3GU Flashcards
Kidney functions
Equilibrium of body fluids
Excretes waste
Production of erythropoietin
Secretion of renin
Anatomy of nephron
Filter water and wastes across glomerular capilaries to maintain:
-body fluids level
-electrolytes
-pH
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
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
Genitourinary assessment
Urine characteristics
Reporting from parent/child
Pain/discomfort
Appearance of genitalia
Edema (local/generalized)
Lab/diagnositics
Urine collection
Clean catch vs sterile
Clean catch:
-specimen cup
-urine bag
-cotton ball method
Sterile:
-straight cath
-foley cath
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
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)
Interpreting the U/A
RBC’s
Bacteria
Casts
RBC’s:
-trauma, stones, infection, glomerulonephritis
Bacteria:
-infection
Casts:
-pyelonephritis, glomerulonephritis, renal disease
Structural defects
Epispadias
Hypospadias
Crytorchidism
Testicular torsion
Hypospadias
Vs
Epispadias
Hypospadias:
-urethral meatus located on ventral surfacr (bottom)
Epispadias:
-urethral opening located on dorsal surface (top)
Dorsal fin is on top
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)
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)
Cryptorchidism
Definition
What happens
Undescended testes
Failure to descend exposes the testes to the heat of the body = leading to low sperm
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)
Testicular torsion
What is it
What is happening
Emergency
Testis rotates on its spermatic cord
=cuts off blood supply
Testicular torsion
S/s
Tx
Engorgement
Scrotal pain/abdominal pain
N/V
Tx:
Surgery
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)
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
- Hemolytic anemia
- Thrombocytopenia
- Acute renal failure
Hemolytic-uremic syndrome (HUS)
- Hemolytic anemia
- Thrombocytopenia
- Results from fragmentation of RBCs (breakdown)
- Plts become trapped within small vessels
Hemolytic-uremic syndrome (HUS)
- 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
