Module 14: Pediatric Renal Alterations Flashcards
(140 cards)
1
Q
What are the roles of the renal system?
A
(A) Regulation of body fluid volume
(B) Endocrine control
(C) Waste removal (metabolism by products)
(D) Regulation of fluid osmolity and composition (ions)
2
Q
What happens to blood pressure when blood volume decreases?
A
Blood pressure decreases when blood volume decreases.
3
Q
What system helps regulate water conservation or elimination in the body?
A
The endocrine system helps regulate water conservation or elimination.
4
Q
hat is the role of renin in blood pressure regulation?
A
Renin triggers a cascade (RAAS) to regulate and increase blood pressure.
5
Q
What hormone stimulates red blood cell production?
A
Erythropoietin stimulates RBC production from the bone marrow (THIS IS WHY IN KIDNEY DISEASE, PEDIATRIC PATIENTS ARE ALWAYS ANEMIC).
6
Q
What is the function of calcitriol (Vitamin D3)?
A
It promotes the absorption of calcium into the bones.
7
Q
What electrolytes are involved in fluid osmolarity regulation?
A
Na⁺, K⁺, Cl⁻, Ca²⁺, and phosphates.
8
Q
What does pH regulation in the body involve?
A
It involves maintaining acid-base balance using the lungs and kidneys.
9
Q
How do the kidneys help regulate pH?
A
The kidneys regulate pH by reabsorbing or excreting HCO₃⁻ (bicarbonate).
10
Q
How do the lungs help regulate pH?
A
The lungs regulate pH by controlling the amount of CO₂ exhaled.
11
Q
This is a by-product of protein metabolism (CHO-N) and contains nitrogenous wastes.
A
UREA
12
Q
What lab test measures the amount of urea in the blood?
A
BUN – Blood Urea Nitrogen. (IF HIGH, IT CAN INDICATE KIDNEY FAILURE (80) OR DEHYDRATION
13
Q
This is a by-product of energy metabolism from muscle activity.
A
CREATININE (MEASURABLE THROUGH BLOOD WORK)
NORMAL: 0.5 TO 1.2
14
Q
This is a biochemical abnormality, defined as elevation, or buildup of, nitrogenous products (BUN-usually ranging 7 to 21 mg/dL), creatinine in the blood, and other secondary waste products within the body.
A
AZOTEMIA
15
Q
These are by-products of fatty acid metabolism (RCOOH).
A
KETONES (SHOULD BE CONVERTED BY THE BILE INTO FATTY ACIDS TO MAKE IT ABSORBABLE)
16
Q
When are ketone bodies elevated in the body?
A
Ketone bodies are elevated in Diabetic Ketoacidosis (DKA) — a serious complication of uncontrolled diabetes where the body breaks down fat for energy due to lack of insulin. This leads to excess ketones in the blood and urine, causing the blood to become acidic.
17
Q
How are ketone bodies excreted from the body?
A
Ketone bodies are excreted through the urine.
18
Q
What is a by-product of carbohydrate (CHO) metabolism related to energy production?
A
Lactic Acid (LACTIC ACIDOSIS - MOST COMMON CAUSE OF SHOCK)
19
Q
What does an elevated lactate level indicate?
A
Elevated lactate levels can indicate septic shock, cardiac failure, or pulmonary failure, where tissues aren’t getting enough oxygen.
20
Q
What are the components of the urinary system?
A
(A) Kidneys
(B) Ureters
(C) Bladder
(D) Urethra
21
Q
What role do capillaries play in nephron function?
A
Capillaries, especially the peritubular capillaries, surround the nephron and absorb substances reabsorbed from the filtrate, returning them to the bloodstream.
22
Q
What are nephrons and where are they mostly located?
A
Nephrons are the functional units of the renal system, with about 1 million per kidney. Most are located in the renal cortex.
23
Q
What are the main parts of the nephron?
A
(A) Bowman’s capsule – filters blood
(B) Glomerulus – network of capillaries for filtration
(C) Proximal convoluted tubule (PCT) – reabsorbs water, glucose, and ions
(D) Loop of Henle – concentrates urine (descending = water reabsorption, ascending = salt reabsorption)
(E) Distal convoluted tubule (DCT) – selective reabsorption, hormone-regulated
(F) Collecting duct – final urine concentration, water reabsorption under ADH control
24
Q
What is the role of RAAS in dehydration?
A
In dehydration, the body activates the RAAS to conserve water and increase blood pressure:
(A) Renin is released by the kidneys in response to low blood volume.
(B) Renin triggers the conversion of angiotensinogen to angiotensin I, which is converted to angiotensin II in the lungs.
(C) Angiotensin II stimulates the release of aldosterone from the adrenal glands, causing sodium and water retention in the kidneys, which helps restore blood volume and pressure.
(D) Angiotensin II also stimulates thirst and vasoconstriction, further increasing blood volume and pressure.
25
This drug classification is effective in decreasing proteinuria.
ACE INHIBITORS
26
What are the functions of the nephron?
(A) Filtration of the blood plasma
(B) Reabsorption of water sugar and salts
(C) Secretion of H, K ions and hormones
27
How does plasma sodium concentration (osmolality) affect fluid regulation?
1. Plasma sodium concentration (osmolality) increases or decreases.
2. Osmoreceptors in the hypothalamus are stimulated.
3. Posterior pituitary is triggered to release Antidiuretic hormone (ADH).
4. ADH targets the collecting ducts of the kidneys.
Effects of ADH:
(A) Increases water reabsorption in the kidneys.
(B) Results in higher plasma volume and lower osmolality.
(C) Leads to scant urine production as water is retained to balance fluid levels.
28
What is the role of Antidiuretic Hormone (ADH)?
ADH is a compensatory response to prevent dehydration. It controls the concentration of body fluids by altering the permeability of the kidneys.
29
How does ADH affect the kidneys?
ADH acts on the collecting ducts of the nephron, promoting water reabsorption.
30
What happens when there is a lack of ADH?
Lack of ADH leads to uncontrolled diuresis, causing frequent urination due to the inability to retain water.
31
This is secreted by the adrenal glands and plays a role in sodium reabsorption in the kidneys.
Aldosterone
32
How does RAAS contribute to fluid balance?
The RAAS system is activated in response to dehydration or hyperosmolality, leading to increased sodium reabsorption and water retention.
33
What happens after angiotensinogen is secreted?
Angiotensinogen is secreted by the liver and converted to Angiotensin I by Renin. Angiotensin I is then converted to Angiotensin II by ACE (angiotensin-converting enzyme), stimulating Aldosterone release.
34
Why are Urinary Tract Infections (UTIs) more common in females?
UTIs are more common in females because they have a shorter urethra, which allows bacteria to reach the bladder more easily.
35
What are the signs of UTI in a toilet-trained child?
Incontinence in a toilet-trained child can be a sign of a UTI.
36
What is a common characteristic of urine in UTI?
Strong-smelling urine is a common symptom of a UTI. Common symptoms include frequency and urgency to urinate.
37
What systemic symptoms might indicate a severe UTI or urosepsis?
Fever and chills (2ND OR 3RD DAY) or hypothermia can be signs of severe infection like urosepsis.
38
What are the laboratory results when a pediatric patient is diagnosed with urinary tract infection (UTI)?
(A) White Blood Cells (WBC) > 5 to 8 WBC/mL
(B) Bacteriuria – > 100,000/mL and/or positive on Gram stain
(C) Hematuria (gross or microscopic) – > 4 to 6/hpf
(D) Culture and Sensitivity – positive for specific bacteria
39
What are the common antibiotics for UTI?
(A) Trimethoprim Sulfamethoxazole (TMP-SMZ)
– Brand names: Bactrim, Septra
(B) Amoxicillin/clavulanate
(C) Nitrofurantoin
(D) Third-generation Cephalosporins
– Cephalexin
– Cefuroxime
– Ceftazidine
40
What is a common bacterial cause of Acute Glomerulonephritis (AGN)?
Acute Post-Streptococcal Glomerulonephritis (APSGN) caused by a specific strain of Group A beta-hemolytic Streptococci.
41
What are the viral causes of AGN?
Viral causes include Epstein-Barr virus (EBV) and Hepatitis B.
42
What age group is most commonly affected by AGN?
AGN is most common in school-aged children, around 6 to 7 years old.
43
What are the diagnostic tests for AGN?
Blood tests include Anti-Streptolysin O (ASO) and Anti-Streptokinase, which indicate recent streptococcal infection.
44
What triggers the inflammatory response in AGN?
Infections or bacterial toxins trigger an inflammatory immune response, forming immune complexes.
45
What causes the glomerular injury in AGN?
Antigen-antibody complexes are deposited in the glomeruli, leading to glomerular inflammation and damage.
46
Enumerate the pathophysiology for AGN.
(A) Bacterial infection of the throat
(B) Impetigo (skin infection)
(C) Acute viral infections (e.g., URTI, varicella zoster virus, Epstein-Barr virus, hepatitis B, HIV)
(D) Antigen (Group A Beta-Hemolytic Streptococci) triggers immune response
(E) Antibody-antigen complexes initiate the inflammatory process in the glomeruli
(F) Deposition of antigen-antibody complexes in the glomerular basement membrane
(G) Inflammatory response causes swelling of the epithelial lining of the glomeruli
(H) Leukocyte infiltration into the glomerulus leads to further inflammation
(I) Kidneys appear large and swollen due to glomerular congestion and inflammation
47
What are the different clinical manifestations of AGN?
(A) Edema with periorbital edema
(B) Oliguria (500ml ) (ANURIA - LESS THAN 200 ml)
(C) Hypertension
(D) Tea-colored urine (Hematuria)
(E) Proteinuria
48
What often precedes PSAGN?
A history of sore throat or pharyngitis caused by Group A Streptococcus typically 4–10 days to 2–3 weeks prior to onset.
49
What is the recovery rate for PSAGN?
About 90% of patients recover fully from PSAGN with proper care within 60 DAYS.
50
What complication can occur in 10% of PSAGN cases?
Around 10% may develop Chronic Kidney Disease (CKD) as a long-term complication.
51
What are the different signs and symptoms of AGN?
(A) Anorexia
(B) Fever
(C) Headache (HA)
(D) Malaise, fatigue
(E) Flank pain or (+) tenderness at costovertebral angle
(F) Grade +2 or +3 edema
52
What is commonly found in a urinalysis for AGN?
Urinalysis may reveal hematuria (microscopic or gross), proteinuria, cellular elements, and various casts.
53
How is mild AGN typically discovered?
Mild cases of AGN are often discovered by accident during routine urinalysis.
54
What tests are done for protein and creatinine clearance in AGN?
A 24-hour urine collection is done to assess:
(i) Increased protein levels
(ii) Reduced creatinine clearance, which helps evaluate kidney function.
55
How should the nurse execute the 24 hour urine collection for protein?
(A) Have patient void, then discard the urine
(B) Write the time of void on the label of the collection container as the start time
(C) Collect all urine from that point until the end of the 24th hour
(D) Ensure to include the last voided urine in the container
56
What's another diagnostic test for AGN?
Qualitative Urine Dipstick - Test for Protein
57
What are the pharmacologic measures for AGN?
(A) Antihypertensives – To manage elevated blood pressure
(B) Diuretic drugs – To reduce fluid retention and edema
(C) Management of hyperkalemia – Due to renal insufficiency, with appropriate interventions like potassium binders or dialysis if necessary
58
What lab values are important in diagnosing AGN?
BUN (Blood Urea Nitrogen) and serum creatinine levels help assess kidney function in AGN.
59
What is the significance of the Antistreptolysin O (ASO) titer in AGN?
The ASO titer indicates the immune response to a previous streptococcal infection, which is associated with AGN.
60
What role does albumin play in the diagnosis of AGN?
A low albumin level can indicate proteinuria, which is common in AGN.
61
What is the role of serum complement in AGN?
Serum complement levels may be decreased in AGN due to immune complex deposition and activation.
62
This shows obstruction of glomerular capillaries caused by proliferation of endothelial cells in response to inflammation.
KIDNEY NEEDLE BIOPSY
63
What is the main goal of AGN management?
Management of AGN is primarily symptomatic, focusing on treating symptoms and underlying causes.
64
This are used to reduce phosphate levels and elevate calcium in patients with AGN.
Phosphate-binding agent
65
What is the nursing management for AGN?
(A) Fluid intake is restricted.
(B) Dietary protein is restricted moderately if there is oliguria and the BUN is elevated. It is restricted more drastically if acute renal failure develops.
(C) Carbohydrates are increased liberally to provide energy and reduce catabolism of protein.
(D) * Potassium and sodium intake is restricted in presence of hyperkalemia, edema, or signs of heart failure.
66
What are the possible complications of AGN?
(A) Hypertension, heart failure, endocarditis
(B) Fluid and electrolyte imbalances in the acute phase – Including hyperkalemia, hyperphosphatemia, and hypervolemia
(C) Malnutrition
(D) Hypertensive encephalopathy – With seizures
(E) End-stage renal disease (ESRD) - REQUIRES DIALYSIS.
67
What is the first step in nursing care for AGN?
Obtain a thorough medical history, focusing on recent infections or symptoms of chronic immunologic disorders (e.g., systemic lupus erythematosus, scleroderma).
68
What should the nurse assess in the urine specimen for AGN?
Assess the urine specimen for blood, protein, color, and amount to monitor renal function and detect abnormalities.
69
What are the key signs to look for during a physical examination for AGN?
Edema, hypertension, and hypervolemia are common findings in AGN patients.
70
What physical signs indicate hypervolemia in AGN?
Engorged neck veins and elevated jugular venous pressure (JVP) suggest hypervolemia.
71
What lung findings should be assessed in AGN patients?
Adventitious lung sounds, such as rales or crackles, may indicate fluid retention in the lungs.
72
What cardiovascular signs should be checked for in AGN?
Cardiac arrhythmias could be a result of electrolyte imbalances or fluid overload in AGN.
73
What electrolyte imbalance is commonly associated with AGN?
Electrolyte imbalances, such as hyperkalemia, hyponatremia, or elevated BUN, may occur due to impaired kidney function.
74
What are the four (4) electrolyte imbalances in renal failure?
(A) Hyperkalemia
(B) Hypocalcemia
(C) Hyperphosphatemia
(D) Hypermagnesemia
75
What are the possible nursing diagnosis for AGN?
(A) Ineffective (Renal) Tissue Perfusion related to damage to glomerular function
(B) Fluid Volume Excess related to compromised renal function
(C) Potential for Infection
76
What should the nurse monitor in pediatric patients with AGN?
(A) Vital Signs
(B) Intake and Output
(C) Maintain dietary restrictions during acute phase (low salt, high protein)
77
Why is fluid balance monitoring important in AGN?
Careful monitoring of fluid balance helps detect fluid overload or dehydration, which can worsen renal function.
78
How should fluid replacement be guided in AGN?
Replace fluids based on patient’s losses (e.g., urine, respiration, feces) to maintain homeostasis.
79
This occurs when fluid output exceeds fluid intake, potentially leading to dehydration or hypovolemia.
NEGATIVE FLUID BALANCE
80
What hemodynamic parameters are monitored in ICU patients with AGN?
Pulmonary artery pressure and central venous pressure (CVP) are monitored to assess fluid status and guide therapy.
81
What are other nursing interventions for AGN?
(A) Explain that the patient and family must attend regular follow-up appointments to monitor blood pressure, urinary protein levels, and BUN (Blood Urea Nitrogen) to detect any worsening of the condition.
(B) Encourage the patient and family to seek prompt treatment for any infections, as infections may trigger or worsen glomerulonephritis.
(C) Instruct them to report signs of decreasing urine output immediately, as this could indicate worsening renal function and requires urgent medical attention
82
What are the expected outcomes after treating AGN?
(A) Urine output adequate; vital signs stable
(B) No edema, no shortness of breath, nor adventitious heart or lung sounds
83
What are the four (4) distinct manifestations?
(A) Edema
(B) Massive Proteinuria (MORE THAN 300 GRAMS)
(C) Hypoalbuminemia
(D) Hypercholesteronemia
84
Which ethnic groups have a higher incidence and more severe forms of Nephrotic Syndrome (NS)?
African American and Hispanic children have a higher incidence and more severe manifestations of NS.
85
What is the annual incidence of NS in healthy children?
2 to 7 new cases per 100,000 children annually.
86
Is NS more common in boys or girls during childhood?
NS is more common in boys than girls at younger ages. No significant difference in incidence between boys and girls during adolescence.
87
What are the two main classifications of the etiology of Nephrotic Syndrome (NS)?
(A) Primary (Glomerulopathies) and Secondary (systemic or drug-related causes).
88
What is the most common primary cause of NS in children?
Minimal Change Disease (MCD) – responsible for 77%–85% of childhood cases (IDIOPATHIC)
89
Name four secondary causes of NS.
(A) Diabetes Mellitus
(B) Prolonged NSAID use
(C) Systemic Lupus Erythematosus (SLE)
(D) Malignancies or post-infectious diseases
90
What does the Underfill Hypothesis in NS suggest?
That decreased plasma colloid osmotic pressure leads to fluid shift into interstitial space and hypovolemia.
91
According to the Underfill Hypothesis, what contributes to edema in NS?
(A) Decreased colloid osmotic pressure
(B) Increased capillary hydrostatic pressure
92
What does the Overfill Hypothesis propose in NS?
NS is due to primary sodium retention by the kidneys, not hypovolemia.
93
In the Overfill Hypothesis, what is the status of intravascular fluid volume?
It may be normal or increased (OVERLOAD) due to sodium and water retention
94
What leads to fluid retention in the Overfill Hypothesis?
(A) Increased interstitial oncotic pressure
(B) Promotes fluid accumulation in peripheral tissues (edema)
95
Enumerate some risk factors of NS.
(A) Idiopathic
(B) Drug-induced (e.g., NSAIDs)
(C) Autoimmune diseases (e.g., Lupus)
(D) Genetic mutations
(E) Post-infectious (e.g., Hepatitis B, HIV)
(F) Malignancies
96
What are the classic clinical manifestation for pediatric patients with NS?
(A) Anasarca (generalized edema)
(B) Peri orbital Edema more common in Children
(C) Insidious onset of pitting dependent edema, periorbital edema, and ascites; weight gain
(D) Fatigue, headache, malaise, irritability
(E) Marked proteinuria - leading to depletion of body proteins (FROTHY URINE)
(F) Hyperlipidemia - may lead to accelerated atherosclerosis
97
What does urinalysis reveal in NS?
(A) Marked proteinuria
(B) Microscopic hematuria
(C) Urinary casts (FOAMY)
98
What is the purpose of a 24-hour urine collection in NS?
To measure total protein excretion (increased). To assess creatinine clearance (usually decreased).
99
Why is urine protein electrophoresis done in NS?
(A) To categorize the type of proteinuria
(B) Helps differentiate glomerular vs tubular vs overflow causes
100
Enumerate the pathophysiology of NS.
A) Glomerular damage
(B) Increased permeability of glomerular capillaries to protein
(C) Massive proteinuria (≥ 40 mg/m²/hr or ≥ 3.5 g/day)
(D) Hypoproteinemia (albumin < 3 g/dL)
(E) Decreased plasma oncotic pressure
(F) Fluid shift from intravascular to interstitial space
(G) Edema (especially periorbital, pedal)
(H) Decreased intravascular volume
(I) Activation of RAAS causing sodium and water retention
(J) Worsening edema
(K) Liver compensates by increasing lipoprotein synthesis
(L) Hyperlipidemia
101
What happens to total serum protein in NS?
It decreases (<4 g/dL) due to massive urinary protein loss.
102
What is the expected serum albumin level in NS?
Decreased (<3 g/dL), leading to edema and fluid shift.
103
What happens to serum creatinine in NS?
May be normal or elevated (>1.5 mg/dL) depending on renal function impairment.
104
Describe lipid abnormalities in NS.
(A) ↑ Triglycerides (>200 mg/dL)
(B) ↑ LDL and VLDL
(C) ↓ HDL
(Leads to altered lipid profile or hyperlipidemia)
105
Why do pediatric patients with NS need needle biopsy of kidney?
For histologic examination of renal tissue to confirm diagnosis.
106
What is the management for NS?
(A) Diuretics (use cautiously) and ACEi to control proteinuria
(B) Corticosteroids or immunosuppressants
(C) Cyclosporine to decrease proteinuria
107
What non-pharmacologic measure helps reduce edema in NS?
(A) Elevate lower extremities to promote venous return and reduce swelling.
(B) Sodium and fluid restriction to minimize fluid retention.
(C) Infusion of salt-poor albumin
(D) Dietary protein supplements
(E) Low saturated fat diet
108
What are the possible complications of NS?
(A) Altered drug metabolism due to decreased plasma proteins
(B) Progression to end stage renal failure (ESRD)
109
What are the different nursing interventions for NS?
(A) Obtain history of onset of symptoms including changes in characteristics of urine and onset of edema.
(B) Monitor vital signs, daily weights, 1 & 0, and lab values grade of edema.
(C) Enforce mild to moderate sodium and fluid restriction if edema is severe.
(D) Provide a high-protein diet.
110
What are the possible nursing diagnosis for NS?
(A) Risk for Deficient Fluid Volume related to disease process
(B) Risk for Infection related to immunosuppressants
111
What should you monitor in NS when preventing for infection?
(A) Monitor temperature (>38 degrees)
(B) Check blood work for WBC and Blood culture 38.5 C.
(C) Use aseptic technique for all invasive procedures (Sterile gloves.
(D) Strict hand washing by patient and all contacts.
(E) Prevent contact by patient with persons who may transmit infection (screen visitors).
112
What should the nurse educate the patient and the family on in cases of NS?
(A) Teach patient signs and symptoms of nephrotic syndrome.
(B) Instruct patient about adverse effects of prescribed medications and methods of preventing infection if taking immunosuppressants.
(C) Call physician if Temp >38 C.
(D) Carefully review with patient and family dietary and fluid restrictions;
(E) Consult dietitian - for assistance with meal planning.
113
A condition where urine flows backward from the bladder into the ureters.
Congenital Vesicourethral Reflux (VUR)
114
What is a common clinical manifestation of VUR?
Frequent urinary tract infections (UTIs) due to backflow of urine (CAN LEAD TO PYLONEPHRITIS).
115
What can untreated VUR lead to?
Kidney damage or kidney failure due to chronic infections and pressure buildup.
116
What diagnostic tests are used for VUR?
(A) Ultrasound to assess kidney and bladder structure
(B) Voiding Cystourethrogram (VCUG) to observe urine flow during urination
117
What are treatment options for VUR?
(A) Surgical correction for severe cases
(B) Prophylactic antibiotics to prevent recurrent UTIs in mild cases
118
A congenital condition where a baby is born without a closed urinary bladder, exposing the inner bladder to the outside.
Bladder Exstrophy
119
What is the urgent management needed for bladder exstrophy?
Surgical bladder closure is ideally done within the first week of life.
120
What are the more complicated surgical procedures involved in bladder exstrophy?
(A) Bladder closure
(B) Genital repair
(C) Urinary sphincter reconstruction
(D) Pelvic osteotomy
121
What is the prognosis for patients with bladder exstrophy?
Most patients live a normal life span after successful surgical interventions and follow-up care.
122
A surgical diversion that creates a new pathway for urine to exit the body when the bladder is removed or bypassed.
UROSTOMY
123
A type of urostomy with an external bag. A piece of the ileum is used to form a conduit for urine. Urine drains continuously into an external appliance (urostomy bag)
ILEAL CONDUIT.
124
Internal urine reservoirs created from intestinal segments. Do not require external bags. Urine is drained through a catheter at intervals
Continent Urostomies
125
What are examples of continent urostomies?
(A) Koch pouch – ileal reservoir with a continent valve
(B) Ileal neobladder – new bladder connected to the urethra
(C) Mitrofanoff procedure – uses the appendix as a catheterizable channel
126
What is the purpose of urinary bladder irrigation?
To maintain catheter patency, flush out blood clots or mucus, and prevent obstruction after bladder surgery (e.g., TURP).
127
What are the key components of a bladder irrigation order?
(A) Physician’s order must include:
(1) Type of solution (e.g., NS or sterile irrigant)
(2) Volume
(3) Frequency
(4) PRN orders if output stops due to clots or mucus plugs
128
What are important nursing responsibilities during bladder irrigation?
(A) Use sterile technique
(B) Monitor temperature for infection
(C) Observe urine color:
1, Bloody in 1st 24 hrs
2, Light pink by day 3
3. Report persistent bleeding after 3rd day
129
What should the nurse do if no urine output is observed during irrigation?
(A) Suspect obstruction from clots or mucus plugs
(1) Perform PRN manual irrigation
(2) Notify physician if unresolved
130
What type of catheter is used for continuous bladder irrigation (CBI)?
A 3-way Foley catheter is used:
(A) One lumen for drainage
(B) One for balloon inflation
(C) One for irrigation solution
131
What is a critical nursing responsibility in post-op bladder irrigation?
Measure input vs. output:
(A) Irrigation input should match or be slightly less than urine output.
(B) Report negative output (more fluid going in than coming out) immediately — may indicate obstruction or bladder rupture.
132
When should bladder irrigation be stopped?
If output becomes negative, stop the irrigation immediately.
133
This is the involuntary urination during sleep at least 2 times a week for 3 months, in a child 5 years or older.
ENURESIS
134
How common is enuresis in 5-year-olds?
Enuresis affects approximately 15% of 5-year-old children.
135
What are the two types of enuresis?
(A) Primary or Monosymptomatic – no other urinary symptoms
(B) Secondary or Non-monosymptomatic – with urgency, frequency, dribbling, or signs of an overactive bladder (DYSFUNCTIONAL VOIDING)
136
What are the risk factors for enuresis?
(A) Younger age
(B) Male
(C) Black race
(D) History of UTI
(E) Positive family history
(F) Obesity
137
Urinary leakage due to increased abdominal pressure (e.g., coughing, sneezing, laughing) caused by weak pelvic floor muscles.
Stress Incontinence
138
Involuntary urination caused by sudden, strong contractions of the bladder muscles (often described as “overactive bladder”).
Urge Incontinence
139
Urinary dribbling due to incomplete bladder emptying often caused by a blockage of the urethra.
Overflow incontinence
140
Loss of bladder control due to neurologic damage or nervous system dysfunction (e.g., spinal cord injury, MS).
Neurogenic Incontinence
