peds - GU Flashcards
1
Q
Urinary Tract Infections due to
A
urinary stasis, vesicoureteral reflux, urethral exposure to organisms
2
Q
Structural Defects are usually
A
hereditary
3
Q
Insufficient Renal Function
A
Acute, chronic, structural causes
4
Q
Genitourinary System
A
- Excretes Wastes
- Maintains acid-base, fluid, and electrolyte balance * Produce Renin –regulates blood pressure
5
Q
GU - Pediatric Differences - nephrons?
A
- All nephrons present at birth
6
Q
Expected urine output according to age -does it increase or decrease?
A
Urinary output per kilogram of body weight decreases as the child ages because the kidney becomes more efficient at concentrating urine.
7
Q
Expected urine output according to age - numbers
(2 to 40)
A
Infants 2 ml/kg/hr Children 0.5 - 1 ml/kg/hr Adolescents 40-80 ml/hr
8
Q
reproductive -
* Pediatric Differences- when is it functional?
A
Functionally immature until puberty
* Genitalia (except clitoris in girls) enlarge gradually through childhood
9
Q
Diagnostic Procedures
A
- Computed tomography
- Cystoscopy
- Intravenous pyelogram
- Magnetic resonance
imaging (MRI) - Renal biopsy
- Renal or bladder
ultasound
10
Q
Laboratory Tests
A
- Blood urea nitrogen
- Creatinine
- Creatinine clearance * Basic metabolic panel * Urinalysis
- Urine culture
- Urine protein to creatinine ratio
11
Q
UTIs - more common in…
A
- More common in males 1st 6 months
- Uncircumcised – 10-12 times – to develop UTI
- After 6 months girls
- More common in girls
- Due to shorter urethra
- Urethra closer to anus & vagina * Increasing risk of contamination
12
Q
UTI pathos - most common bacteria
A
Most common cause * Escherichia coli
* Urinary stasis
* Due to infrequent voiding
* Neurogenic bladder
* Interrupted nerve supply
* Poor hygiene
* Inadequate cleansing after BMs
* Irritated perineum
13
Q
UTI - clinical manifestations - Infants - what about diaper?
A
vFever
vWeight loss/failure to gain weight vFailure to thrive
vPoor feeding
vIrritability
vVomiting & diarrhea
vFoul smelling urine
vPersistent diaper rash
14
Q
UTI - clinical manifestations - Older children - same as adults
A
vUrinary frequency
vPain during micturition
vAbdominal pain
vHematuria
vFever chills
vEnuresis (incontinence)
vFlank pain
15
Q
UTI - assessment - what type of catch?
A
- Urinalysis (UA)
- Urine culture
- Microscopic –large numbers of WBCs
- Large numbers of bacteria
1) Obtain catheter specimens in infants and young
children
2) Clean-catch specimen
16
Q
Normal Urine pH
A
- pH 5 to 9
17
Q
urine shouldn’t have
(no GHK in urine)
A
ØGlucose
ØKetones
ØHgb
18
Q
Hypospadias - what about circumcision? and does it interfere with voiding?
A
- Does not interfere with voiding
- Could interfere with reproduction
- If not repaired by adulthood
- Routine circumcision may be avoided * As foreskin may be needed for the repair
19
Q
Hypospadius - mild
A
- Congenital anomaly
- Involving abnormal location of the urethral meatus
- Incidence - 1 out of 300 male births
- Mild – slightly off center from tip of penis
20
Q
Chordee
(cord down the middle)
A
- Most often accompanies hypospadias * Fibrous line of tissue
- Downward curvature of penis
21
Q
hypospadias - Surgical Correction - what age?
A
- Mild cases not indicated
- Choice of surgical procedure-depends on defect * 6-12 months
- Silicone stent
22
Q
hypospadias - Post-op care - restraints?
A
Sedation
* Arm & leg restraints
* Pain management
* Care of stint or indwelling catheter
* Irrigation if ordered
* I & O
23
Q
Cryptorchidism - can impair what?
(no sperm in the crypt)
A
- Failure of one or both testes to descend from the inguinal canal into scrotum
- Can impair spermatogenesis (the creation of sperm).
24
Q
Cryptorchidism - common in
A
- Occurs in 3% of term male infants
- Higher incidence in preterm infants
- Normal descent occurs in late gestation
25
Cryptorchidism - Abdominal
(abdominal ring)
Proximal to internal inguinal ring
26
Cryptorchidism - Canalicular
(cana you go between internal and external)
Between the internal and external
inguinal rings
27
Cryptorchidism - Ectopic
(ectopic abdomen)
Outside the normal pathways of descent between the abdominal cavity and the scrotum
28
Cryptorchidism - patho - exposure to what?
* Failure to descend exposes testes to heat of body (higher temp in abdomen)
* Leading to low sperm counts at sexual maturity
29
Cryptorchidism - assessment - just absence of testes
* Absence of one or both testes in scrotal sac may be noted at birth
* Noted by parent/provider
* If not felt on exam
* Monitor as testes may descend later
30
Cryptorchidism - diagnosis
* Physical exam
* Help locate non-palpable testis that migrated intra-
abdominally
* Ultrasound
* CT scan
* MRI
* Laparoscope (locate testis)
* Hormonal & chromosomal evaluation
31
Cryptorchidism - treatment - when can they spontaneously descend?
* Testes do not descend spontaneously * Orchiopexy (surgery to lower testes)
* Can descend spontaneously by 3 months *
32
Cryptorchidism - preoperative - is it inpatient or out?
* Usually outpatient
* Prepare parents & child
for procedure
* Surgery on “private parts” can be embarrassing
* Assure penis will not be affected
33
Cryptorchidism - post op - ice or heat?
* Scrotal support
* Ice
* Monitor Voiding
* Pain management * Prevent infection
* Psychological and emotional support
34
Cryptorchidism - Discharge Instructions - how long to not take a bath?
* Proper incision care
* Clean diaper area
* Sponge for 2 days
35
Inguinal Hernia - who gets it? and is it one side, or both?
* Inguinal hernia is a painless inguinal or scrotal swelling of variable size
* protrusion of abdominal tissue, such as bowel, extends into inguinal canal
* Hernia may exist elsewhere on the abdominal wall
* Mostly in males
* Bilateral
36
Inguinal Hernia - more common in
* More likely in males
* Due to inherent weakness along inguinal canal * Due to the way males develop in womb
* Testicles form within abdomen
* Than move down
37
Inguinal Hernia - may be noticed when (2 things)
* May be noticed when child is crying * Straining for a BM
* Pre-op education
* Expected post-op status
* Hernia repair
* Surgical management
38
Incarceration - hernia - symptoms
* Medical emergency
* Acute onset of pain
* Irritability
39
incarceration - post op - the usual
* Outpatient basis
* Keep wound clean and dry
* Pain management
* Dressing/sealant
* Change diapers frequently
40
Acquired Renal Health Problems
vAcute Postinfectious glomerulonephritis (APIGN) vNephrotic syndrome
41
Glomerulonephritis - can lead to what?
(glom builds up in my system)
* Condition that interferes with kidney function
* Can lead to potentially
1) Dangerous buildup of waste products in blood stream
2) Hampers kidney’s ability to remove
q Waste
q Excessfluids
42
Glomerulonephritis - is it acute or chronic?
* Can be acute
* Chronic
* Part of a systemic disease like:
q Lupus
qDiabetes
* Or by itself
* Most common form:
* Acute Postinfectious Glomerulonephritis
43
Acute Postinfectious glomerulonephritis (APIGN) - what type of bacteria? And are one or both kidneys affected?
* Allergic reaction (antigen-antibody) to group A beta- hemolytic streptococcal infection
* Antibodies produced to fight invading organisms also react against glomerular tissue
* Both kidneys usually affected
* Mild cases usually recover in a couple of days
44
Acute Postinfectious glomerulonephritis (APIGN) - patho
* Acute inflammation of the glomeruli
* Acute post-infectious glomerulonephritis
* Preceded by a streptococcal infection
* Respiratory
* Skin
45
Acute Postinfectious glomerulonephritis (APIGN) - clinical manifestations
(glom has a puffy eye infection)
$Many are asymptomatic
$Abrupt onset
$Flank or mid-abdominal pain
$Irritability
$Malaise
$Periorbital Edema (early)
46
Acute hypertension
can cause encephalopathy
* Headache * Nausea
* Vomiting
* Irritability
* Lethargy * Seizures
47
Acute Postinfectious glomerulonephritis (APIGN) - diagnostic labs - protein?
ðWBC & Sed rate up
ðBUN up
ðCreatinine up
ðSerum protein - low
ðASO - INDICATES PREVIOUS STREP INFECTION
48
Acute Postinfectious glomerulonephritis (APIGN) -urinalysis
(a cutie glom has blood, protein, and casts)
* Hematuria
* Proteinuria
* Red & white cell casts
49
Acute Postinfectious glomerulonephritis (APIGN) -clinical therapy - what might be limited in diet?
* Supportive
* I&O
* Fluid & Electrolyte imbalance
* Weigh daily – monitor fluid imbalance
* Maintain fluid restriction if ordered
* Sodium, potassium, & protein may be limited * Monitor dietary intake
* Activity level
50
Nephrotic Syndrome
(nephrotite is not specific)
* Not a specific disease
* Clinical state
* Cause unknown
* Minimal Change Nephrotic Syndrome (MCNS) – most
common(85%)
51
Nephrotic Syndrome - clinical manifestations
(other than edema - one thing)
* Gradual onset of massive edema
* Massive proteinuria
* Hyperlipidemia
* Weight gain
52
Nephrotic Syndrome - Diagnostic Tests
(test nephrotiti for al and salt)
* History
* Symptoms
* Lab findings
* Urinalysis
* Serum albumin * Sodium
* BUN
* Electrolytes
53
Nephrotic Syndrome - planning and implementation
* Monitor weight
*I&O
* Measure abdominal girth
* Promote nutrition
* Fluids – may not be restricted * No salt added
54
Nephrotic Syndrome - Planning and Implementation
* Prevent skin breakdown
* Prevent infection
* Medication therapy
55
Wilms Tumor - at what age?
(wil is 2 or 3)
* Description
Intrarenal tumor that is also called a nephroblastoma
Common abdominal tumor during childhood 6% of all childhood tumors
Occurs between2 & 3 years of age
56
Wilms Tumor- Etiology and Pathophysiology - is it one side or both? which has a worse prognosis?
* Small proportion show a genetic basis * Family members at increased risk
* Unilateral or bilateral
* Bilateral have a poor prognosis
Often encapsulated
* Metastasizes to lungs & liver
* Prognosis based on stages of disease
* 75% of children have 5 year survival rate
57
Wilms Tumor- clinical manifestations - and is it tender?
Most common – swelling or mass in abdomen * Firm
* Non-tender
* Confined to one side (midline of abdomen)
58
Wilms Tumor- how to identify
vUltrasound
vIV pyelogram (x-ray of bladder) reveals a growth
vCT scan of lungs, liver, spleen, and brain (identify
metastasis)
vCBC, BUN, Creatinine levels, liver function tests
59
Wilms Tumor- nursing care - don't do what before surgery?
uPost sign
uAVOID PALPATING ABDOMEN PREOPERATIVELY uReduce risk of rupturing capsule and causing tumor
spillage
60
Wilms Tumor- theraputic management - just radiation
* Unless bilateral tumors are present – ØSurgery to remove affected kidney ØExamine opposite kidney
ØLook for metastasis
* Radiation/Chemotherapy or both before or after
61
Wilms Tumor- Post op
uFocus on Pain management
uClose monitoring of fluid levels uIncisional pain
uPain from postop shift of internal organs uTo compensate for loss of kidney
uI & O
uDaily weight
uDaily urine specific gravity uComplete pain assessment with VS
62
Wilms Tumor- more post op
* Assess bowel sounds * Abdominal distention * Bowel movements
* Infection
* Observe surgical wound * Body temperature
* Education
* Protect remaining kidney
Monitor for UTI & avoid contact sports
63
renal growth - when does it take place?
(kidneys are kids until 5 yrs)
* Most takes place during first 5 years
* Full size by adolescence
64
Renal efficiency
Increases as child matures
65
Bladder capacity and control - number at birth and adulthood
(20 pees at birth)
Increases from 20 to 50mL at birth to 700mL in adulthood
66
normal Specific gravity
(space in 1001)
* Specific gravity 1.001 to 1.035
67
normal protein
(no protein after 20)
* Protein <20 mg/dl
68
normal Urobilinogen
(uro is small)
* Urobilinogen up to 1 mg/dls
69
urine shouldn't have
(CRWN urine)
ØWBCs
ØRBCs
ØCasts
ØNitrites
70
hypospadius - severe
(severe meat)
* Severe – meatus on scrotum on perineum
* May have inguinal hernia, cryptorchidism, & partial absence of foreskin
71
hypospadius - post op care - avoid what?
(hypo can't hyper kick)
* Avoid kicking, twisting, blockage
* Home care
* Activities limited
* Fluids
* Antibiotics
* Signs of infection
72
cryptochidism - risk for what?
(crypto gives me cancer and infertility)
* Risk for infertility
* Malignancy (risk for cancer is 35-50 times greater)
73
cryptochidism - risk for what?
(cripto is twisted)
* Greater risk for torsion (twisting of testis on its blood
supply) and trauma
* Higher incidence of cancer
* Associated with inguinal hernia
* Testes continue to secrete hormones
74
cryptochidism - surgery recommended when?
Surgery –
* Recommend at 6 months full term infant
* 12 months – premature infants
* Avoid damage
* Preserve fertility
* Avoid psychological effects
* Fear of castration
* Body image issues in older children
75
cryptochidism - ointment?
* No medication/ointment over incision
* Signs of infection
* Pain management
* No straddling across hip or toy riding
76
incarceration - symptoms
(distended and vomiting by incarceration)
* Tenderness
* Anorexia
* Abdominal distension
* Vomiting
* Bloody stools
* Incarcerated (Irreducible)
* Symptoms of complete obstruction
77
incarceration can lead to
strangulation & necrotic bowel
78
incarceration - sponge bath - how many days?
* Sponge bath for 2-5 days
79
incarceration - post op activities?
(not restricted by incarceration)
* No restriction on activity
* Older children caution against lifting, pushing, wrestling or fighting, riding bike, sports
80
acute postinfectious glomerulonephritis - when does it appear?
(a cutie from 10 to 21)
* Appears after a latent period of 10 – 21 days days
81
acute postinfectious glomerulonephritis - what ages and gender?\
(a cutie at 2)
* Incidence 2-6 years of age * More common in boys
82
nephrotic syndrome - treatment?
(nephrotiti on steroids)
* 95% respond to steroid therapy
83
nephrotic syndrome - symptoms
(nephrotiti is irritable and in pain)
* Abdominal pain
* Irritability
* General malaise * Anorexia occur
* Pallor
* Hypertension
84
nephrotic syndrome - IV what?
(nephrotiti loves IV al)
1) IV albumin (to pull fluid in) &/or diuretics to flush it out reduce edema
85
nephrotic syndrome - meds (nephrotiti on steroids)
2) Corticosteroids – reduce inflammatory process reduces proteinuria
86
wilms tumor - symptoms
(will could hurt, or not)
* Can be asymptomatic
* Pain
* Hematuria
87
wilms tumor - HTN - why?
* Hypertension (25%) -
Due to increased renin production
88
acute postinfection glomerulonephritis - what's in the pee? and HTN?
$Fever
$Hematuria –dark colored urine (tea/cola) $Proteinuria
$Azotemia (build up of nitrogen)
$Edema – feet & ankles
$Hypertension
89
glomerulonephritis - treatment
I/O, fluids, monitor
90
glomerulonephritis - how to test?
2 rising ASO tests (measures strep)
91
nephrotic syndrome - may restrict
fluid due to edema
92
if kidney is removed - monitor for
UTI to preserve other kidney
93
periorbital edema
EARLY sign - post acute glom, not glomerulonephritis
