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NSG 434 > GU Dysfunction > Flashcards

GU Dysfunction Flashcards

1
Q

filtration of the kidney is dependent upon

A

adequate blood pressure - therefore any change in BP can cause a loss in kidney function

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2
Q

Loop of Henle and convoluted tubules reduce fluid by

A

90%

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3
Q

ROS

A

Rule out sepsis

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4
Q

Differences Between Pediatric and Adult GU System

A

-loop of henle in children is not long enough yet, so infant cannot concentrate urine as efficiently

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5
Q

by what age is kidney function of a child like that of an adult

A

6-12 months

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6
Q

what increases the risk of UTIs in children

A

short urethras

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7
Q

Children with acute renal failure will often…

A

regain full kidney function.

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8
Q

how do we get a urine sample from an infant

A

straight cath

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9
Q

how do we get a urine sample from a toddler/preschooler

A

clean catch with parents help since they are potty trained

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10
Q

how do we get a urine sample from a school-aged child

A

child can take instruction well, so clean catch

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11
Q

how do we get a urine sample from an adolescent

A

give instructions and provide privacy

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12
Q

labs and diagnostics for GU

A

urinalysis
creatinine clearance: asses GFR
radioisotopes :given IV and kidneys scaned to watch filtration
urine culture
blood studies
ultrasound/MRI
xray

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13
Q

Intravenous Pyelogram (IVP) looks at the

A

UPPER urinary tract with radiopaque dye injected into a vein

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14
Q

when doing an Intravenous Pyelogram (IVP) what needs to be assessed

A

if the child has an iodine allergy

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15
Q

during an Intravenous Pyelogram (IVP) the child may experience

A

flushing of face, salty taste

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16
Q

voiding cystourethrogram is a study of

A

LOWER urinary tract

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17
Q

what are the steps to a Voiding cystourethrogram

A

-Dye inserted via catheter into bladder,
-X‐ray taken during void
-Void may be painful
-Test is not done if child has UTI

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18
Q

clinical manifestations of UTI

A

-Fever!!!!
-Vomiting
-Abdominal pain, back pain, flank pain
-Dysuria, frequency, urgency
-Hematuria
-Jaundice

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19
Q

a subtle fever alone in a child can indicate

A

a UTI

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20
Q

why are UTIs often seen in ages between 2 and 6

A

play is important in toddler and preschool age so they may not want to stop playing to urinate, or they may not want to pee in an unfamiliar place

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21
Q

UTI diagnostic studies

A

-Urinalysis: nitrates, leukocyte, esterase
-Urine culture
-Renal US
-Voiding cystourethrogram (VCUG)

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22
Q

UTI treatments

A

-antibiotic specific to organism
-FLUIDS
-tylenol for pain

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23
Q

Conditions that Predispose Infants and Children to UTIs

A

-Urinary tract obstructions
-Voiding dysfunction resulting in urinary stasis
-Anatomic differences
-Individual susceptibility to infection
-Reflux
-Urinary retention while toilet‐training
-Bacterial colonization of the prepuce of uncircumcised infants
-Sexual activity in adolescent girls

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24
Q

teaching for prevention of UTI

A

-Wear cotton underwear
-Avoid bubble baths (esp. girls)
-Urinate frequently (at least 4 times/day)
-Drink plenty of liquids (amount varies with age)
-Change diapers often
-Wipe front to back

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25
Q

enuresis

A

Bed wetting, Continued incontinence of urine past the age of toilet training (UTI can cause temporary urinary control problems)

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26
Q

when does nocturnal enuresis usually subside by

A

6 years (further investigation is needed if its later)

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27
Q

interventions for enuresis

A

-limit fluids in the evening, give rewards
-set alarm to get child up to pee in the middle of the night
-behavior modification and positive reinforcement

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28
Q

what is Vesicoureteral Reflux (VUR)

A

abnormal retrograde (backward) flow of urine from bladder into the ureters

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29
Q

primary VUR is caused by

A

incompetence in the valve

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30
Q

risk factors for VUR

A

-Recurrent UTI in the female
-Single episode of UTI in the male
-Congenital defect
-Family history of VUR

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31
Q

treatment for Vesicoureteral Reflux (VUR)

A

-Antimicrobials if UTI is present
-Increased fluids
-Hygiene/voiding practices to prevent UTI
-Prophylactic antibiotics may also used to prevent UTI
-Serial urine cultures
-Severe cases, require surgical interventions

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32
Q

surgery for vesicouretal reflux

A

ureters are resected from the bladder and replanted elsewhere in the bladder wall;
often we hold off on surgery because sometimes it can clear up on its own

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33
Q

Hypospadias

A

urethral defect with the opening is on the ventral(bottom) surface of the penis rather than at the end

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34
Q

Epispadias

A

urethral defect with the opening is on the dorsal(front) surface of the penis

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35
Q

treatment for Hypospadias & Epispadias

A

-Do not circumcise at birth
-Surgery is usually done by 18 months of age

36
Q

why do we not circumcise if an infant has Hypospadias or Epispadias

A

so that surgeon can use this skin when correcting problem (may possibly be able to perform after repair surgery)

37
Q

post op for Hypospadias & Epispadias

A

-Urethral drainage catheter temporarily
-Oxybutynin (Ditropan)

38
Q

why is Oxybutynin (Ditropan) given after Hypospadias or Epispadias surgery

A

given to relieve bladder spasms

39
Q

what can happen if Hypospadias & Epispadias is left untreated

A

-may not be able to aim urine stream
-Interferes with deposition of sperm - sterile
-Affects self-esteem and body image

40
Q

oxybutynin action

A

works directly on the smooth muscles of the urinary tract by blocking parasympathetic nerve impulses

41
Q

oxybutynin use

A

urinary incontinence, neurogenic and overactive bladder

42
Q

oxybutynin Side effects

A

drowsiness, tachycardia, anticholinergic effects (constipation and urinary retention), insomnia

43
Q

Phismosis

A

Narrowing or stenosis of prepubital opening of the foreskin, FORESKIN IS NOT ABLE TO BE RETRACTED

44
Q

Phismosis is a …

A

Normal finding in infants - usually resolves as the child grows

45
Q

treatment for Phismosis

A

-Steroid cream may be applied twice/day for 1 month
-Circumcision in severe cases (rare)

46
Q

why do we not force retraction in Phismosis

A

it could cause scarring and possible paraphismosis

47
Q

Paraphosmosis

A

retracted foreskin cannot be replaced to its normal position - edema and venous congestion created by CONSTRICTION of the tight band of foreskin - a urologic EMERGENCY

48
Q

Hydrocele

A

Peritoneal fluid in the scrotum

49
Q

communicating hydrocele

A

-opening between
scrotum and peritoneum
*Can change in size during the day

50
Q

Noncommunicating hydrocele

A

-no opening between scrotum and peritoneum
-No change in size

51
Q

hydrocele is common in newborns and usually resolves by

A

12 months of age

52
Q

Cryptorchidism

A

Undescended testicle (one or both)

53
Q

interventions for Cryptorchidism

A

-Use warm hands to examine infant
-Exam can be done in parents lap to aid comfort and cooperation in infant
-Testes will retract normally if infant is cold or upset

54
Q

If testes do not descend:

A

surgery may be required (between the ages of 6 months and 2 years)

55
Q

Nephrotic Syndrome

A

Increased glomerular membrane permeability causing an abnormal loss of protein in the urine

56
Q

Nephrotic Syndrome incidence

A

more boys 70% before age 5, peak incidence between 2 yrs and 7 yrs.

57
Q

clinical manifestions of nephrotic syndrome

A

-Weight gain
-Massive proteinuria
-Hypoalbuminemia
-Edema around eyes, hands and face
-Growing waistline (ascites)
-Nausea or vomiting (may be related to ascites)
-Pale tight skin from progressing edema
-Weakness or fatigue
-Irritability or fussiness
-Hypertension

58
Q

intervention for ascites

A

sit in upright position so that it does not compress the lungs

59
Q

intervention fro N/V

A

may need to give calorie supplementation to increase caloric intake because the child is still growing, SMALL FREQUENT FEEDING of fav foods

60
Q

diagnostic testing for nephrotic syndrome

A

-Urinalysis
-Serum protein, electrolytes
-Renal US

61
Q

nursing care for nephrotic syndrome

A

-Elevate head of bed and change positions often to decrease edema and to allow better breathing
-May need to restrict fluids acutely, diuretics
-Daily weights
-Measure abdominal circumference
-Strict I&O
-Skin care due to edema‐lotion, good hygiene
-Give IM in non‐edematous skin (usually higher on body)
-Restrict sodium intake

62
Q

where do you measure abdominal circumference

A

belly button

63
Q

medications for nephrotic syndrome

A

-Prednisone (to initiate remission)
-Diuretics
-Antibiotics

64
Q

when is a child considered tl be in remission from nephrotic syndrome

A

when urine is zero to trace for protein for 5‐7 days

65
Q

Acute Glomerulonephritis

A

Inflammation of the glomeruli in response to a preceding illness

66
Q

causes of Acute Glomerulonephritis

A

Streptococcal -causes strep throat, impetigo

67
Q

manifestations of Acute Glomerulonephritis

A

-Dark brown color of urine from old blood
-Proteinuria (mild to moderate)
-Abdominal pain
Hypertension
-Mild edema
-Lung congestion - crackles
-Decreased urine output
-Lethargy

68
Q

Acute Glomerulonephritis diagnostic testing

A

-Serum urea and creatinine
-Serum protein
-Serum WBC count
-Urinalysis
-Renal biopsy
-Throat culture

69
Q

treatment for acute glomerulonephritis

A

-Antihypertensives and diuretics
-Antibiotics
-Maintain sodium and fluid restrictions during initial edematous phase
-Weight daily, strict I & O
-Bed rest d/t fatigue during acute phase
-Emergency care - hemodialysis for renal failure

70
Q

Hemolytic Uremic Syndrome

A

The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia

71
Q

Hemolytic Uremic Syndrome caused by

A

E. Coli

72
Q

clinical manifestations of Hemolytic Uremic Syndrome

A

-GI symptoms: diarrhea
-Anemia
-Fever
-Abdominal pain
-Low hemoglobin

73
Q

isolation precautions for e. coli

A

Contact isolation

74
Q

diagnostics for Hemolytic Uremic Syndrome

A

-Hematuria
-Mild proteinuria
-Increased blood urea nitrogen (BUN)
-Increased creatinine

75
Q

treatment for Hemolytic Uremic Syndrome

A

-Blood products (for low hemoglobin)
-May require peritoneal dialysis

76
Q

what is the triad for Hemolytic Uremic Syndrome (HUS)

A

decreased RBC, decreased platelet count, renal failure

77
Q

Hemolytic Uremic Syndrome is contagious..

A

up to 17 days after the resolution of diarrhea; contact precautions

78
Q

Acute Renal Failure

A

A sudden, often reversible, decline in renal function that results in the accumulation of metabolic toxins (particularly nitrogenous wastes) as well as fluid and electrolyte imbalance.

79
Q

causes of acute renal failure

A

-Dehydration
-Hemorrhage
-Shock
-Severe diarrhea
-Traumatic injury
-Prolonged anesthesia after heart surgery
-Antibiotics

80
Q

clinical manifestations of acute renal failure

A

-Oliguria and/or anuria
-Azotemia (blood urea nitrogen [BUN] elevated)
-Creatinine elevated
-Hyperkalemia (weak irregular pulse, lower BP, abdominal cramps)
-Increased phosphorus levels
-Fluid retention and edema
-Hypertension, cardiac arrhythmias

81
Q

treatment for acute renal failure

A

-Support body systems: cardiovascular, respiratory
-Treat cause
-Give insulin and glucose to help move potassium into cells to lower circulatory level
-Aluminum hydroxide gel to bind with phosphorus and prevent absorption of it
-Prevent infection
-Support nutrition

82
Q

Dietary modifications in acute renal failure

A

-Restrict protein intake if chronic failure
-Restrict potassium and sodium intake
-Restrict phosphorus intake
-Provide maximum calories within fluid restrictions to help with growth
-Fluid restriction - as much as 1/3 of daily maintenance fluid requirement

83
Q

Dialysis

A

diffusion through a semi-permeable membrane

84
Q

if you get a cloudy return on dialysis…

A

peritonitis, use antibiotics

85
Q

Hemodialysis

A

Blood is removed from the body, an external membrane is used to diffuse out urea and electrolytes before blood is returned to child.

86
Q

3 hours of hemodialysis is equal to ___ hours of peritoneal dialysis

A

12

NSG 434 (17 decks)

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