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Nursing 3 Exam 4 > Unit 34 GU/GI & Nutritional Dysfunction > Flashcards

Unit 34 GU/GI & Nutritional Dysfunction Flashcards

1
Q

What are general GU diagnostic studies?

A

VCUG/VCG - “Voiding cystourethrogram” x-ray of urinary system to see how urine flows, catheter with corntrast die.

  • Ultrasound/bladder scan
  • Urinalysis
  • Urine C and S (if a sterile sample is needed, cauterization is required)
  • BUN (assesses kidney function)
  • Creatinine (assesses kidney function)
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2
Q

What are some GU anatomy defects? Vesicoureteral Reflux, Hypospadias, Cryptorchidism.

A

Vesicoureteral Reflux - reflux of bladder urine up into the ureters. May present with chronic pyelonephritis and require antibiotics

Hypospadias (males) - urethral opening is behind glans penis or anywhere along penile shaft - surgically repaired. DO NOT CIRCUMCISE

Cryptorchidism (males) - one or both of the testicles fails to descend- hcg therapy or surgical repair - common in premies

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3
Q

What is pyelonephritis?

A

Renal infection eventually causing kidney failure

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4
Q

What do these terms mean, Cystitis, Urethritis , Pyelonephritis, Urosepsis? Where do UTIs start? What do reaccurent UTIs lead to?

A
  • Cystitis (In Bladder)
  • Urethritis (In Urethra)
  • Pyelonephritis (In kidney’s)
  • Urosepsis (worst kind, systemic infection that started renal and spread to blood)

Usually ascend from urethra up
The longer untreated, the move severe

Recurrent UTI’s = scarring, which means permanent renal dysfunction

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5
Q

What are the pediatric manifestations of a UTI? Specifically pyelonephritis? Urosepsis?

A

**Pediatric PT’s with significant bacteriuria may have no symptoms or vague symptoms like fatigue or anorexia

  • Frequency, Dysuria (painful urination)
  • Fever
  • Odiferous urine
  • Blood or blood tinged urine

Pyelonephritis: CVA tenderness, HIGH fever, chills

Urosepsis: Serious changes in MS, tachycardia, possibly hypotension

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6
Q

What are diagnostic studies for UTI’s? How could the urine be collected?

A
  • Dipstick (reagent strip) for bedside urinalysis
  • Microscopic urinalysis
  • Culture and Sensitivity

> Clean catch
U-bag for collection from child
Catheterization or suprapubic needle aspiration specimen more accurate, or if clean catch cannot be performed

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7
Q

What is the UTI drug therapy for uncomplicated cystitis?

For complicated UTI’s/pyelonephritis? For repeated UTIs?

A

Uncomplicated UTI’s: short term oral antibiotics

Complicated UTI’s/pyelonephritis: long term IV antibiotics

Repeated UTIs: Prophylactic or suppressive antibiotics such as,

  • TMP-SMX (trimethoprim-sulfamethaxole) check for sulfa allergy
  • Bactrim (push fluids w/ bactrim)
  • Given everyday to prevent reoccurrence, or single dose before invasive events

-Nitrofurantoin (Macrodantin) - urinary antiseptic that stays in urinary tract

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8
Q

What is the nursing care for UTI’s? What do you want to teach?

A
  • Accurate weight measuring (gold standard for IandOs)
  • Monitor renal function tests (BUN/Creatinine)

-Monitor urine color, character, amount

Teach:

  • bathroom breaks!
  • wipe front to back
  • white cotton underwear
  • LOTS of fluids - water NOT juice
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9
Q

Describe what is the Glomerular Disease, Acute Glomerulonephritis.

A
  • Inflammation of glomeruli that decreases plasma filtration which leads to sodium and water retention, increasesing BP.
  • Hypertension
  • Decreased filtration = decreased urine
  • Often follows strep
  • Immune process injury to glomeruli = inflammation
  • No specific medical treatment

Complication: renal failure

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10
Q

What can be assessed in Glomerulonephritis?

A
  • Previous infection
  • Decreased urine output
  • Anorexia/nausea/vomiting
  • HYPERTENSION
  • HEMATURIA! (to describe, tea,cola, dirty green)
  • Increased Anti-streptolysin O (antibody made against streptolysin)
  • edema
  • Fatigue
  • Hx of sore throat
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11
Q

What is the nursing management for Glomerulonephritis? What don’t you want to give?

A
  • BP monitoring and control with (labetalol, nifedipine/diuretics, CCB)
  • Sodium/ fluid restrictions during edematous phase
  • I and O’s
  • Daily weights
  • Monitor edema (periorbital and general)
  • Watch for encephalopathy/seizures (fluid has nowhere to go)
  • NO NSAIDS (inflames kidneys)
  • Monitor labs BUN/Creatinine for kidney function
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12
Q

Describe Nephrotic Syndrome.

A

Glomerulus basement membrane doesn’t filter urine correctly, therefor:

  • massive protein loss**PROTEINURIA!! (mostly albumin)
  • Fluids follows protein, leaking out of blood vessels into third space (tissues) resulting in edema
  • Liver senses protein loss = produces lipids = Hyperlipidemia
  • Increased clotting risk due to decreased intravascular volume
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13
Q

What is the therapeutic/nursing management of Nephrotic Syndrome?

A

-Corticosteroids long term therapy -prednisone; solumedrol IV
-Albumin if needed
-Diuretics furosemide/potassium
-I and O’s/weights
(If not effective, immunosuppressive therapy, cytotoxic rx’s)

> Prevent infection:

  • Monitor temp
  • Pneumococcal vaccine (this is ok)
  • NO LIVES VACCINES
  • Prophylactic antibiotics

> Encourage adequate nutrition and growth:

  • Possible sodium/fluid restrictions
  • Text says give protein

> Educate family:
-Urine dipstick/diet/medication

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14
Q

What do you want to watch out for and do with corticosteroids?

A
  • Watch for infections and they increase BP

- Wean off

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15
Q

What can be assessed in Nephrotic Syndrome?

A
  • EDEMA: periorbital edema and general edema/anasarca/ascites
  • Fluid weight gain
  • Nausea/vomiting/ from (ascites)- belly edema
  • Weakness/fatigue
  • May have increases dyspnea
  • Irritability
  • NO HYPERTENSION
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16
Q

What are significant labs seen in Nephrotic Syndrome?

A
  • PROTEINURIA (Massive)!!!
  • Hyperlipidemia
  • Creatinine and BUN may be elevated
17
Q

What are causes of dehydration?

A

Most often result of abnormal losses like diarrhea and vomiting due to [gastroenteritis] caused by [rotavirus], salmonella, c-diff, e-coli, shigella, etc.

other causes:

  • *heat stroke/exhaustion
  • stomatitis
  • pharyngitis
  • tonsillitis
  • febrile illness
  • CF
  • procedural blood loss
18
Q

What are the pediatric mild to moderate dehydration symptoms?

A
  • Dry, sticky mouth
  • Dry skin
  • Sleepiness or tiredness
  • Thirst
  • Decreased urine output
  • No wet diapers for 3 hours (infants)
  • Headache
  • Constipation
  • Dizziness or lightheadedness
19
Q

What are the pediatric severe dehydration symptoms?

A
  • Extreme thirst
  • Very dry mouth, skin, and mucous membranes
  • Little to no urine (dark colored urine)
  • Sunken eyes
  • Shriveled dry skin that lacks elasticity (doesn’t bounce back)
  • Dysphagia
  • Sunken fontanels (in infants)
  • Low BP
  • Tachycardia
  • Tachypnea
  • Fever
  • Delirium, decrease LOC, or unconsciousness
20
Q

What will a nurse assess for regarding dehydration?

A
  • Intake and Output
  • VS
  • Skin color, temp, turgor, cap refill
  • Mucous membranes
  • Body weight**
  • Fontanels (in infants)
  • Mental status**
  • Urine specific gravity, stool specimen
21
Q

What is one of the body’s early response to dehydration? Late response?

A

Tachycardia

Decreased BP

22
Q

What is the management of mild to moderate dehydration?

A

Concept: Rehydrate the losses, give maintenance fluids

-Oral rehydration such as pedialyte. (5-10ml Q5 min)

-Can introduce regular diet and milk as tolerated
(no more need for BRAT diet)

23
Q

What is the management for severe dehydration or those with continued vomiting?

A

IV Fluids for rehydration:

  • Give 50ml/kg over a 4 hr period to treat acute dehydration**
  • Isotonic fluids good choice: NS 0.9, Lactated RIngers
  • If calories needed D5NS or D5 1/2NS
24
Q

Regarding severe dehydration or those with continued vomiting, what is the IV fluids for maintenance formula (per 24hrs)?

A

Add 100ml/kg for first 10 kg of body weight

Add 50ml/kg for second 10 kg of body weight

Add 20 ml/kg for any remaining body weight

Example 32kg child = 1740ml/24hrs

25
Q

Regarding infants with cleft lip/palate, how would you feed them? What precautions are important with them?

A

Upright, with special nipple/bottle help

Aspiration precautions

lay on opposite side of where Lip Sx was

26
Q

What are typical concerns with cleft lip/palate?

A

Feeding
Ensuring proper growth
Preventing aspiration

27
Q

When is cleft lip repair usually performed? Palate?

A

2-3 months old

6-9 months old

28
Q

What is the nursing care for cleft lip/palate before and after sx?

A 
Before:
E - Enlarged nipple
S - Stimulate suck by bottom lip
S - Swallow
R - Rest

After

  • Logan bar to prevent tension
  • No straws, pacifiers, spoons, or fingers in or around mouth for 7-10 days
  • With cleft palate take liquids from a cup
  • No tooth brushing for 1-2 weeks
  • Elbow restraints possible

Long term:

  • Speech therapy
  • Orthodontics
29
Q

Describe Hirschprung Disease.

A
  • Congenital disorder, more common in males and downs syndrome
  • Part of large intestine has inadequate nerve supply/motility, narrowed
  • Distended abdomen, signs of obsruction
  • AKA congenital aganglionic megacalon

They have ribbon like stools`

30
Q

What is the treatment for Hirschprung Disease?

A
  • Most will require surgery, colon resection where area is removed
  • Usually temporary ostomy to let bowel rest and return to normal size
  • Nursing concerns: preventative antibiotics, adequate fluid and caloric intake, skin care around site, teaching ostomy care.
31
Q

Describe the obstructive disorder “Intussusception”, the symptoms, and treatment.

A
  • Segment of bowel/intestine telescopes into a distal segment of bowel
  • More common in males and children with CF
  • 3 months old to 3 years old (peak 5-9 months)
  • Frequent cause of intestinal obstruction

Some symptoms include:

  • Jelly stools (little berry like bloody mucus stools)
  • Sausage like mass under skin in abdomen
  • Abdominal pain

Treatment:

  • NGT
  • IV Fluids
  • Contrast and CO2 instilled into rectum which pushes bowel back into place (if not successful then Sx)
32
Q

What is Celiac Disease? What can it cause?

A
  • Chronic malabsorption and inflammatory disorder of the small intestine
  • Reaction to gluten, (protein in wheat, barley, rye, and oats)
  • Usually diagnosed in children but can present in adulthood

Can cause:

  • Steatorrhea (excess fat in stool)
  • Sever malnutrition and vitamin deficiencies
  • Abdominal distention
  • Behavioral changes
  • Growth retardation
  • Anemia
33
Q

What is the Celiac Disease treatment?

A

-Low or gluten free diet (substitute with corn and rice)

Nursing priorities:

  • Dietician evaluation
  • Reinforcement of teaching
  • Supplement deficiencies
  • Follow growth and labs closely
34
Q

Name common food allergies, the reactions, and possible prevention.

A

Common food allergies: *nuts, *milk, eggs, wheat, fish, shellfish, citrus

Reactions range from GI intolerance, skin rashes to anaphylaxis

Prevention?

  • Breastfeeding
  • Introduce foods 1 at a time between 4-6 months, less allergenic foods first then progress

Nursing 3 Exam 4 (9 decks)

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