Ch 46 Lecture

Question 1

The Genitourinary system functions by:

Answer 1

Maintains balance of fluid and electrolytes. It removes waste products.

Reproduction is functionally immature until puberty.

Question 2

structures in the Genitourinary system

Answer 2

kidneys (under 2 yrs, less efficient)
ureters
bladder
urethra

Question 3

UTI

Answer 3

Viral, bacterial, or fungal infection of the lower or upper urinary tract

Organism enters genitourinary tract and ascends from the urethra to the bladder toward the kidney

Cystitis (lower)
Pyelonephritis (upper)

Question 4

Lower UTI s/s

cystitis

Answer 4

fever, hematuria, vomiting, irritability, lethargy, foul-smelling urine, dehydration, abdominal pain, enuresis

Question 5

upper UTI s/s

pyelonephritis

Answer 5

high fever, chills, abdominal pain, nauseas, vomiting, flank pain, costovertebral angle tenderness, moderate to severe dehydration

Question 6

Teaching for UTI’s

Answer 6

1. Teach proper perineal hygiene. Girls should always wipe the perineum from front to back after voiding.
2. Encourage the child to drink plenty of fluids and avoid long periods of “holding urine.“
3. Caution against tight underwear, children should wear cotton rather than nylon underwear.
4. Encourage the child to void frequently and to fully empty the bladder.
5. Discourage bubble baths, bath oils, and hot tubs, which can irritate the urethra.
6. Encourage abstinence of sexual activity. However, if girls are sexually active, instruct to void before and after sexual intercourse to prevent urinary stasis and flush out bacteria introduced during intercourse.

Question 7

A history of UTI’s in babies is not ___.

Answer 7

normal.

Think “something structural.”

Question 8

common lab tests for UTI’s

Answer 8

1. BUN – blood urea nitrogen
2. Creatinine clearance
3. UA – Urinalysis
4. Urine culture
5. Urine protein to creatinine ratio

Question 9

bladder exstrophy

Answer 9

Congenital abnormality in which the posterior bladder wall extrudes through the lower abdominal wall

• Females have bifid clitoris
• Males have short penis (Undescended testicles and inguinal hernias are common)

Surgical repair to close abdominal wall, promote urinary continence, create functional and normal-appearing genitalia, correct to promote later sexual functioning

Question 10

hypospadias and epispadias

Answer 10

urethral opening on ventral (hypo) side or dorsal (epi) side of the penis.

surgical repair:
Postoperative care
i.	Protect surgical site
ii.	Pain management
iii.	Double diapering

Question 11

Vesicoureteral reflux

Answer 11

Retrograde flow of urine from bladder into ureters. Reflux prevents complete emptying of bladder, reservoir for bacterial growth.

Postoperative care

a. Monitor urine
b. IV administration

Family teaching

a. Monitor for infection
b. Incision care

Question 12

cryptorchidism

Answer 12

Undescended testes

Occurs when one or both testes fail to descend through inguinal canal into scrotum

Question 13

inguinal hernia and hydrocele

Answer 13

Painless inguinal or scrotal swelling

Peritoneal sac precedes the testicles’ descent into scrotum

Question 14

acute glomerulonephritis

Answer 14

immune reaction to strep infection (or one that was not completely eliminated)

abrupt onset

grossly bloody

proteinuria (not massive)

mild edema

marked hypertension

mild or no hyperlipidemia

5-10 years of age

Question 15

nephrotic syndrome

Answer 15

idiopathic; possibly a hypersensitivity reaction

insidious onset

rarely bleeds

massive proteinuria

massive edema

mild hypertension

marked lipidemia

2-3 years of age

Question 16

acute glomerulonephritis

Answer 16

interventions: limited activity, anti-hypertensives as needed; symptomatic therapy if CHF occurs

low protein, no added salt diet

antibiotics

lasts 2-3 weeks

Question 17

nephrotic syndrome

Answer 17

interventions: bedrest during edema stage;
corticosteroids

regular protein and low sodium diet; frequent meals may be desirable

no known prevention

chronic (may have relapses)