ch 24 and 25 GI elimination and renal dysfunction Flashcards
differences in renal system in infants
-GFR and absorption low until 1-2 yo
-unable to concentrate urine
-unable to reabsorb Na and water
-very dilute urine
normal pH urinalysis
5-9pH
normal specific gravity urinalysis
1.001-1.035
normal urobilinogen
up to 1
what substances should be absent in urinalysis
protein
glucose
ketones
Hgb
WBC
RBC
casts
nitrates
normal volume production urine per hour
-newborns
-children
newborn: 1-2 mg/kg/hr
child: 1 mL/kg/hr
S+S upper UTI
-fever
-chills
-flank pain
2 classifications of upper UTI
-pyelonephritis
-glomerulonephritis
S+S lower UTI
-no systemic manifestations
-frequency
-chronic constipation
-burning
-urgency
2 classifications lower UTI
-cystitis
-urethritis
6 types UTIs
-uncomplicated
-complicated
-recurrent
-persistent
-febrile
-urosepsis
causes complicated UTIs
-stones
-obstructions
-catheters
-diabetes/neurologic disease
-recurrent infections
S+S UTI in newborn
-failure to thrive
-feeding problems
-V/D
-abdominal distention
-jaundice
S+S UTI in kid >2 yo
-daytime incontinence
-foul smelling urine
-frequency
-urgency
-abdominal/flank pain
S+S UTI in adolescent
-frequency
-urgency
-dysuria
-no fever
med options for complicated UTI (long Tx)
-TPM-SMX
-nitrofurantoin
-amoxicillin
-cephalexin
-gentamycin/carbenicillin
-pyridium
meds for repetitive UTIs
prophylactic/suppressive Abx
-TMP-SMX everyday
classification of vesicureteral reflex (VUR) - 5 grades
grade 1: doesn’t reach renal pelvis
grade 2: up to renal pelvis w/o dilation
grade 3: renal pelvis w/ mild-moderate dilation
grade 4-5: distention of renal pelvis, reflux into intrarenal collecting system
S+S glomerulonephritis
-puffiness of face, edema
-dark colored urine (tea/cola colored)
-pale
-irritable, lethargic
-anorexia
-decreased urine output
-mild-moderate elevation in BP
-elevated BUN and Cr
-decreased GFR
-urine contains protein and blood
signs of improving glomerulonephritis
increased urine output
decreased BUN and Cr
Tx glomerulonephritis
-fluid and Na restrictions
-BP Tx q4-6h
-avoid fatigue
-spontaneous recovery (no specific Tx)
Dx tests for glomerulonephritis
-urine analysis
-titers (strep)
-serum complement (C3)
what age group gets nephrotic syndrome
preschool age
precipitating factor causing nephrotic syndrome
viral upper resp infection
S+S nephrotic syndrome
-edema (high risk skin breakdown)
-hypoalbuminemia
-*proteinuria
-hyperlipidemia
-hypovolemia
-severe proteinuria
-weight loss
-pallor
Tx nephrotic syndrome
-*diet
-corticosteroids
-immunosuppression
-diuretics
-daily weights and skin care
Major disorder associated with a
defect in ability to concentrate
urine
nephrogenic diabetes insipidus (NDI)
S+S NDI in newborn
-vomiting
-fever
-failure to thrive
-hypernatremia
S+S NDI
-copious amounts dilute urine
-growth retardation
-hypernatremia
-extreme thirst
Tx NDI
-fluid management
-meds: hydrochlorothiazide, DDAVP
-low Na diet
S+S hemolytic uremic syndrome (HUS)
-acute kidney injury
-hemolytic anemia
-thrombocytopenia
-D/V
-anorexia, lethargic, irritable
-bruising, purpura, rectal bleeding
-elevated BUN and Cr
-HTN
-possible anuria/oliguria
causes HUS
-shiga toxin
-e coli
-shigella
Tx HUS
-fluid replacement
-treat HTN
-correct acidosis and electrolyte imbalances
-early hemodialysis
-possible blood transfusion
-enteral nutrition
when would a kid with HUS need early hemodialysis
-anuric for 24 hrs
-oliguric with uremia or HTN + seizures
3 types unexplained proteinuria
-transient (with illness, exercise, dehydration)
-persistent (signifies renal disease)
-orthostatic (needs more testing)
2 types renal failure
acute renal failure (ARF)
chronic renal failure (CRF)
S+S acute renal failure
-*oliguria
-azotemia
-met acidosis
-electrolyte disturbances (hyperkalemia, hyponatremia, hypocalcemia)
most common cause acute renal failure
transient renal failure from severe dehydration
possible complications of acute renal failure
-hyperkalemia
-HTN
-anemia
-seizures
-hypervolemia
-cardiac failure with pulmonary edema
possible causes chronic renal failure
-congenital
-recurrent UTIs
-chronic pyelonephritis
-chronic glomerulonephritis
3 types dialysis
-hemodialysis
-peritoneal dialysis (PD)
-hemofiltration
accumulation of nitrogenous waste in blood
azotemia
Tx hyperkalemia
calcium gluconate
EKG monitoring
S+S chronic renal failure
-growth disturbance
-anemia
-low levels calcium and phosphorus
-metabolic acidosis
-hyperkalemia
-water and sodium retention
S+S possible rejection from kidney transplant
-fever
-swelling and tenderness over graft
-diminished urinary output
-elevated BP
-elevated Cr
-proteinuria, hematuria
Urethral opening is located
below the glans penis or
anywhere along the underside
of the penile shaft
hypospadias
S+S inguinal hernia
-pain
-abdominal distention
-anorexia
-difficulty with bowel movement
2 types hydrocele
communicating: fluid moves from abdominal cavity to scrotum
non-communicating: fluid is enclosed
Tx hydrocele
-communicating
-non-communicating
communicating: surgery (usually leads to herniation)
non-communicating: self-resolves
Failure of the testes to descend
through the inguinal canal to the
scrotum
cryptorchidism
3 types cryptorchidism
-abdominal
-canalicular
-ectopic
S+S cryptorchidism
-nonpalpable testis
-affected side(s) appear small
Tx cryptorchidism
-retractile testis
-undescended testis
retractile: self-resolves
undescended:
-leutiniing hormone
-avoid straddled toys
-orchiplexy (surgery) between 1-2 yo
