxes, or straddling)
pain meds for incision pain and antispasmodics for bladder spasm
prophylactic abx for 1-2 months following surgery

Question 13

inguinal hernias

Answer 13

should be able to be pressed flat and smooth and should not feel any intestines
asymptomatic and painless
more visible when child cries, strains, coughs, or stands for long periods of time
needs surgical correction

Question 14

diaphragmatic hernia

Answer 14

opening between thorax and abdominal cavity

abdominal contents enter thoracic cavity, compressing lungs and even effecting fetal lung development

Question 15

s/s of diaphragmatic hernia

Answer 15

often detected in utero
after birth- respiratory distress, cyanosis, scaphoid abdomen and impaired cardiac output
needs immediate medical attention, intubation, GI decompression, IV fluids and surgery to repair

Question 16

pre-op nursing management of diaphragmatic hernia

Answer 16

monitor respiratory and fluid status, acidosis, thermoregulation, cardiac output, sedation, gastric decompression

Question 17

post-op nursing management of diaphragmatic hernia

Answer 17

continued ventilation
monitor of acidosis, fluid status, GI decompression, thermoregulation, sedation, pain control, cardiac output, parental bonding

Question 18

umbilical hernia

Answer 18

teach parents to assess at home should be able to push flat and feel squishy
if you feel intestines go to ER
usually self resolves in 3-5 years without medical tx or home remedies

Question 19

UTI’s

Answer 19

most common in females, less common in males
uncircumcised males more likely to have UTI as young infant
E.Coli causes most in females

Question 20

risk factors of UTI’s

Answer 20

Constipation
bubble baths
pinworms
dysfunctional voiding, urinary stasis
decreased fluid intake
VUR
urologic abnormalities
indwelling catheter
neurogenic bladder
sex abuse
sexual intercourse

Question 21

UTI clinical manifestations in infants

Answer 21

fever
weight loss
FTT
Vomiting
diarrhea

Question 22

UTI clinical manifestations in children

Answer 22

dysuria
frequency, urgency, incontinence
foul smelling urine
possibly hematuria
abdominal pain
fever

Question 23

what does a positive UTI urine test show?

Answer 23

nitrites
rbc
wbc
urine culture is positive if shows >100,000 colonies of single bacteria

Question 24

UTI prevention

Answer 24

no bubble baths, tub baths are fine
take ABX properly
push fluids
drink water
avoid caffeine and cola
encourage cranberry juice
empty bladder 
wipe front and back
cotton undies
avoid tight fitting clothes
void after intercourse

Question 25

enuresis

Answer 25

involuntary passage of urine by child >5 yrs

Question 26

primary enuresis

Answer 26

``` Kids have NEVER been dry familial tendency, decreased bladder capacity maturity lag sleep disorder nocturnal polyuria ```

Question 27

secondary enuresis

Answer 27

psychological factors child has been potty trained and starts wetting bed out of the blue caused by bullying, abuse, sickle cell anemia, DM, constipation

Question 28

diagnosis of enuresis

Answer 28

urine sample good H&P wait for maturation- most children outgrow by age 10 retention/ control exercises drug therapy (oxybutinin (ditropan), imipramine (neurologic side effects), DDAVP (nasal spray or tablet) moisture alarm behavior modification (POSITIVE reinforcement is key)

Question 29

Hemolytic- uremic syndrome (HUS)

Answer 29

combo of hemolytic anemia and thrombocytopenia that occurs with acute renal failure most often in children 6 months-5 yrs

Question 30

how does HUS progress?

Answer 30

watery diarrhea that progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia

Question 31

causes of HUS

Answer 31

``` undercooked meat unpasteurized milk/ dairy unclean water unclean lettuce idiopathic inherited drug related malignancies ```

Question 32

pathophysiology of HUS

Answer 32

occlusion of the glomerular capillary loops and glomerulosclerosis, resulting in renal failure RBC's and platelets are damaged as they move through the occluded blood vessels

Question 33

source of infection in HUS

Answer 33

undercooked ground beef (most common) | consuming animal feces, unpasteurized dairy and fruit products, fresh vegetables.

Question 34

s/s of HUS

Answer 34

``` vomiting (mimics GI bug) marked pallor oliguria or anuria (kidneys start to shut down) edema fatigue elevated BP altered LOC ```

Question 35

are antibiotics helpful with HUS?

Answer 35

NO!!! self limiting, it will run its course

Question 36

HUS lab findings

Answer 36

elevated BUN/Creatine mod to severe anemia UA positive for blood, protein, pus, and casts

Question 37

how long does bacteria shed in the stool of HUS

Answer 37

17 days

Question 38

complications of HUS

Answer 38

``` chronic renal failure seizures and coma pancreatitis intussusception rectal prolapse cardiomyopathy CHF ARDS ```

Question 39

nursing considerations for HUS

Answer 39

``` contact precautions fluid volume status encourage adequate nutrition within dietary restrictions monitor for bleeding teach prevention ```

Question 40

Diet for HUS

Answer 40

pasteurized dairy/milk clean water clean fruit/veggies well cooked meats

Question 41

Acute post-streptococcal Glomerulonephritis (APSG)

Answer 41

acute post strep infection that has damaged the kidneys

Question 42

clinical manifestations of APSG

Answer 42

edema with weight gain flank or abdominal pain with CVA tenderness urine is cloudy and smoky brown/tea colored and decreased in volume hypertension and s/s of circulatory overload

Question 43

diagnosis of APSG

Answer 43

UA shows gross hematuria, MILD proteinuria, elevated specific gravity negative urine culture normal electrolytes, elevated ASO titer (recent strep infection)

Question 44

therapeutic management of APSG

Answer 44

bed rest during acute phase ( 1-2 weeks) diet- NO ADDED SALT, low protein (if BUN is elevated) control Hypertension antibiotics if evidence of current strep infection (fever)

Question 45

how do children show us they are getting better with APSG?

Answer 45

increased urine output

Question 46

APSG nursing interventions

Answer 46

fluid volume excess r/t to decreased glomerular filtration rate daily weight strict I and O monitor BP, electrolyte imbalance, s/s of cardiomyopathy administer diuretics safely infection prevention

Question 47

nephrotic syndrome

Answer 47

MASSIVE proteinuria, hypoproteinemia, hyperlipidemia, and edemia

Question 48

clinical manifestations for nephrosis

Answer 48

``` massive proteinuria sudden, rapid weight gain generalized edema pleural effusion decreased urine output diarrhea anorexia muejrcke lines b/p normal or slightly elevated frequent infections fatigue ```

Question 49

diagnosis of nephrosis

Answer 49

ua, serology, renal biopsy

Question 50

therapeutic management of nephrosis

Answer 50

bed rest during edema, resume regular activity during remission NO SALT added diet, high protein during edema, regular during remission drugs- corticosteroids, immunosuppressants, loop diuretics, salt poor, albumin

Question 51

nursing considerations nephrosis

Answer 51

fluid volume excess r/t accumulation of fluid in tissues and third spacing potential intravascular fluid volume deficit r/t protein and fluid loss

Question 52

main take away of glomerulonephritis

Answer 52

``` + ASO titer hypertension periorbital and peripheral edema circulatory congestion mild proteinuria gross hematuria norm. to slightly elevated K+ mild decrease serum protein normal serum lipids 5-7 yrs old ```

Question 53

main take away from nephrotic syndrome

Answer 53

``` negative ASO normal BP generalized/severe edema no circulatory congestion MASSIVE proteinuria microscopic/no hematuria normal potassium marked decrease serum protein elevated serum lipids 2-3 yrs old ```

Question 54

acute renal failure

Answer 54

caused by nephrotoxic med (vancomycin) or dehydration for nephrotoxic need to flush system with fluids for dehydration rehydrate body with fluid

Question 55

prevention of acute renal failure

Answer 55

``` treat underlying cause manage fluid and electrolyte disturbances decrease BP provide supportive therapy Drugs: mannitol, albumin, furosemide draw pea/ trough vancomycin levels ```

Question 56

chronic renal failure

Answer 56

occurs over time >6m treated with dialysis usually peritoneal in kids can effect bone development watch for osteodystrophy

Question 57

prevention of osteodystrophy in chronic renal failure

Answer 57

calcium carbonate | aluminum hydroxide gel

Question 58

treatment of CHF

Answer 58

supportive therapy dialysis transplant