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ABSN > Peds Exam 3b - GU > Flashcards

Peds Exam 3b - GU Flashcards

(96 cards)

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1
Q

what age group is more prone to dehydration

A

newborns

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2
Q

S/s of GU disease: newborns

A

poor feedings
res distress
poor urinary stream
jaundice
seizures
dehy
vomiting

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3
Q

S/s of GU disease: infants

A

poor feeding
pallor
fever
failure to gain wt
persistent diaper rash
seizure
dehy
vomiting

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4
Q

if we are having urine problems, what else should we check

A

blood pressure (RASS system happens in kidneys)
do a manual blood pressure

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5
Q

nursing care for GU mgt

A

-accurate measurement & recording of wt, ht, I&O, and BP
-prepare child and family for tests (not pleasant tests)
-collection of specimens (harder in kids bc they can’t be trusted)

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6
Q

what is the best way to collect urine from a newborn

A

in & out cath

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7
Q

what does urine specific gravity tell us

A

hydration status

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8
Q

should nitrates be in your?

A

yes, they should
nitrites should not and they indicate infection

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9
Q

what indicates infection in the urine

A

-nitrites
-cloudy
-WBCs

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10
Q

what are 80% of UTI’s caused by

A

E.coli
send sample to the lab and if positive then send for culture

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11
Q

what medication will not work for a UTI

A

amoxicillin bc it will not kill E.coli
put children on bactrum

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12
Q

voiding cystoureterography (VCUG)

A

a catheter is inserted into the bladder and then we inject dye so we can watch the child urinate under xray
will be on exam

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13
Q

why do we preform a VCUG

A

to see if the child is reflexing any urine back from the bladder to the kidneys
if doing can cause repeated UTIs, scarring, hydronephrosis and damage to kidneys

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14
Q

when will a VCUG be ordered

A

-if a little girl has 2 to 3 UTIs
-if a little boy has 1 to 2 UTIs

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15
Q

when doing a physical assessment on a GU kid, what is important to look at

A

the ears, bc they develop at the same as the kidneys in utero so if there is something wrong with your ears then probably something wrong with your kidneys

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16
Q

hypospadias

A

when the urethral opening does not go all the way to the tip of the penis, it is on the ventral surface (under the penis)

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17
Q

hypospadias complications

A

-more at risk for UTIs d/t urine stasis
-body image issues (can’t stand and pee)

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18
Q

epispadias

A

urethral opening is on the top of the penis
not as common as hypospadias & it is usually paired with another problem

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19
Q

hypospadias therapeutic mgt

A

-eval of penis before discharge of newborns bc if present, need to repair
-if present, do not preform circumcision bc will do it during the repair

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20
Q

when does surgical correction of hypospadias occur

A

between 6-18 months, lets the child grow but will be fixed before they are potty trained

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21
Q

hypospadias post opt care

A

-pressure dressing do not change but assess for drainage
-check tip of penis if visible
-catheter / stent in place needs to be closed drainage
-if open drain, double diaper
-teach home care

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22
Q

what needs to be avoid while catheter and stent are in

A

-tub baths
if internal stent, only need to avoid for 48 hrs
-sand boxes
-straddle toys
-do not carry on hip

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23
Q

cryptorchidism

A

a condition in which one or both testicles fail to descend into the scrotum, often associated w/ hypospadias

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24
Q

if one testicle is not descending, what is the child more at risk for

A

cancers

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25
cryptorchidism: undescended
testes is located somewhere along the normal pathway of descent
26
cryptorchidism: ectopic
testes is located outside normal pathway
27
cryptorchidism: retractile
testes can be manipulated into the scrotum
28
cryptorchidism: absent
testes is absent
29
cryptorchidism nursing interventions
make sure testicle is present
30
obstructive uropathy
an obstruction at any level of the upper and lower urinary tract (ex: tumor, stricture, kidney stone, constipation)
31
obstructive uropathy therapeutic mgt
-surgical correction -monitor BP -prepare families -close observation post opt (pain from stent) -catheter care -teaching home care
32
vesicoureteral reflux
-regurgitation of urine from the bladder into the ureters and kidneys -graded 1 to 5 -can lead to repeated UTIs, HTN, renal insufficiency or renal failure -primary reflux is familial and is usually outgrown
33
what can repeated UTIs cause
scarring which leads to long term kidney damage
34
what is one of the leading causes of dialysis later in life
repeated UTIs
35
what grades of vesicoureteral reflux can be treated w/ antibiotics
grades 1-3
36
what test do we do when vesicoureteral reflux is suspected
VCUG
37
when is it best to take antibiotics for vesicoureteral reflux
at night because that is when most of the urinary stasis occurs
38
vesicoureteral reflux nursing considerations
-teach infection prevention (antibiotic compliance, empty bladder completely, good hygiene) -have siblings screened -age appropriate preparation for procedures
39
vesicoureteral reflux post opt nursing considerations
-no tub baths -analgesics for pain -antispasmodics for bladder spasms -prophylactic abx for 1-2mo post surgery -urine bag below bladder
40
hernia
protrusion of a portion of an organ or organs though an abnormal opening
41
hernia danger arise when
-protrusion is constricted -circulation is impaired -interference w/ function of development of other structure
42
3 types of hernias
1) diaphragmatic (most severe) 2) abdominal wall 3) inguinal canal
43
diaphragmatic herina
a hole in the diaphragm and depending when it occurred during fetal development will depend on how well they do (late the heart and lungs had a chance to grow & develop without other organs coming up and squishing them)
44
if baby has a left diaphragmatic hernia, what is a nursing consideration
the organs will come up on the left side and push to the right **things will not be in correct spot when you listen**
44
diaphragmatic hernia mgt
-detected in utero (can be fixed prenatally) -after birth if not fixed: res distress, cyanosis, scaphoid abdomen, impaired cardiac output -immediate med attention: intubate, GI decompression, IV fluids, surgery
45
what is an umbilical hernia filled with
fluid & air, push on it during diaper changes **should be able to squish this and push it flat, if can't then emergency bc organs are in there and can be strangled**
46
what happens to the umbilical hernia when a child gets mad or bears down
the hernia will expand and get bigger
47
treatment of umbilical hernias
most likely will resolve by itself
48
inguinal hernia
-can be more severe -deep in groin **d/t gravity, more likely for things to go through the hole, make sure to be pushing**
49
UTI: urethritis
infection limited to the urethra
50
UTI: cystitis
infection limited to the bladder
51
UTI: pyelonephritis
infection involving the kidney
52
why do girls get UTIs more frequently then boys
-anatomy -the close proximity between the anal opening and the urethra -girls do not have prosthetic secretions
53
UTI S/s: infants
-fever -wt loss -FTT -vomiting -diarrhea
54
UTI S/s: children
-**dysuria** -frequency, urgency, incontinence -foul smelling urine ~hematuria -abdominal pain -fever
55
3 goals of therapeutic mgt for UTIs
-cure the infection -identify predisposing factors -prevent recurrent infections
56
UTI nursing strategies
-appropriate specimen collection -ensure adequate admin of abx -push fluids -avoid tight fitting underwear -promote comfort -adequate follow up cultures - teach preventive measures -pee after sex -change pads regularity
57
what type of bath increases the risk of a UTI
bubble baths **tub baths are good**
58
enuresis
wetting the bed
59
enuresis: primary
-familial -decreased bladder capacity -developmental lag -sleep disorder -nocturnal polyuria theroy
60
enuresis: secondary
-psychological factors (divorce) -abuse -UTI -diabetes -sickle cell -constipation **figure out cause**
61
enuresis treatment
-most will grow out of it -kegle exercises -good abdominal tone -meds (not daily, only for special occasions) -moisture alarm -behavior modification **positive reinforcement, do not punish**
62
enuresis nursing strategies
-limit caffeine & chocolate -limit fluids after dinner -use bathroom right before bed -use bed pads & 2 sets of sheets -teach use of alarm / wake them up to pee throughout night -**only use pulls on sleep overs bc it wicks moisture away and we want them to feel wet & wake up**
63
hemolytic uremic syndrome (HUS)
combination of hemolytic anemia and thrombocytopenia that occurs with acute renal failure (usually ingests a toxin like E. coli) -most common between 5-6 yr
64
HUS clinical manifestation
**watery diarrhea** progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia **usually always misdx bc it presents like gastroenteritis**
65
what labs will be low in HUS
RBCs & platelets
66
HUS source of infection
E. Coli (also s.pneum. or shigella) -cows (playing with or consuming) -salad -don't wash hands well before preparing food -unpasteurized dairy or fruit products
67
HUS S/s
-vomiting -marked pallor -oliguria or anuria -edema -fatigue -elevated BP -abdominal pain & tenderness -neuro changes
68
HUS urinalysis results
positive for blood, protein, pus and casts
69
HUS blood panel results
-BUN & creatinine: elevated -moderate to severe anemia -mild to severe thrombocytopenia -leukocytosis w/ left shift -hypoNa -hyperK -hyperPhos
70
HUS complications
-chronic renal failure -seizures & coma -pancreatitis -rectal prolapse -cardiomyopathy -congestive heart failure -acute res distress syndrome **she just showed this**
71
HUS therapeutic mgt
-maintain fluid balance -correct hypertension, acidosis & electrolyte abnorms -replenish circulating red blood cells -provide dialysis if needed **abx do not work, symptom treatment**
72
HUS nursing considerations
-contact precautions -close attention to fluid volume status -family support (we do not know if they will get better) -encourage adequate nutrition w/ diet restriction -monitor for bleeding -teach prevention
73
prevention of HUS
-cook foods to proper temp -wash hands well -do not consume well water -wash all fruits & vegetables
74
nephrotic syndrome
you lose a lot of protein in the urine causing low protein in blood stream, cholesterol goes up and you have edema **hypoproteinemia, hyperlipidemia, & edema**
75
nephrosis clinical manifestations
-massive proteinuria -sudden, rapid wt gain -**generalized edema** -pleural effusion -decreased urine output -diarrhea -anorexia -pallor, fatigued -meuhrcke lines -**decreased BPP** -hypoalbuminemia -mild hematuria
76
nephrosis goals of treatment
-reducing protein excretion -reducing tissue fluid retention (albumin & lasix) -preventing infection & other complications like anemia, infection, poor growth, peritonitis, thrombosis and renal failure
77
nephrosis therapeutic mgt
-bed rest during edema, unrestricted during remission -**no added salt, high pro diet during edema**, reg during remission -drugs: corticosteroids, immunosuppressant therapy, loop diuretics, salt poor, albumin
78
nephrosis nursing considerations
immunocompromised so screen visitors and do not put them in the room with other sick people
79
nephrosis: additional nursing diagnoses
-ineffective breathing pattern r/t pressure of ascites -body image disturbance r/t change in appearance -activity intolerance r/t fatigue -altered family processes related to a child w/ serious illness
80
acute glomerulonephritis (APSG)
a condition in which immune processes injure the glomeruli, ranging from minimal to severe **untreated strep**
81
APSG clinical manifestations
-fever -lethargy, fatigue, malaise, weakness -**headache**, give pain meds -anorexia, vomiting -puffy face -discolored urine (coke color) -edema -pallor -flank or abdominal pain -HTN
82
APSG urinalysis
-gross hematuria, milld proteinuria, specific gravity elevated -culture: negative
83
in APSG, how do kids show us they're getting better
increase in urine output
83
APSG therapeutic mgt
-bed rest during acute phase -no salt added, low protein diet -control htn **manual BP** -antibiotics if strep still present or fever -isolation from other sick kids
84
APSG nursing considerations
-daily wts -I&Os, USG, monitor hematuria -monitor BP, lytes, & signs of cardiopulmonary congestion -admin diuretics -infection prevention
85
APSG potential for injury
-renal failure -encephalopathy -seizures **not peeing out what they should be**
86
for a child with APSG, teach parents
-how to take BP -follow the prescribed diet -monitor urine output & color
87
why do we see acute renal failure in kids
dehydration and nephrotoxic medication **give fluids or stop med then give fluids**
88
acute renal failure prevention
-treat underlying cause -manage fluid & lytes -decrease BP -provide supportive therapy -drugs: mannitol, albumin, furosemide
89
acute renal failure nursing considerations
-monitor VS and I&Os -regulate fluid intake -nutrition -monitor for complications
90
chronic renal failure
treat w/ dialysis (peritoneal bc more gentle & can do at night)
91
what are we monitoring closes in kids with chronic renal failure
bones because they still need to grow **calcium (low) & phos (high) disturbances -> osteodystrophy**
92
how to treat osteodystrophy
-calcium carbonate -aluminum hydroxide gel
93
supportive therapy for chronic renal failure
-diet (high kcal, adequate pro **not high**, low phos/Na/K+) -vitamins -prevention of osteodystrophy -possible transplant
94
chronic renal failure nursing considerations
-activity is self limited -body image disturbances -watch for metabolic acidosis -**no fleet enemas**

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