3GU Flashcards by Brendon Allen

Kidney functions

Equilibrium of body fluids

Excretes waste

Production of erythropoietin

Secretion of renin

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Anatomy of nephron

Filter water and wastes across glomerular capilaries to maintain:

-body fluids level
-electrolytes
-pH

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Difference between adults and infants

Renal development done when?
Nephrons?
Concentration of urine?
BUN/Creatinine?
GFR/absorption?
Vulnerable to what 2 things?

Renal development not complete until 2y/o

Nephrons immature and less efficient

Less ability to concentrate urine
(lower specific gravity)

BUN/Creatinine lower

Decreased GFR/absorption

Vulnerable to severe metabolic acidosis & dehydration

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Difference between adults and infants

Bladder capacity of newborn vs 1y/o
Urethras?
Most children with acute renal failure?

Bladdar newborn: 30mL
1y/o: 270mL

Younger children have shorter urethras —>
—>more vunerable to UTIs

Most children with acute renal failure regain normal function

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Genitourinary assessment

Urine characteristics
Reporting from parent/child
Pain/discomfort
Appearance of genitalia
Edema (local/generalized)
Lab/diagnositics

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Urine collection

Clean catch vs sterile

Clean catch:
-specimen cup
-urine bag
-cotton ball method

Sterile:
-straight cath
-foley cath

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Urinary labs/diagnostics

Urinalysis/culture & sensitivity
Renal US
Abdominal/renal CT
VCUG (xray and contrast dye)
Cystoscopy

RFP (electrolytes/BUN/Creatinine/GFR)function panel
-like a CMP/BMP

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Interpreting the UA

Specific gravity=
PH=
Protein=
Glucose=
Ketones=
Leukocytes=
Nitrates=

Specific gravity= concentration
PH=increased with UTI
Protein= 1st indicator of renal disease
Glucose= diabetes
Ketones= acidosis/DKA
Leukocytes=present w/ WBCs and bacteria

Nitrates= present w/ bacteria (biggest give away of UTI)

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Interpreting the U/A

RBC’s
Bacteria
Casts

RBC’s:
-trauma, stones, infection, glomerulonephritis

Bacteria:
-infection

Casts:
-pyelonephritis, glomerulonephritis, renal disease

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Structural defects

Epispadias
Hypospadias
Crytorchidism
Testicular torsion

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Hypospadias
Vs
Epispadias

Hypospadias:
-urethral meatus located on ventral surfacr (bottom)

Epispadias:
-urethral opening located on dorsal surface (top)

Dorsal fin is on top

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Hypospadias

What is it
What is usually present
Associated with what

Opening ventral surface of the penis, scrotum, or perineum

Chordee (downward curve) usually present

Associated w/ cryptorchidism (testicles undescended)

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Hypospadias/epispadias

When can you be circumcised
Tx (age)

No circumcision until repair done

Tx:
-release of chordee/lengthening urethra
-repositioning of meatus at penile tip
-reconstruction of penis
(6-12mo old)

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Cryptorchidism

Definition
What happens

Undescended testes

Failure to descend exposes the testes to the heat of the body = leading to low sperm

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Cryptorchidism

Who has higher incidences
Tx?
Increased risk of?

Premature infants (higher incidences)

Usually descend on own (if not sx repair)

Increased risk of :
-testicular malignancy
(d/t exposure to heat)

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Testicular torsion

What is it
What is happening

Emergency

Testis rotates on its spermatic cord
=cuts off blood supply

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Testicular torsion

S/s
Tx

Engorgement
Scrotal pain/abdominal pain
N/V

Tx:
Surgery

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Uti causes (5)

Urinary stasis (leading factor)

Incomplete bladder emptying (reflux/overdistention)

Dysfunction of voiding mechanism
(neurogenic bladder)

Extrinsic factors
(bladder neck obstruction/constipation)

Irritation:
(Catheters, tight clothing, poor hygiene, bubble bath, local inflammation)

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UTI

What causes it
Whose more likely to get it
Generic s/s

Bacterial infection (usually ecoli)

Neonatal period : more males
After 4y/o: more females

Inflammation causes:
-irritibility
-spasm of bladder walls
-urinary frequency, urgency
-hematuria

S/s of UTI in infants

7 FFDDPIV

Fever or hypothermia
Foul smelling urine
Dehydration
Diaper rash
Pallor
Irritability
Vomiting or poor feeding

S/s of UTI in children

V (3)
A (2)
P (3)
E (4)
F

Vomiting/poor appetite/growth failure
Abd pain, flank pain
Pallor, fatigue, hematuria
Enuresis, frequency, urgency, dysuria

Fever

UTI nursing management

What to do
What to avoid

Hygiene
Push fluids
Cotton underwear

Avoid:
-holding urine
-tight clothes
-bubble baths

UTI nursing care Goals

Eliminate infection w/ (ABX)
Prevent systemic (sepsis)
Preserve renal function (push fluids)

Vesicoureteral reflux

What is happening/ what does it cause

Abnormal back flow of urine from the bladder into the ureters and possibly kidneys

Reflux prevents complete emptying of bladder

Vesicoureteral reflux (VUR) Primary VUR Vs Secondary VUR

Primary: -congenital abnormality at the vesicoureteric junction caused incompetence of the valve Secondary: -its structural or functional problems Ex: neurogenic bladder or bladder dysfunction

Vesicoureteral reflex (VUR) Usually presents how? Tx

Presents with UTI graded on scale 1-5 (How its presents but after a few UTIs they realize) 1-3: -handled conservatively, treated w/ meds (Hygiene, prophylactic abx) 4-5: -surgery

Vesicoureteral reflex (VUR) Goal

Prevent pyelonephritis and renal scarring

Nursing considerations for children undergoing renal surgery 6

Assess/medicate for bladder spasms: -antispasmodics (oxybutynin (Ditropan) Prophylactic abx Pain control Keep I/O (may have drain) Monitor fluid/electrolytes, DW Will have foley after sx (urine will be bloody but will clear 2-3days) Early ambulation (ADT)

Acute glomerulonephritis (AGN) What is it/what it leads to What can cause it

Inflammation of glomerulus -unable to filter = retention of sodium and water -injury = blood in urine Causes: acute post streptococcal -immune reaction to group A strep

Acute glomerulonephritis (AGN) Acute post streptococcal

Clinical symtpoms appear 7-21 days after infection Acute clinical episodes: Self limiting, w/ resolution in 6-12 weeks

Acute glomerulonephritis (AGN) S/s Usually who

Hematuria/cola colored urine HTN Edema/abrupt unset: -mild periorbital or extremeties Usually school age kids

Acute glomerulonephritis (AGN) Labs

RBC/casts/small protein in urine Decreased Hct, Hgb Altered electrolytes, elevated BUN & creatinine

Acute glomerulonephritis (AGN) Tx Primary goal 1 Others 4

Primary goal: -maintain fluid volume/manage HTN If HTN uncontrolled can lead to encephalopathy/seizures Others: Fluid volume excess (tissues) -may need antihypertensives ex: ca channel blockers, beta blockers, ACE inhibitors Limit sodium/water Diuretics I/O, DW

Nephrotic syndrome 3 forms

Congenital Secondary: caused by other diseases (diabetes) Idiopathic: unknown cause

Nephrotic syndrome What is it Issues

Glomerular injury: membrane becomes permeable to proteins Characterized by massive: -proteinuria -hypoproteinemia -hyperlipidemia -edema

Nephrotic syndrome S/s Usually who

-frothy, cloudy urine -hypovolemia -normotensive -palor, fatigue -massive edema (slow onset) = worsens as day progresses Usually toddler, preschool

Nephrotic syndrome Labs

Hallmark: proteinuria 4+ Hypoalbuminemia (<2.5) D/t decrease fluid = concentation Elevated cholesterol and triglycerides Elevated Hgb/Hct/Plts

Nephrotic syndrome Tx 5

Corticosteroids (Continue unit protein free & remain for 2 wks) Immunosupressive therapy (if unresponsive to steroids) Albumin & diuretics Severe salt restrictive diet ABX (prevent infection

Steroid induced cushings D/t what Side effects

Long term use of steroids SEs: -Increased risk of infection (⬇️ immune system) -Hyperglycemia -GI bleeding -Obesity -HTN

Hemolytic-uremic syndrome (HUS) 3 distinct features

1. Hemolytic anemia 2. Thrombocytopenia 3. Acute renal failure

Hemolytic-uremic syndrome (HUS) 1. Hemolytic anemia 2. Thrombocytopenia

1. Results from fragmentation of RBCs (breakdown) 2. Plts become trapped within small vessels

Hemolytic-uremic syndrome (HUS) 3. Acute renal failure (starting cause) What causes it (3 organisms) Results in what Leads to

Bacterial toxins damages endotheial cells of capilary wall -ecoli, salmonella, shigella Results in occlusion of capillaries (glomerular vessels) with plts and fibrin occlusion causing: -futher damage to RBCs (sequestered in spleen) Leads to ⬇️ GFR and renal failure

Hemolytic-uremic syndrome (HUS) S/s Initial (VAB) Symptoms d/t fluid retention (SEG) Hemorragic signs (PPBB)

Intially: -vomiting, bloody/watery diarrhea, abdominal pain S/s from fluid retention: -elevated BP, swelling hands/feet, generalized edema Hemorrhaic signs: -bruising, pallor, petechiae, blood diarrhea

Hemolytic-uremic syndrome (HUS) Signs of renal failure (3) Other labs you see (3)

Signs of renal failure: -low Na -elevated K -elevated BUN & Creatinine Other labs: -low H/H -low plts -increased liver enzymes & bilirubin

Hemolytic-uremic syndrome (HUS) Tx 5

Fluid replacement Tx of ⬆️ BP Monitor I/O, DW, bleeding Blood transfusion (watch for circulatory overload) -kidneys cant filter out fast enough Correction of acidosis/electrolytes: -Peritoneal or hemdialysis