Preschool: GU alterations

Question 1

What is included in a renal function assessment?

Answer 1

• Urine characteristics (colour, amount, odour)
• Pain or discomfort
• Edema
• Appearance of genitalia/sexual development

Question 2

What are the red flags in renal function assessment?

Answer 2

• atypical urination pattern (ex. urgency, hesitancy, burning)
• edema, unexpected weight gain
• easily fatigued, lethargic/irritability
• decreased appetite
• abdominal pain

Question 3

What are the diagnostic assessment tools for renal function? and what would you see?

Answer 3

• Blood Test (renal function – invasive): Elevated WBC
• Urinalysis (routine, culture & sensitivity – non-invasive): WBC in urine, Presence of bacteria and antibiotic sensitivity
• Renal /Bladder Ultrasound (visualization of structures- non-invasive)
• CT Scan (cross section of structures– non-invasive)
• Voiding Cystourethrogram (VCUG) (filling, storage & evacuation function – invasive): usually for frequent UTIs
• Renal Biopsy (percutaneous removal of kidney tissue- invasive)

Question 4

What is the lower UTI called and where is the inflammation?

Answer 4

cystitis

Bladder/urethra inflammation

Question 5

what is the upper UTI called and where is the inflammation?

Answer 5

pyelonephritis

Ureters, renal pelvis, renal parenchyma (kidney inflammation)

Question 6

How many voids should you have a day?

Answer 6

5-6

Question 7

What is the risk of urine in renal pelvis (hydronephrosis) or pyelonephritis?

Answer 7

Accumulation of urine in renal pelvis (hydronephrosis) or pyelonephritis → renal scarring from inflammation and ischemia → can lead to HTN, renal disease, end stage KD

Question 8

When is there an increased risk for renal scarring?

Answer 8

• UTI infants under 1 year
• Delay in diagnosis & treatment
• Obstruction
• Recurrent episodes of UTI

Question 9

What are the S&S of cystitis in neonates? (7)

Answer 9

Poor feeding, vomiting, failure to gain weight, jaundice, abdominal distension, lethargy, fever?

Question 10

What are the S&S of cystitis in infants? (8)

Answer 10

Fever, diarrhea, vomiting, irritability, lethargy, foul smelling diapers, poor feeding, failure to gain weight

Question 11

What are the S&S of cystitis in preschoolers? (10)

Answer 11

Fever, hematuria, urgency, dysuria, frequency, cloudy urine, foul smelling urine, dehydration, abdominal pain, enuresis

Question 12

What are the S&S of cystitis in school age? (11)

Answer 12

Fever, hematuria, urgency, dysuria, frequency, cloudy urine, foul smelling urine, dehydration, abdominal pain, suprapubic or flank pain, enuresis

Question 13

What are S&S of pyelonephritis? (8)

Answer 13

High fever, chills, abdominal pain, nausea, vomiting, flank pain, costovertebral angle tenderness, moderate to severe dehydration

Question 14

What is clinical therapy for UTIs?

Answer 14

• administer antibiotics and antipyretics
• encourage fluid intake
• frequent voiding minimizes urinary stasis
• document in and outs (weigh daily)

Question 15

What are preventative strategies for UTI?

Answer 15

• Proper perineal hygiene

-Encourage child to drink fluids

• Do not hold urine/ void frequently
• Dont wear tight underwear
• Discourage bubble baths and hot tubs: can irritate urethra
• Encourage abstinence of sexual activity

Question 16

What is vesicoureteral reflux? (VUR)

Answer 16

• Retrograde flow of urine from bladder into ureters (goes back up)
• ranges from reflux of urine into ureter (stage 1) to severe dilation of ureter and renal pelvis with severely blunted calyces at stage 5
• Reflux prevents complete emptying of the bladder = urine returns to bladder = reservoir for bacterial growth
• Bacteria can be moved to kidneys = pyelonephritis

Question 17

Can you outgrow VUR?

Answer 17

Yes, as they get older, the ureter gets longer and straighter and will shut correctly

Question 18

How is VUR graded?

Answer 18

Renal ultrasound, voiding cystourethrogram (VCUG) and and/or dimercaptosuccinic acid (DMSA) scan

Question 19

What are the treatment options of VUR?

Answer 19

use of prophylactic antibiotics is controversial but may be pre-scribed to prevent urinary tract infections

• surgical reimplantation of ureters
• deflux

Question 20

What is enuresis?

Answer 20

repeated involuntary voiding by a child who has reached an age at which bladder control is expected

Question 21

What age should you have bladder control?

Answer 21

5-6

Question 22

What is primary enuresis?

Answer 22

child has never had a dry night; attributed to maturational delay and small functional bladder;not associated with stress or psychiatric cause.

Question 23

What is secondary enuresis?

Answer 23

child who has been reliably dry for at least 6 months begins bedwetting; associated with stress,infections, and sleep disorders

Question 24

What are the treatment approaches for enuresis?

Answer 24

• Medication
• Bed wetting alarms
• Bladder exercises
• timed voiding
• Reward system
• fluid restrictions

Question 25

What is the fluid restrictions for enuresis?

Answer 25

- limit in evening and before bed - do not take fluids with caffeine

Question 26

What are bladder exercises for enuresis?

Answer 26

- drink large amount of water and hold urine - practice stopping voiding midstream

Question 27

What are timed voiding for enuresis?

Answer 27

void every 2 hours and use double voiding pattern

Question 28

What are enuresis alarms?

Answer 28

detector attached to child's pants alarm sounds do child can get up and finish voiding

Question 29

What kind of medications may be used for enuresis?

Answer 29

- Tricyclics, anticholinergics – antispasmodic effect - Desmopressin – anti diruretic