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AN305 > 3GU > Flashcards

3GU Flashcards

1
Q

Kidney functions

A

Equilibrium of body fluids

Excretes waste

Production of erythropoietin

Secretion of renin

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2
Q

Anatomy of nephron

A

Filter water and wastes across glomerular capilaries to maintain:

-body fluids level
-electrolytes
-pH

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3
Q

Difference between adults and infants

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

A

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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4
Q

Difference between adults and infants

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

A

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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5
Q

Genitourinary assessment

A

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

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6
Q

Urine collection

Clean catch vs sterile

A

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

Sterile:
-straight cath
-foley cath

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7
Q

Urinary labs/diagnostics

A

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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8
Q

Interpreting the UA

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

A

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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9
Q

Interpreting the U/A

RBC’s
Bacteria
Casts

A

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

Bacteria:
-infection

Casts:
-pyelonephritis, glomerulonephritis, renal disease

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10
Q

Structural defects

A

Epispadias
Hypospadias
Crytorchidism
Testicular torsion

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11
Q

Hypospadias
Vs
Epispadias

A

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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12
Q

Hypospadias

What is it
What is usually present
Associated with what

A

Opening ventral surface of the penis, scrotum, or perineum

Chordee (downward curve) usually present

Associated w/ cryptorchidism (testicles undescended)

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13
Q

Hypospadias/epispadias

When can you be circumcised
Tx (age)

A

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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14
Q

Cryptorchidism

Definition
What happens

A

Undescended testes

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

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15
Q

Cryptorchidism

Who has higher incidences
Tx?
Increased risk of?

A

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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16
Q

Testicular torsion

What is it
What is happening

A

Emergency

Testis rotates on its spermatic cord
=cuts off blood supply

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17
Q

Testicular torsion

S/s
Tx

A

Engorgement
Scrotal pain/abdominal pain
N/V

Tx:
Surgery

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18
Q

Uti causes (5)

A

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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19
Q

UTI

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

A

Bacterial infection (usually ecoli)

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

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

20
Q

S/s of UTI in infants

7 FFDDPIV

A

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

21
Q

S/s of UTI in children

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

A

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

Fever

22
Q

UTI nursing management

What to do
What to avoid

A

Hygiene
Push fluids
Cotton underwear

Avoid:
-holding urine
-tight clothes
-bubble baths

23
Q

UTI nursing care Goals

A

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

24
Q

Vesicoureteral reflux

What is happening/ what does it cause

A

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

Reflux prevents complete emptying of bladder

25
Q

Vesicoureteral reflux (VUR)

Primary VUR
Vs
Secondary VUR

A

Primary:
-congenital abnormality at the vesicoureteric junction caused incompetence of the valve

Secondary:
-its structural or functional problems
Ex: neurogenic bladder or bladder dysfunction

26
Q

Vesicoureteral reflex (VUR)

Usually presents how?
Tx

A

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

27
Q

Vesicoureteral reflex (VUR)

Goal

A

Prevent pyelonephritis and renal scarring

28
Q

Nursing considerations for children undergoing renal surgery 6

A

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)

29
Q

Acute glomerulonephritis (AGN)

What is it/what it leads to

What can cause it

A

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

30
Q

Acute glomerulonephritis (AGN)

Acute post streptococcal

A

Clinical symtpoms appear 7-21 days after infection

Acute clinical episodes:
Self limiting, w/ resolution in 6-12 weeks

31
Q

Acute glomerulonephritis (AGN)

S/s
Usually who

A

Hematuria/cola colored urine
HTN

Edema/abrupt unset:
-mild periorbital or extremeties

Usually school age kids

32
Q

Acute glomerulonephritis (AGN)

Labs

A

RBC/casts/small protein in urine

Decreased Hct, Hgb

Altered electrolytes, elevated BUN & creatinine

33
Q

Acute glomerulonephritis (AGN)

Tx
Primary goal 1
Others 4

A

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

34
Q

Nephrotic syndrome

3 forms

A

Congenital

Secondary: caused by other diseases (diabetes)

Idiopathic: unknown cause

35
Q

Nephrotic syndrome

What is it
Issues

A

Glomerular injury: membrane becomes permeable to proteins

Characterized by massive:
-proteinuria
-hypoproteinemia
-hyperlipidemia
-edema

36
Q

Nephrotic syndrome

S/s
Usually who

A

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

Usually toddler, preschool

37
Q

Nephrotic syndrome

Labs

A

Hallmark: proteinuria 4+

Hypoalbuminemia (<2.5)

D/t decrease fluid = concentation
Elevated cholesterol and triglycerides
Elevated Hgb/Hct/Plts

38
Q

Nephrotic syndrome

Tx 5

A

Corticosteroids
(Continue unit protein free & remain for 2 wks)

Immunosupressive therapy
(if unresponsive to steroids)

Albumin & diuretics

Severe salt restrictive diet

ABX (prevent infection

39
Q

Steroid induced cushings

D/t what
Side effects

A

Long term use of steroids

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

40
Q

Hemolytic-uremic syndrome (HUS)

3 distinct features

A
  1. Hemolytic anemia
  2. Thrombocytopenia
  3. Acute renal failure
41
Q

Hemolytic-uremic syndrome (HUS)

  1. Hemolytic anemia
  2. Thrombocytopenia
A
  1. Results from fragmentation of RBCs (breakdown)
  2. Plts become trapped within small vessels
42
Q

Hemolytic-uremic syndrome (HUS)

  1. Acute renal failure (starting cause)

What causes it (3 organisms)
Results in what
Leads to

A

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

43
Q

Hemolytic-uremic syndrome (HUS)

S/s

Initial (VAB)
Symptoms d/t fluid retention (SEG)
Hemorragic signs (PPBB)

A

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

44
Q

Hemolytic-uremic syndrome (HUS)

Signs of renal failure (3)

Other labs you see (3)

A

Signs of renal failure:
-low Na
-elevated K
-elevated BUN & Creatinine

Other labs:
-low H/H
-low plts
-increased liver enzymes & bilirubin

45
Q

Hemolytic-uremic syndrome (HUS)

Tx 5

A

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

AN305 (15 decks)

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