Alterations in Genitourinary Function Flashcards
UTI
Infection of bacterial, viral, fungal origin that occurs in the urinary tract
-second mores common infections in children
Cystitis
lower UTI that involves urethra or bladder
females more prone due to short urethra
pyelonephritis
upper UTI that involves the ureters, renal pelvis, and renal parynchema
may be acute or chronic
UTI sxs (infants)
nonspecific fever or hypothermia (neonate) irritability dysuria (crying when voiding) change in urine odor or color poor weight gain feeding difficulties
UTI sxs (children)
abdominal or suprapubic pain voiding frequency voiding urgency dysuria new or increased incidence of enuresis fever
Pyelonephritis sxs
same as UTI &.... high fever, chills back pain costovertebral angle tenderness N/V appears sick (toxic)
UTI Dx
urinalysis
urine culture
VCUG: voiding cystourethrogram
ultrasound or CT
UTI RN Interventions
Assess fluid/ lyte status
ABX: IV or PO
renal impairment: falsely low specific gravity
UTI prevention education
wipe from front to back keep foreskin as clean as possible avoid holding urine, empty bladder void at least qid avoid tight clothing or diapers use cotton underwear avoid bubble baths girls void immediately after sex
VUR Dx
- Hx of UTIs
- VCUG: Voiding cystoeurethrogram
- Dye into bladder via catheter
- x-rays taken before, during and after voiding
- visualize: bladder, urethra reflux
VUR Management
Most can be treated medically: Grades I-III
low dose abx
frequent urine cultures
VUR surgical Management
Surgical criteria
- Grades IV, V
- recurrent UTI (w/ abx tx)
- Noncompliance w/ abx
- intolerance to abx
- VUR after puberty in females
VUR surgery
Reimplant the ureters into bladdder stents into ureters foley postop abx until Normal VCUG -3 months -1 year -3 years
Acute Postinfectious Glomerulonephritis (AGN)
inflammation of the glomeruli of the kidneys
highest incidence in 5-8 yrs and more common in boys than girls
AGN clinical manifestation
hematuria: mild-gross (tea colored) periorbital and ankle edema > in AM < UO febrile/ lethargic abdominal pain headache HTN urine slight-mod> protiens > BUN > creatinine
AGN Dx test
- ESR elevated and lipid levels elevated
- + ASO titer confirms the streptococcal infection
AGN Tx
relief of s/s & supportive therapy
diuretics
antihypertensives
Abx
AGN RN Interventions
Daily weight, strict I/O Assess BP resp assessment prevent skin breakdown low Na Diet limit fluid if ordered encourage rest in acute phase
Nephrotic Syndrome (NS)
edema massive protienuria hypoalbuminemia hyperlipidemia altered immunity Classified as congenital, primary or secondary Occurs 2-7 years boys> girls
NS s/s
edema/ weight gain massive protienuria (frothy urine) hyperabuminemia hyperlippidemia fatigue/ abd pain nomotensive anorexia
NS Dx
protienuria possible microscpic hematuria hypoalbuminemia hyperlipidemia kidney biopsy
NS Management
corticosteroids (< protienuria) diuretics (< edema) possible albumin administration ABX: prevent infection no added salt diet fluid restriction (if severe edema)
NS RN Assessment
hydration status
monitor edema/ I&O
vital signs: BP and temp
NS Patient education
corticosteroids common side effects include > apetite, hyperglycemia, decreased resistance to inf., aseptic technique to prevent infection
Wilms Tumor (nephroblastoma)
embrionic tissue origin
encapsulated tumor
peaks 3-4 yrs
Wilms s/s
Nontender, firm, flank mass often asymptomatic abdominal pain vomiting mocorscopic-gross hematuria anemia HTN
Wilms Dx
physical assessment ID mass abdominal ultrasound eval for mestasis -CT -MRI
Wilms Management
don't palpate flank or abdomen surgery chemo radiation: stages II-IV survival: overall > 90% recurrence 50%
Hypospadias
congenital defect
urethral opening on ventral side of penis
hypospadias s/s
abnormal meatus placement altered voiding stream chordee: ventral curvature of penis caused by a fiberous band may occur with -undescended testes -inguinal hernia
Mypospadias Management
No circumcision
OR correction before 3 yrs
OR urethroplasty
Post OP care
monitor urine output
catheter care
