GU Dysfunction Flashcards
1
Q
Urinary Tract Disorders/Disease S/S
birth to 1 mn.
A
Poor feeding
Vomiting
Failure to gain weight
Rapid respiration (acidosis)
Respiratory distress
Spontaneous pneumothorax or pneumomediastinum
Frequent urination
Screaming on urination
Poor urine stream
Jaundice
Seizures
Dehydration
Other anomalies or stigmata
Enlarged kidneys or bladder
2
Q
Urinary Tract Disorders/Disease S/S
1 -24 months
A
Poor feeding
Vomiting
Failure to gain weight
Excessive thirst
Frequent urination
Straining or screaming on urination
Foul-smelling urine
Pallor
Fever
Persistent diaper rash
Seizures (with or without fever)
Dehydration
Enlarged kidneys or bladder
3
Q
Urinary Tract Disorders/Disease S/S
2-14 y/o
A
Poor appetite
Vomiting
Growth failure
Excessive thirst
Enuresis, incontinence, frequent urination
Painful urination
Swelling of face
Seizures
Pallor
Fatigue
Blood in urine
Abdominal or back pain
Edema
Hypertension
Tetany
4
Q
Prevention of UTIs
A
prevent contamination
- front to back (after voiding and defecating)
- children should void as quickly as they feel the urge
no tight clothing or diapers (wear cotton panties )
empty bladder completely (double-voiding)
no constipation
encourage adequate fluid intake
5
Q
What gender has the most UTIs?
A
females - shorter urethra
6
Q
If the female is sexually active, then they are advised to
A
urinate after intercourse
low-dose antibiotics if recurrent
7
Q
Inguinal hernia
A
Protrusion of abdominal contents through the inguinal canal into
scrotum
8
Q
Inguinal hernia tx
A
Detected as painless inguinal swelling of variable size
Surgical closure of inguinal defect
9
Q
Hydrocele
A
Fluid in scrotum
10
Q
Hydrocele tx
A
Surgical repair indicated if persists past 1 year old
11
Q
Phimosis
A
Narrowing or stenosis of the preputial opening of the foreskin
12
Q
Phimosis tx
A
Mild cases: May not require therapy if urine flow not obstructed; steroid cream may be prescribed,
typically twice a day for one month
Severe cases: Circumcision or dorsal slit in severe, rare cases
13
Q
Hypospadias
A
Urethral opening located behind glans penis or anywhere along
ventral surface of the penile shaft
14
Q
Hypospadias tx
A
Enable child to void in standing position and direct stream voluntarily in usual manner
* Improve physical appearance of genitalia
* Produce a sexually adequate organ
15
Q
Chordee
A
Ventral curvature of the penis, often associated with hypospadias
16
Q
Chordee tx
A
Surgical release of fibrous band causing the deformity
17
Q
Epispadias
A
Meatal opening is located on the dorsal surface of the penis
18
Q
Epispadias tx
A
Surgical correction, usually including penile and urethral lengthening and bladder neck
reconstruction (if necessary)
19
Q
Cryptorchidism
A
Failure of one or both testes to descend normally through the inguinal canal
20
Q
Cryptorchidism tx
A
Detected by the inability to palpate testes within the scrotum
Medical: Administration of hormonal therapy has historically been used in some centers to induce
testicular descent but is controversial and not currently recommended
Surgical: Orchiopexy
Objectives of therapy: Place and fix viable undescended testes in a normal scrotal position or remove
nonviable testicular remnants
Allows for easier examination of the testis because there is an increased risk of testicular cancer in
undescended testes; early surgical correction may reduce the risk of cancer as well as infertility
Decrease risk of trauma and torsion
Decrease the risk of inguinal hernia by closing the inguinal canal
Potentially improved body satisfaction
21
Q
Exstrophy of bladder
A
Eversion of the posterior bladder through the anterior bladder wall
and lower abdominal wall; associated with an open pubic arch (a severe defect)
22
Q
Exstrophy of bladder tx
A
- Preserve renal function
- Attain urinary control
- Provide adequate reconstructive repair
- Improve sexual function
23
Q
UTI increased risk in
A
Females > than males
Urinary Stasis
Uncircumcised males less than 3 months of age and females younger than 12 months have the highest prevalence of UTIs
unexplained fevers
24
Q
UTIs can lead to
A
Cystitis
Pyelonephritis
urosepsis with kidneys stopping
25
Kidney damage if a UTI is less than
a year
26
Path reasons of UTIs
E. coli
Gram-negative organisms
Anatomic factors in females
Diapers
27
If the baby ever has an unexplained fever, then you need to evaluate for what
UTI
28
Urinary Stasis S/S (after toilet training)
incontinence in a toilet-trained child (Enuresis)
strong-smelling urine
urinary frequency or urgency
pain with urination (dysuria)
Fever
Hematuria
29
Urinary stasis is the
urine sits in the bladder bringing bacteria to infection
30
Urinary stasis caused by
neurological (neurogenic bladder)
spinal problem
no stopping while playing
not complete emptying all the way (neurogenic)
blood in urine for all ages
Newborn
31
Newborn urinary stasis s/s
fussy,
cry,
stop eating,
difficult to console,
**go to the restroom in pain**,
**typically fever**
**diarrhea or jaundice,**
different urine odor,
pink tint to the urine (blood)
32
Toddlers urinary stasis s/s
easier to **say hurts when they go to the bathroom, grab themselves**
Accidents if toilet trained
33
In preschoolers and up, what are the s/s of urinary stasis?
increased frequency and urgency
34
In UTI, the UA shows
nitrate, leukocytes, blood, cloudy, smell foul
35
Urine cultures are used to
identify bacteria and meds sensitivity to
36
Can you identify a UTI based on only s/s?
If no, then what is the definitive way to determine a UTI?
No
- UA, urine culture and sensitivity
37
Urine Non-sterile Specimen Collections for children
- **Non-sterile Cotton ball in diaper in a syringe** and push down in syringe (not mixed with poop)
- **Bagged (nonsterile)** attached to the kid and into the bag
- Midstream clean catch (non-sterile) for older children
38
Before doing a midstream clean catch, what needs to be done?
peri care
39
What is a sterile catheter specimen used in children?
suprapubic tap aspiration (physician only-PICU)
bladder catheterization (straight cath)
40
pH normal range
4.8-7.8
41
If you have a positive in the UA, what does that mean?
red flag
- occasional in casts
- negative protein, glucose, ketones, leukocyte esterase, and nitrites is normal
42
UTI Tx
Antibiotics
increase fluids
- proper peri care
- void and frequent diaper checks
- double voiding
Preserve renal functions
43
UA final result in
72 hours
44
What antibiotics are used in UTIs?
**Penicillin**
Sulfonmide
Cephalosporins
- finish all
45
To avoid a UTI, what should you avoid?
bubble baths or with irritates (salts, )
46
If the UTIs are recurrent, what procedures need to be done?
bladder scan
voiding Cystourograph (Cath in bladder and inject dye, pictures from in and out) - VCG
47
Voiding Cystourograph need to know I
F THEY ARE POTTY TRAINED and with the dye
If potty trained, it's okay if they have an accident on the table
Kidney functions – Output, GFR, **Creatinine, and BUN**
Shellfish and iodine allergies
Drink plenty of fluids to flush out all the dye
48
Prevention for a female adolescent against UTIs
double voiding and voiding after intercourse
49
Kidney function labs
Creatinine and BUN
50
Vesicoureteral Reflux (VUR)
The abnormal flow of urine from the bladder into the ureters
-backflow
51
Primary VUR
most common, **congenitally misplacement of the ureters** on the bladder being **too low**
- the ureter is too low and goes up
52
Secondary VUR
WITH NEUROGENIC BLADDER
53
VUR patients typically have frequent
kidney infections (Pyelonephritis)
54
What lab will show the SEVERITY of reflux backflow of urine in the ureters?
VCUG
- contrast injected into the bladder through a cath
- pics before, during, and after
Grading
LET THEM KNOW THAT ACCIDENTS ARE OKAY ON THE TABLE!
55
Grade 1 VUR
least ONLY in the ureters
56
Grade 2 VUR
in the renal pelvis
- kidney middle
57
Grade 3 VUR
renal pelvis
causes **mild pyelonephritis**
58
Grade 4 VUR
**moderate pyelonephritis**
59
Grade 5 VUR
Most
**Severe hydronephrosis** causing ureter to **twist causing obstruction**
60
Grade 1-3 VUR Tx
**Conservative - bladder grows over (age 5) and move to the right spots in less reflux**
Daily low-dose antibiotic therapy
Annual VCUG
61
Grade 4-5 VUR Tx
typ. do not resolve by themselves
Surgical -
Ureteral **reimplantation**
- from side to top of the bladder
62
Indications for surgery in VUR if a grade 1-3
severe forms of VUR
- risk of damaged kidney permanent
**not resolved by 4-5 y/o**
renal scarring
significant anatomic abnormality
**Noncompliance** with medical therapy
antibiotic intolerance
**infrequent** access to the health care system
63
How to prevent VUR?
PREVENT BACTERIA FROM REACHING KIDNEYS
- increase fluids (**water, no spicy foods or caffeine**)
- avoid **unnecessary cath
- Double voiding**
- Daily**prophylactic antibiotics**
Routine **cultures (2-3 months)** and PRN if fever
64
The bladder will grow into place at what age?
5 y/o
65
Obstructive Uropathy
Structural or functional abnormality of the urinary system that **obstructs the normal flow of urine, producing renal disorders**.
1 or both kidneys
congenital/acquired
66
Obstructive uropathy is more prevalent in
boys
67
Obstructive uropathy obstruction can occur
at any level of the urinary tract
68
Congenital obstructive uropathy
anatomic conditions
neurological conditions
functional condition
69
Obstructive Uroppathy Patho
obstruction
damage to distal nephrons
altered ability to concentrate urine
increased urine flow
decreased excretion of acid
urine pools
Hydronephrosis
UTI
**repeat to damage distal nephrons**
70
Inguinal Hernia
Protrusion of abdominal contents through inguinal canal into scrotum
-5% newborns and 11% preterm
71
Tx of inguinal hernia
surgical closure of defect
72
Is an inguinal hernia painful?
no, generally painless
- unless stragulation or vascular compromise becomes painful
73
Hydrocele
fluid in scrotum
- perioneal fluid overproduction or defect with absorption
74
Hydrocele is usally solved by
self
75
Hydrocele if not resolved in 1 year then it needs
surgical repair (hydrocelectomy)
76
If the scrotum glows through with a flashlight, then it is what
Hydrocele - fluid
77
If the scrotum does not glow through with a flashlight, then it is what
Mass
78
If the newborn or preterm has a hydrocele, what was the typical cause?
peritoneal fluid
79
If the older child has a hydrocele, what was the typical cause?
trauma
80
Post-Op of Hydrocelectomy
swelling is normal and surgery in the perineal area
- child can not ride on straddle toys for 2-4 weeks for healing
- limit strenuous activity for a month (difficult in toddlers)
81
What toys need to be avoided after hydrocelectomy?
no riding on straddle toys for 2-4 weeks due to healing
- limit strenous activity for a month
82
Phimosis
Narrowing or stenosis of the opening of the foreskin
Inability to retract the foreskin (tight rubber band around the tip)
83
Tx of Phismosis
**Mild** not forcible: manual foreskin retraction
- **resolves with growth** and occasional flow decrease (balloon foreskin)
Moderate: **Steroid cream BID for 1 month**
**severe: circumcision** or vertical division of foreskin
84
What type of cleaning is used in Phimosis for routine baths?
sterile
85
Phimosis Teachings
do not force the foreskin as it can cause damage
sterile cleansing with bathing
86
Hypospadias
Urethral opening located below or behind the glans penis or anywhere along the ventral surface of the penile shaft
87
Hypospadias Tx
surgical correction
88
What warning needs to be given to parents of a child with hypospadias?
can not have a circumcision until after the repair bc dr will possibly use the foreskin to seal the area
89
Why does the surgery of hypospadias need to be done quickly?
allow the child to *void standing up and adulthood adequate sexual organ*
**before 6-12 months before developing body image**
90
What needs to be avoided with Hypospadias?
avoid straddling and peri clean the area
91
Cryptorchidism
**Failure of one or both testes to descend normally** through the inguinal canal into the scrotum
92
Cryptorchidism Tx
orchiopexy
- Surgical = releases the teste into the scrotum
- might have a button on post-op then remove when done
93
If Cryptorchidism is not corrected, then
increase for malignancy and infertility
94
Nursing considerations for external defects of children
Routine preop/postop care (child life explained)
Tub baths discouraged for a few days to week
Possibly catheter care
Activity restriction – no straddle, lifting, vigorous play, (spell out because of concrete thinking), infection s/s and skin care
Parental support - Infection s/s
95
Avoid what activities during external defects of children post-op
no straddle, lifting, vigorous play, (spell out because of concrete thinking), infection s/s and skin care
96
Nephrotic Syndrome aka
Glomerular Dzs
97
Nephrotic Syndrome characterized by
increased glomerular permeability to plasma protein, which results in massive urinary protein loss.
98
What protein is lost in the urine when not working correctly?
-In Nephrotic Syndrome-
Albumin
- massive protein loss in urine
99
Nephrotic Syndrome is caused by
Idiopathic 80%
Idiopathic Nephrosis,
MCNS, (minimal chnage nephrotic syndrome)
Lupus,
toxins (secondary)
congenital
100
What gender most likely has Nephrotic Syndrome?
males 2x
(also RSV correlation)
101
Nephrotic Syndrome is seen between these years
Peak 2-3 y/o and can see up to 7 y/o
102
Nephrotic Syndrome is these major s/s
proteinuria
hypoalbuminemia (low protein in the blood)
hyperlipidemia (high fat in the blood)
edema
103
Protienuria is greater than ___ + on dipstick
2
104
Nephrotic Syndrome Patho
The glomerular membrane becomes permeable to proteins, especially albumin
Proteins lost in the urine (Hypoproteinemia and **massive proteinuria**)
serum albumin level decrease **(hypoalbuminemia)**
osmotic pressure in the cap decreases
vascular pressure exceeds the pull of osmotic pressure
fluid accumulates in intestinal spaces **1(edema)**
shift fluid from plasma to interstitial spaces reduces vascular vol **(hypovolemia)**
RAAS stimulated
ADH and aldosterone secreted
Reabsorption of Na and water in an attempt to increase intravascular vol
105
S/S of Nephrotic Syndrome
**Weight gain in a seemingly well child**
- facial and periorbital
**Edema**
pattern
gaining fluid weight **but losing true body weight**
- ascites
- pleural effusion
**Massive proteinuria
Hypoalbuminemia**
Hyperlipidemia
Anorexia (low appetite)
Irritability
Decreased activity - self-limit
106
Edema s/s
ascites
pleural effusion (Fever, chest pain, dyspnea, and nonproductive cough)
107
Hyperlipidemia is seen in Nephrotic Syndrome by
The liver is rapidly making lipids to replace the proteins lost
-
108
Nephrotic Syndrome has a high risk of infection and
losing immunoglobulins (for immune response)
-** avoiding infectious areas and staying in clean space**
- avoid crowds
109
What is a hallmark of massive proteinuria (Nephrotic Syndrome)
venous thrombosis
110
Nephrotic Syndrome UA indications
*Decreased volume (RETAIN FLUID)*
**dark and frothy**
Froth = proteins
**Massive Proteinuria
greater than 2+**
May have a **few RBCs**
- Not gross/large blood in the urine
111
Froth in urine is
proteins
112
Nephrotic Syndrome relationship to volume
retain volume
113
Is the GFR impacted by Nephrotic Syndrome?
no, but do Creatinine and BUN
114
Nephrotic Syndrome Tx
- 1st line: **corticosteroids** (prednisone) for 6 weeks
- **Cyclophosphamide** or cyclosporine (immunosuppressants)
= cannot tolerate prednisone or who have repeated relapses, too many side effects
- Possibly **furosemide** to provide temporary relief from edema
- Possibly **25% albumin**
decreases edema
increases plasma and protein
115
If the child does not tolerate steroids, repeated relapses, or too many side effects, then they can use what for nephrotic syndrome?
**Cyclophosphamide** or cyclosporine (immunosuppressants)
116
Relapse of Nephrotic Syndrome triggers
allergies, immunizations, bacterial or viral infection
2/3 of children will have a relapse
**Dx early bc routine dipstick (2+ protein in urine)**
Repeat but shorter length high dose steroid therapy
117
Nursing Considerations for Nephrotic Syndrome while in the hospital/labs
**Strict I&Os plus daily weight**
- fluid restriction
- **cotton ball method** not potty
**Thermoregulation - keep warm**
Prevention of infection (hygiene, avoiding sick contact)
- minimize complications
Assessment of edema (skincare)
- abdominal circumference
- level/location(s) of swelling
- degree of pitting
- lung assess
Loss of appetite/diet **(Na restricted diet)**
Long-term steroid use
Home care for relapse(s)
118
How do you evaluate for edema in children?
abdominal circumference
- level/location(s) of swelling
- degree of pitting
- lung assess
119
Why are collection bags generally not used for UA?
skin breakdown and avoid infections
- cotton ball preferred
120
Edema s/s
Wt gain, insomnia, irritability, unwanted male apttern hair growth in females, growth retardation, HTN, GI bleed, bone demineralization, risk of infection, raises Blood sugar
121
acute glomerulonephritis is characterized by
inflammatory injury in the glomerulus, most caused by an immunological reaction
unknown patho
122
What is the most common cause of acute glomerulonephritis?
**strep (winter and spring)**
Impetigo (pyoderma) - summer and fall
10-21 days onset
123
acute glomerulonephritis caused by
Immunological/**Autoimmune** diseases
Following **strep infection of the pharynx or skin**
- Acute: 2-3 after infection
- Chronic: after the acute phase or slowly over time
History of pharyngitis or tonsillitis 2-3 weeks before symptoms
124
acute glomerulonephritis patho
Immune complexes depsoti in glomerular basement membrane
increase glomerular membrane permeablity to RBCs and proteins (**gross hematuria and proteinuria**)
glomeruli edematous and infiltrated with leukocytes
cap lumen occluded
decreased cap flow and decrease in plasma filtration
excessive accumulation of water and retention of Na
interstiital fluid and plasma vol expand
circulatory congestion **(edema, HTN)**
125
acute glomerulonephritis s/s
HA, tired, low appetite
**Edema - especially periorbital**
Morning than later
Mild if unfamiliar may seem normal
Urine:
**cloudy, tea/cola-colored
parallel proteinuria & hematuria
**Blood and protein (2+ and 2+)**
Increase BUN and creatinine abnormal increase
- negative strep test
Azotemia
ASO titer – measure against antibodies for the strep
**HTN**
126
What is the main difference between acute glomerulonephritis and nephrotic syndrome?
acute glomerulonephritis has massive blood in urine
both have large proteins in the urine
127
Azotemia
abnormal increase of BUN and Creatinine
128
Dietary restrictions of acute glomerulonephritis
moderate sodium restriction (regular diet with no added salt)
possible fluid restriction
restriction of foods with substantial potassium during period of oliguria (prevent hyperkalemia - HTN)
- antihypertensive and diuretics for HTN
129
If the acute glomerulonephritis pt has HTN and decreased output then
stay at hospital
130
Nursing Considerations for acute glomerulonephritis
**strict I&Os, daily weight**
**BP**
Monitor for dehydration in fluid-restricted pts
Offer **appealing meal choices with restrictions for NA and K**
Allow for **frequent rest periods and voluntary restricted activity**
Parental education r/t follow-up & home care
131
Why does the BP need to be monitored for an acute glomerulonephritis pt?
Normotensive or with a range of urine can be treated at home
Hypertension or decreased urine output stay in the hospital
132
acute glomerulonephritis pt is not allowed to do this until UA is normal?
no contact sports
133
What electrolytes are restricted for glomerulonephritis?
Na and K
and water
134
If untreated glomerulonephritis goes into acute renal failure, do they go on dialysis
do not usually go on dialysis - because the kidneys are not excessively damaged
135
What is the 1st sign of kidney failure with an acute glomerulonephritis pt?
decrease urine output
136
Acute Glomerulonephritis vs Nephrotic Syndrome
Cause
AG: STREP
NS:idiopathic
137
Acute Glomerulonephritis vs Nephrotic Syndrome
Additional symptoms
AG: anorexia, lethargy, HA
NS: fatigue, facial and generalized edema, ascites
138
Acute Glomerulonephritis vs Nephrotic Syndrome
edema
AG: mild to moderate mainly periorbital
NS: severe ascites
139
Acute Glomerulonephritis vs Nephrotic Syndrome
BP
AG: mild to severe
NS: generally normotensive
140
Acute Glomerulonephritis vs Nephrotic Syndrome
URINE APPEARANCE
AG: cloudy, tea/cola-colored
NS: dark, frothy
141
Acute Glomerulonephritis vs Nephrotic Syndrome
URINE PROTEIN
AG: mild to moderate (parallels hematuria)
NS: massive proteinuria (3+ higher)
142
Acute Glomerulonephritis vs Nephrotic Syndrome
URINE BLOOD
AG: up to gross amounts
NS: few RBCs
143
Acute Glomerulonephritis vs Nephrotic Syndrome
ASO TITER
AG: postive
NS: negative
144
Acute Glomerulonephritis vs Nephrotic Syndrome
Tx
AG: supportive, moderate dietary restrict, antiHTN, and diuretics, abx for cause
NS: corticosteroids, diet restrict, possible diuretics and albumin
145
Severe AGN can lead to
nephrotic syndrome
146
Enuresis
Intentional or **involuntary passage of urine into bed (usually at night) in children who are beyond the age when voluntary bladder control** should normally have been acquired
147
Primary Enuresis
: bedwetting in children who have **never been dry for an extended period**
- small bladder, persistent UTIs, severe stress, developmental delays
148
Secondary Enuresis
the onset of wetting **after a period of established urinary continence**
- stress or events (moved)
The older the more concentrated on toilet training established
149
Factors of Primary Enuresis
small bladder, persistent UTIs, severe stress, developmental delays
150
Factors of Secondary Enuresis
stress or events
The older the more concentrated on toilet training established
151
Behavioral Tx Enuresis
1st must rule out organic cause(s)
Restrict or eliminate fluids after dinner
Avoidance of caffeine & sugar-containing drinks after 1600
Purposeful interruption of sleep to void
**Motivational therapy**
- Parents wake them up in the middle of sleep to go to the restroom
- Bribing with rewards
**Bed alarm** (in PJs)
152
How long does the child need to use the bed alarm for enuresis?
Continue until 14 days of consistent dry nights
153
Medicationl Tx Enuresis
**Imipramine (Tofranil) and desmopressin**
**tricyclic antidepressants** – cardiac toxic if overdosed,
**anticholinergics**
All side effects = dry mouth, HA, constipation
154
Hemolytic Uremic Syndrome (HUS)
uncommon, acute renal disease that occurs primarily in infants and small children **between the ages of 6 months and 5 years**
155
Hemolytic Uremic Syndrome (HUS) associated with
bacterial toxins, virus, and chemicals
156
HUS clinical features "Triad"
Hemolytic anemia
Thrombocytopenia
Renal injury
157
Hemolytic Uremic Syndrome (HUS) patho
toxin damages endothelial lining of glomerular arteriloes
glomerular arterioles swollen and occluded with deposits of platelets and fibrin clots (hypovolemia)
TRBCs damaged attempt to move through partially occluded vessels (Acute hemolytic anemia)
damaged cells are removed by the spleen (thrombocytopenia)
158
HUS S/S
Preceded by illness
- gastroenteritis
- upper respiratory infection
*Vomiting*
*Irritability*
Lethargy
Pallor – low RBCs
Hemorrhagic manifestations
- **small dots on hands**
Oliguria or anuria
CNS involvement
- **SMALL BLEEDING OR BRUISING IN NOSE OR MOUTH**
- signs until a week after infection (unable to fight infection)
159
The s/s of HUS may not become apparent until a week after
digestive problems have occurred
160
HUS Tx
need **aggressive tx and early (prevent renal failure)**
Goals of therapy are early diagnosis & aggressive care of renal failure & hemolytic anemia
consistently **effective treatment is dialysis**
- any child anuric 24hrs or oliguric with uremia or HTN & seizures
**FFP
Plasmapheresis
PRBC**
161
HUS - any child anuric 24hrs or oliguric with uremia or HTN & seizures TYPE OF TX
dialysis
162
HUS pt needs to go on dailysis if
no urine output for 24 hours, combo of HTN, seizures, and
FFP, F f platelets, PRBCs does not work
163
If a HUS patient gets acute renal failure what percentage will survive?
95% other 5% die
10-50% will have residual kidney impairment
164
HUS Nursing Considerations
Strict I&Os
Management of dialysis (ICU)
Thermoregulation
Reduction of anxiety (**calm** environment)
Closely monitor for fluid overload – prevent circulatory overload
165
Which of the following patients can be discharged from the ED without the need for a urinalysis to evaluate for a UTI?
A) A 4-month-old female who presents with irritability and poor appetite: her current vital signs includes T 101.5 F axillary and HR 120 bpm.
B) An 8-year-old male who presents with a finger laceration. His mother states he had surgical re-implantation of his ureters 2 years ago.
C) A 12-year-old female complaining of pain to her lower right back. She denies any burning or frequency at this time. She has an oral temperature of 101.5 F.
D) A 4-year-old female who states “it hurts to pee”. Her parent states that she has been asking to urinate every 30 minutes. Vital signs are within normal range.
B) An 8-year-old male who presents with a finger laceration. His mother states he had surgical re-implantation of his ureters 2 years ago.
- Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.
166
The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse’s best response?
“Circumcision is a fading practice and is contraindicated in most children.”
“Circumcision in children with hypospadias is recommended because it helps prevent infection.”
“Circumcision is an option, but it cannot be done at this time.”
“Circumcision can never be performed in a child with hypospadias. "
Circumcision is an option, but it cannot be done at this time.”
- It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.
167
A nurse is assessing an infant who has a suspected urinary tract infection. Which of the following are anticipated findings?
Select all that apply.
Increase in hunger
Irritability
Decrease in urination
Vomiting
Fever
Irritability
Vomiting
Fever
168
A child is admitted to the pediatric unit with nephrotic syndrome. Which of the following laboratory results should the nurse expect to see?
Thrombocytopenia
Hypoalbuminemia
Neutropenia
Hypermagnesemia
Hypoalbuminemia
169
A child is admitted to the pediatric unit with a diagnosis of HUS. The child is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse should expect which of the following to be added to the plan of care?
Administration of blood products and initiation of dialysis.
Administration of blood products and close observation of the child’s hemodynamic status.
Administration of blood products followed by diuretic therapy to force urinary output.
Administration of clotting factors to diminish blood loss and continued monitoring of urinary output.
Administration of blood products and initiation of dialysis.
- Blood products are given to control the anemia. Because the child is symptomatic, dialysis is the treatment of choice.
170
A child is diagnosed with acute glomerular nephritis (AGN). Which of the following changes would the nurse expect to see in the child’s laboratory results?
Urine white blood cells: elevated
Urine specific gravity: decreased
Urine creatinine clearance: increased
Urine red blood cells: elevated
Urine red blood cells: elevated
171
A 10-year old child diagnosed with acute post streptococcal glomerular nephritis is being discharged home. Which of the following statements made by the child indicates that the child understood the teaching?
Select all that apply.
“I can’t eat any potato chips or other salty foods.”
“I can’t go to school for a week because I am contagious.”
I won’t be able to go to soccer practice for a long time.”
“I’m going to have to go to the doctor’s office a lot during the next few weeks.”
“I can’t eat any potato chips or other salty foods.”
I won’t be able to go to soccer practice for a long time.”
“I’m going to have to go to the doctor’s office a lot during the next few weeks.”
