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NU 374 > Ch. 24 > Flashcards

Ch. 24 Flashcards

1
Q

cryptorchidism

A
  • 1 or 2 testicles without descent by age 6 months
  • Testes that are not palpable or not easily guided into the scrotum
  • Managed by observation as testes may descend within the first year
  • surgical repair if testes do not descend (recommended around 1 yr old by AAP)
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2
Q

enuresis

A

uncontrolled bed wetting
- higher incidence in B>G
- usually ceases btwn 6-8 years
- primary vs secondary

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3
Q

epispadias

A
  • Less frequent than hypospadias; EXTREMELY RARE!!
  • Dorsal (top) surface urethral opening (if seen in females opening is between clitoris and labia or on abdomen)
  • Congenital
  • Surgical repair is required….no circumcision
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4
Q

hypospadias

A
  • Urethral opening is located below the glans penis or anywhere along the underside of the penile shaft (ventral opening)
  • congenital
  • hereditary
  • 1/300 births
  • Requires surgical correction around 6-12 months old (normal adult sexual functioning)…no circumcision
  • Nursing assessment of every male newborn
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5
Q

hydrocele

A
  • Presence of peritoneal fluid in the scrotal area
  • May be indicative of an inguinal hernia
  • Common in newborns but may not resolve until the end of infancy
  • May prevent teste from descending
  • Resolves spontaneously
  • Surgical repair if continues into toddlerhood
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6
Q

neurogenic bladder

A

lack of bladder control due to nerve, spinal, brain injury
- MS
- spinal cord injury
- CP

catheter to empty bladder

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7
Q

oliguria v anuria

A

decreased urine output
v
no urine output

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8
Q

phimosis

A

the inability to retract the foreskin from the glans on the penis
- okay in newborn phase
- should retract by 3 years old
- may require circumcision to correct

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9
Q

paraphimosis

A

when foreskin is trapped behind the corona of the glans penis

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10
Q

pyelonephritis

A

inflammation of upper urinary tract and may involve kidneys

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11
Q

pyeloplasty

A

surgery performed when the tube that drains urine from the kidneys to the bladder is blocked
- if not corrected causes loss of kidney function, infections, and pain

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12
Q

renal insufficiency

A

poor function of the kidneys
- may be due to reduction in blood flow to the kidneys (renal artery disease)

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13
Q

vesicoureteral reflux (VUR)

A
  • backwards ureteral flow of urine
  • can be uni or bilateral
  • normally affects the ureterovesical junction
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14
Q

GU physical exam: inspection

A
  1. general appearance
  2. physical growth (wt, ht, or length, Tanner staging)
  3. skin assessment
  4. LOC
  5. external genitalia
  6. abdomen: distention/mass
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15
Q

what are you “inspecting” when looking at the external genitalia?

A
  • diaper rash
  • placement of urethral opening
  • discharge
  • urine dribbling
  • swelling
  • bruising
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16
Q

GU physical exam: percussion and palpation

A
  1. distention/masses
  2. CVA tenderness (push on flank- assess for pain, if yes could be kidney infection)
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17
Q

GU physical exam: auscultation

A
  1. heart sounds
  2. HR- tachycardia?
  3. BP (machine <3, manual >3)
  4. lung sounds if child seems “puffy” (think pulmonary edema)
  5. bowel sounds
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18
Q

a + murmur is seen in children with what disorders?

A
  • anemia
  • renal disease
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19
Q

HTN is a sign of what GU disease?

A

renal disease

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20
Q

hypoactive or absent bowel sounds could mean what?

A

peritonitis

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21
Q

urine output: infants

A

9-10x/day

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22
Q

urine output: preschoolers

A

4-8x/day
*need reminders

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23
Q

expected urine output is calculated with what formula?

A

UO = 1ml/kg/hr

*newborns will produce 1-2ml/kg/hr; after 1 month, 1ml/kg/hr

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24
Q

1 gram of wet diaper = ___ mL of urine

A

1mL of urine

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25
Q

when is bladder capacity close to that of an adults?

A

12 years

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26
Q

normal urine characteristics: urine specific gravity

A

USG: 1.005-1.020

in-hospital hydration status; normal intake status

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27
Q

normal urine characteristics: appearance

A

clear, pale, yellow/gold

should be transparent straw color with minimal odor

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28
Q

normal urine characteristics: pH

A

avg. 6 (5-8)
- want the urine to be closer to 5 (more acidic to prevent infection)
acid base balance

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29
Q

abnormal urine lab characteristics

A

presence of:
- protein
- glucose (diabetes)
- ketones
- leukocyte esterase
- nitrites
- WBCs (< 1-2 is normal- irritation)
- RBCs (< 1-2 is normal- irritation)
- Bacteria
- Casts

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30
Q

pediatric issues related to GU

A
  • can be difficult to examine (restraint)
  • urine collection is complicated by age and determination of child
  • conflict is created btwn parental teaching r/t exposed “private parts” and the need to perform exams, lab specimen collection, and nursing interventions
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31
Q

DDAVP (desmo-pressin)

A

action: antidiuretic hormone effect; causes renal tubule to increase H2O absorption leading to decreased volume of urine

indication: nighttime enuresis

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32
Q

nursing implications with DDAVP (desmo-pressin)

A
  • nasal spray may cause irritation, nausea, flushing, or headache
  • administer at bedtime alternating nostrils
  • PO is preferred at bedtime
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33
Q

Lasix

A

action: inhibits reabsorption of sodium/chloride; leads to increased excretion of H2O and lytes

indication: nephrotic syndrome

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34
Q

nursing implications with Lasix

A
  • give with food/milk
  • monitor BP, renal function, lytes (esp. K+)
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35
Q

Albumin (IV)

A

action: results in fluid shift from interstitial to intravascular space

indication: nephrotic syndrome

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36
Q

nursing implications with Albumin (IV)

A
  • use filter on IV tubing
  • rapid infusion can cause vascular overload
  • monitor VS
  • observe for cardiac failure and pulmonary edema
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37
Q

antibiotics for a UTI are

A

not always appropriate for use in children
- some are, some aren’t

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38
Q

corticosteroids

A

indication: nephrotic syndrome

action: induces remission and promotes diuresis

ie. prednisone

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39
Q

what % of children respond to prednisone within 2 weeks?

A

90%

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40
Q

after remission of proteinuria, how long is prednisone continued for?

A

another 6 weeks at lower doses

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41
Q

IVIG

A

medication used for nephrotic syndrome

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42
Q

renal diagnostic studies

A
  • UA
  • Urine C&S
  • BUN
  • uric acid
  • creatinine
  • KUB
  • IVP
  • VCG/VCUG
  • renal scan
  • cystogram
  • retrograde pyelogram
  • ultrasound
  • CT scan
  • MRI
  • renal arteriogram
  • renal biopsy
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43
Q

renal biopsy

A

removal of a small piece of the kidney to examine the tissue

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44
Q

ultrasound

A

can be used on abdominal area or back to get a picture/scan of kidneys, bladder, ureters

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45
Q

VCG/VCUG

A
  • a voiding cystourethrogram uses a small amount of radiation to make images of a person’s urinary system
  • these images help doctors see problems in parts of the urinary system: bladder, urethra, ureters
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46
Q

creatinine

A

elevated in renal disease

infant: 2-5.5
child: 0.3-0.7
adolescent: 0.5-1

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47
Q

uric acid

A

elevated in renal disease

2-5.5

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48
Q

BUN

A

elevated in renal disease

newborn: 4-18
infant, child: 2-5.5

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49
Q

urine C&S

A

urine culture
- tests for bacteria
- next test after a UA
- 48hr results

50
Q

UA

A

urinalysis
- the urine that is sent off to the lab for analysis (USG, pH, protein, ketones, nitrites, etc.)

51
Q

how is urine collected for an infant?

A
  • collection bag
  • wool cotton pads
  • perez reflex stimulation
  • catheterization
  • suprapubic needle aspiration
52
Q

how is urine collected for a child?

A
  • on toilet into hat
  • catheterization
  • suprapubic needle aspiration
53
Q

how is urine collected for a teenager/adolescent?

A

typically clean-catch

54
Q

UTI: lower tract

A
  • cystitis: contained in bladder
  • urethritis: irritation; infection; potential for ascending
55
Q

UTI: upper tract

A
  • pyelonephritis: inflammation of the upper tract; may involve kidneys
  • VUR: retrograde flow of urine from bladder into upper tract
  • glomerulonephritis: immunologic disease un kidney proper; did not begin in the bladder and ascend
56
Q

UTI: complicated infections

A

UTI is complicated by another condition
- stones
- obstruction
- catheters
- diabetes or nephrotic disease
- recurrent infections

57
Q

types of UTIs

A

recurrent: repeated episodes in a person whose prior infection was successfully eradicated

persistent: bacteria despite antibiotics; occurs because original infection was not adequately eradicated

febrile: typically indicates pyelonephritis

urosepsis: bacterial illness; urinary pathogens in blood

unresolved bacteriuria: bacteria resistant or drug discontinued before bacteria is completely eradicated

58
Q

UTI: subjective s/sx

A
  • N/V
  • anorexia
  • chills
  • nocturia
  • urinary frequency
  • urgency
  • incontinence
  • dysuria
  • suprapubic or low back pain
  • bladder spasms
  • dysuria
  • burning on urination
59
Q

UTI: objective s/sx

A
  • fever
  • hematuria: foul odor; tender, enlarged kidney
    • UA: leukocytosis: increase in WBCs; Nitrates, Blood
  • positive findings of bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP
  • inconsolable
  • grimacing, visible signs of pain
60
Q

vesicoureteral reflux (VUR): anatomy

A
  • bladder tunnel is too short “leaky valve”
  • urine flows in both directions
61
Q

VUR management: grade I & II

A
  • Prophylaxis antibiotics (bactrim, nitrofurantoin)
  • Voiding schedule
  • Hygiene
  • Routine VCUG
  • can self resolve
62
Q

VUR management: grade III, IV, V

A
  • Same as I and II plus
  • Surgical intervention (ureteral re-implantation) for severe cases (does not self resolve)
  • VCUG procedure is upsetting for toilet trained children
63
Q

VUR management: post-op

A

IVF at 1 ½ times FMR
I & O
Foley, suprapubic, and/or ureteral tubes for urine drainage (bloody urine- inform parents this is normal)
Pain mgmt.
OOB (out of bed- promotes motility, gravity & healing, prevent blood clots & PNA)
Abd. assessments
Advance diet as tolerated
Prophylaxis antibiotics for 1-2 months, small dose/day
Follow-up VCUG
Psychosocial support

64
Q

how does a VCG/VCUG work?

A
  • the patient’s bladder is filled with liquid contrast material
  • X-ray machine sends radiation beams through abdomen and pelvis
  • images are recorded in special film/computer
65
Q

urethral reimplantation

A

a surgery to treat VUR
- reimplantation of the ureter(s)
- corrects the anatomy at the insertion of the refluxing ureter into the bladder

66
Q

acute glomerulonephritis (AGN)

A
  • inflammatory response in the glomerular system
  • inflammation of kidney tubules
  • most common form: (APSGN) acute post-streptococcal glomerulonephritis
  • most commonly caused from strep throat infection
  • usually in ages 3-12 years; uncommon in children <3 years
67
Q

onset of AGN

A
  • 1-2 weeks after other type of pneumococcal, streptococcal, and viral infections
  • 3-6 weeks after skin infections, ie. impetigo
67
Q

diagnosis of AGN is made through testing:

A
  • throat culture: +/-
  • urine: + bld, + protein, ^ USG, + RBCs, + HGB, + leukocytes, + red casts
  • serology: electrolytes WNL, ^ BUN, ^ CR, + ASO (anti-streptolysin O) titer, decreased C3&C4
  • EKG: heart fx eval if HTN develops
  • CXR: cardiac enlargement, pulmonary congestion, plural effusion
  • renal biopsy (only in atypical cases)
68
Q

AGN clinical presentation: latent phase

A
  • Previously healthy kids are often asymptomatic.
  • Mild URI (respiratory) s/sx.
  • Recent history of strep infection.
69
Q

AGN clinical presentation: acute phase

A

s/sx:
Periorbital Edema (Worse In Am Then Becomes Dependent)
Anorexia, Pallor, Irritability, Lethargy
Older Children: Headaches, Abdominal Pain, And Dysuria
Cola (Smoky Or Tea) Colored Urine
Hematuria, Proteinuria (Mild/Moderate),
Azotemia (Elevated Nitrogen)
Oliguria (decreased UO)
Hypertension (Mild To Severe)
Weight Fluctuations
Hypervolemia
Rare: Seizures From Hypertensive Encephalopathy, CHF, Or Hematuria Without HTN Or Edema

70
Q

AGN clinical presentation: recovery phase

A

s/sx:
Increase in UO
Decrease in weight (resolution of edema)
Increased appetite
Normalized BP
Normalized Renal function and hypocomplementemia

71
Q

timeline of AGN latent phase

A

begins 7-21 days between onset of strep and development of clinical s/sx

72
Q

timeline of AGN acute phase

A

begins 1-2 weeks post-strep or 3-6 weeks post skin infection
- usually persists 1-3 weeks
- encourage rest during this phase

73
Q

timeline of AGN recovery phase

A

begins with s/sx of improvement
- most s/sx resolve within 8 weeks of onset of latent phase

74
Q

prognosis of AGN

A
  • 95% rapid improvement to complete recovery
  • 5-15% chronic glomerulonephritis
  • 1% irreversible damage
75
Q

management of AGN

A

Serial VS, weight, and I/O
Na (NAS) and H20 restriction
Limit potassium with oliguria
Protein restriction with azotemia
Diuretics with mild renal failure
Dialysis (rare)
BP q 4 hrs.
Antihypertensives
Possible anticonvulsants with BP meds
ABTs if strep +
May test other family members
Bedrest-acute phase
Restrict strenuous activity until urine is negative

76
Q

nephrotic syndrome (NS)

A
  • can be primary or secondary
  • different types
  • occurs in all ages but most frequently in preschoolers
  • swollen eyes*, swollen feet, swollen abdomen
  • result of increased glomerular basement membrane permeability –> proteinuria (usually albumin)
77
Q

most common type of glomerular injury in children

A

nephrotic syndrome
more common in boys than girls

78
Q

80% of nephrotic syndrome types are classified as

A

80% are classified as minimal change nephrotic syndrome

79
Q

what is the relationship between viral URI and NS

A

viral URI typically preceded diagnosis but is not the cause of MCNS

80
Q

diagnosis of NS is made through testing:

A
  • urine: +++ proteinuria, + casts, RBCs, ^ USG
  • serology: decrease protein, decrease albumin, ^ lipids, ^ cholesterol, ^ PLT (hemoconcentration), H&H (slightly ^), decrease Na, decrease Ca
  • renal biopsy: will differentiate type and probable course of disease (not always performed)
80
Q

MCNS clinical presentation

A

Child is previously well and begins to develop:
**Periorbital edema (worse in am)
***Progresses to swelling generalized edema (anasarca) from abdomen to feet bilaterally
**Weight gain greater than expected for age
**Urine characteristics: dark white (opal), frothy/bubbles
**Skin breakdown
** Gradual or rapid onset.
Pallor
Fatigue
Irritable, easily fatigued, lethargic
Hypoalbuminemia → white lines on fingernails
Normal BP (or slightly decreased)
Edema of the intestinal mucosa results in diarrhea, anorexia, and ↓ intestinal absorption.
UO
Dull hair
Ear cartilage may feel less firm
Food intolerances or allergies

81
Q

MCNS management

A

VS with close B/P monitoring
Daily wt.
Monitor for s/sx edema. Assess degree of edema.
I & O (strict)
Routine vaccinations. No live vaccines until steroids are discontinued
Urine dipsticks (inpatient and at home)
Heart, lung, and abdomen assessments
Skin assessments/skin care

82
Q

MCNS nutrition management

A

Low Na++ - if edema and steroid therapy
Fluid restriction- if renal failure or if hospitalized
Low protein foods-if azotemia or renal failure

83
Q

MCNS pharmacology management

A

Corticosteroids (starts at around 60mg/day and slowly taper down)
- IV in hospital, po post discharge
- Immunosuppressant therapy (some cases)
- IV albumin (protein) f/b diuretic (i.e. furosemide)
- Antibiotics PRN- for secondary infections

84
Q

MCNS activity management

A

bedrest (edema phase)
cluster care

85
Q

what are the concerns with long-term steroid use?

A
  • itching
  • may harm immunity: immunocompromised
  • moon face
  • increased appetite
  • emotional, very energetic
86
Q

family concerns with NS

A
  • chronic condition with relapses
  • developmental milestones
  • social isolation: lack of energy, immunosuppression/protection, change in appearance due to edema- self-image
87
Q

hemolytic-uremic syndrome (HUS)

A
  • acute pediatric renal disease
  • caused by e. coli (diarrhea +)
  • preceded 1-2 weeks by severe gastroenteritis, UTI, or URI
88
Q

most common cause of ARF in infants and children under 3?

A

hemolytic-uremic syndrome (HUS)

89
Q

HUS: classic triad of s/sx

A
  • AKI: acute kidney impairment/injury
  • hemolytic anemia: RBCs are destroyed faster than they are made
  • thrombocytopenia: low platelets
90
Q

hemolytic-uremic syndrome (HUS): prodromal phase symptoms

A

V/D (Most common)
** Diarrhea (often bloody)
Abdominal pain, cramping or bloating
Vomiting
Fever
If URI, UTI, or viral cause will present differently

91
Q

hemolytic-uremic syndrome (HUS): prodromal phase management

A

Symptomatic care
Enteral nutrition
Parenteral PRN (colitis)

92
Q

hemolytic-uremic syndrome (HUS): hemolytic phase symtoms

A

Days to 2 weeks
Anorexia
Personality changes (irritable, lethargic)
*Rapid onset of pallor
*Hemorrhagic features (ecchymosis, purpura, rectal bleeding, orifice bleeding)
If mild=anemia, thrombocytopenia, azotemia
If severe=oliguria or anuria and HTN
If CNS involvement=seizures, LOC→ stupor, stroke
If cardiac involvement=HF (ex. SOB)
If GI involvement: mild jaundice, ascites
If renal involvement: ↑ BUN ↑ CR ↓ Hgb ↓ Hct. ↑ retic. count
(effects all symptoms)

93
Q

hemolytic-uremic syndrome (HUS): hemolytic phase management

A

Focus on controlling complications and managing ARF
Calorie intake (foods)
Monitor fluid balance
Restrict fluids
Routine labs
Assess for physical s/sx
Assess for fluid overload
Limit fluid volume with IV meds
Keep child calm and afebrile
Education on prevention
Peritoneal dialysis (PRN)

94
Q

defects in the GU tract

A
  • enuresis
  • phimosis
  • hydrocele
  • cryptorchidism
  • hypospadias
  • epispadias
95
Q

primary enuresis

A

bed-wetting in children who have never been dry for extended periods of time

96
Q

secondary enuresis

A

the onset of bed-wetting after a period of established urinary continence

97
Q

enuresis: diagnostic criteria

A
  • developmental age > 5 years
  • careful history of baseline information
  • physical exam
98
Q

management of enuresis

A

Conditioning therapy
Bladder retention training
Fluid restriction in evenings
Interruption of sleep to void
Conditioned reflex response devices
Drugs: DDVAP, oxybutynin, imipramine (tofranil)

99
Q

phimosis is treated with

A
  • steroid cream BID
  • vitamin E cream
100
Q

phimosis: patient teaching

A
  • Not forcing foreskin retraction in newborns
  • Frequent diaper changes
  • Washing penis daily with soap and water
  • Cleansing skin around glans when able to retract skin routinely (infant and older)
  • Always remembering to replace retracted foreskin (after age 3)
101
Q

post-op hydrocele

A
  • no straddle toys or strenuous activities x1 month post-op
  • dressing in place until bathing is allowed
  • bathing pos-op day 3
102
Q

cryptorchidism surgery

A
  • Surgery involves incision to release spermatic cord, pull down of testes, and “tacking in place”
  • Typically between 9-15 months of age
  • orchidopexy
  • Must be corrected before school-age years otherwise
103
Q

what are some considerations with cryptorchidism surgery?

A
  • sterility
  • high risk for testicular cancer
104
Q

predisposing factors to cryptorchidism

A

Predisposing factors:
Premies
First born males
Section babies
LBW
Hypospadias

105
Q

retractile testes

A

testes can be manually descended but migrate out of the scrotum
- not problematic *UNLESS no descent is possible OR continues past age 14 yr

106
Q

assessing for crytorchidism

A

Examine the infant in a warm environment. Be sure the infant is calm before the examination.
*Warm your hands before touching the infant.
*Milk the testis downward from the groin and document its distal point.
*Examine the older child in both a sitting and a frog-leg position.

107
Q

the testes normally descend by what age?

A

6 months (may take longer for adjusted age infants)

108
Q

what may cause a false dx of cryptorchidism?

A
  • testes retract if the infant is upset or cold
  • the cremasteric reflex: testicular retraction in response to tactile stimulation to the front inner thigh
109
Q

why is a male infant with hypospadias/epispadias not circumcised?

A

no circumcision- skin is used for reconstructive surgery

110
Q

long term effects of epispadias

A
  • incontinence
  • infertility
  • UTIs
111
Q

hypospadias post-op care

A

Surgery typically between age 6-12 months
Urine drainage tube care and maintenance
Teaching re: catheter care…..d/c’d home with tube
Penis should remain in upright position to reduce incision strain
Compression Dressing maintenance; DO NOT CHANGE (removed typically on day 4)
ABT’s
Pain management (i.e., analgesics, antispasmodics) for bladder spasms
Double diapering (inner smaller diaper for stool, outer larger for urine; cut slit in small to pull catheter through (see next slide)
Encourage PO intake
Assess for s/s UTI/infection
Quiet play

112
Q

double diapering

A

used for hypospadias post-op infants
- hole in first diaper where catheter goes through
- put second diaper over first to keep sanitary (d/t hole in first diaper)

113
Q

elevated HR, elevated BP related to renal disease because

A

the heart is working harder to pump blood to the kidneys

114
Q

KUB

A

flat plate the scans the kidneys, ureters and bladder

115
Q

uncomplicated UTI

A

treated, 3 weeks later repeat culture is clear

116
Q

1 pathogen causing UTI

A

E. coli

117
Q

VUCG is required for what circumstances? (r/t UTI)

A

children < 2 years old, 2 UTIs with a fever or 1 UTI with renal issues

118
Q

treatment for UTI

A
  • bactrim
  • nitrofutantoin

NU 374 (18 decks)

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