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NURS 332 > Chapter 26: Genitourinary Dysfunction > Flashcards

Chapter 26: Genitourinary Dysfunction Flashcards

1
Q

Describe how urinary output changes as children age.

A

– urinary output per kg decreases as the child ages because the kidneys become more efficient
* infants = 1 - 2 mL/kg/hr
* children = 0.5 - 1 mL/kg/hr
* adolescents = 40 - 80 mL/hr

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2
Q

What is a UTI? Differentiate between cystitis and pyelonephritis.

A
  • urinary tract infection caused by bacteria, viruses, or fungi (but most commonly E. coli)
  • can also be caused by urinary stasis or vesicoureteral reflux
  • can be the lower or upper urinary tract
    – cystitis: lower UTI (urethra/bladder)
    – pyelonephritis: upper UTI (ureters/kidneys)
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3
Q

Do males or females experience UTIs more frequently?

A
  • more common in males in first 6 months of life – uncircumcised infants
  • more common in females after 6 months – shorter urethra
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4
Q

What is a neurogenic bladder?

A

interrupted nerve supply to the bladder that impairs ability to urinate

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5
Q

What is vesicoureteral reflux (VUR)?

A

backflow of urine from bladder into ureters; fairly common

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6
Q

What is hydronephrosis?

A

overfilling and stretching of one or both of the kidneys d/t excessive urine

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7
Q

What is pyelonephritis?

A

infection of the kidneys

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8
Q

Approximately how many times per day should children be voiding?

A

5 - 6x per day

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9
Q

What are the signs and symptoms of UTIs?

11 s/s

A
  • depend on location of infection and age of child
    – newborns = non-specific – poor feeding, FTT, vomiting, diarrhea, strong-smelling urine, irritability
    – older children = more classic s/s – abdominal tenderness, foul-smelling urine
  • urinary frequency
  • urinary hesitancy
  • dysuria – discomfort during urination
  • bladder cramping
  • bladder spasms
  • cloudy or blood-tinged urine
  • musty-smelling urine
  • fever
  • poor feeding
  • FTT
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10
Q

How do the s/s of lower UTI compare with s/s of upper UTI?

A

– lower UTI:
* fever
* irritability
* foul-smelling urine
* enuresis
* dysuria
* dehydration

– upper UTI:
* high fever
* chills
* abdominal pain – indicative of kidney infection
* flank pain – indicative of kidney infection
* costovertebral-angle tenderness (CVA) – indicative of kidney infection

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11
Q

How is UTI diagnosed?

A
  • clean urine collection – look for leukocytes or nitrates
  • C&S test – ID infecting organism
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12
Q

What are some nursing interventions for UTIs?

7 interventions

A
  • encourage fluids
  • encourage frequent voiding
  • perineal hygiene
  • discourage holding in urine
  • use of cotton underwear – discourage tight, thong, or nylon underwear
  • discourage bubble baths
  • encourage abstinence – if sexually active, encourage voiding before and after
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13
Q

How is VUR diagnosed?

A

renal ultrasound (VCUG) – this also grades the progression

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14
Q

How is VUR treated?

4 treatments

A
  • surgery – usually done in infancy
  • prophylactic antibiotics to prevent UTIs
  • urine output monitoring
  • pain control
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15
Q

What is enuresis?

A
  • repeated, involuntary voiding of urine in children old enough to have bladder control
  • usually diagnosed ~5 - 6 y.o.
  • can be either nocturnal (night) or diurnal (day)
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16
Q

What is the difference between primary and secondary enuresis?

A

– primary:
* child has never had a dry night
* caused by maturational delay or small functional bladder
* no psychological cause

– secondary:
* child who has been reliably dry for at least 6 months begins to wet the bed
* caused by stress, infections, or sleep disorders

17
Q

What is nephrotic syndrome?

A

kidney disorder characterized by hyperproteinuria – the glomerular membrane allows proteins to pass into urine

18
Q

What are the s/s of nephrotic syndrome?

12 s/s

A
  • generalized edema – worse in scrotum and abdomen
  • ascites
  • hypoalbuminemia
  • hypoproteinemia
  • hypolipidemia
  • altered immunity
  • dramatic weight gain
  • pale
  • fatigue
  • anorexia
  • decreased urinary output
  • dark, frothy urine
19
Q

How is nephrotic syndrome diagnosed?

3 diagnostics

A
  • urinalysis – proteinuria, color change
  • serum chemistry – hypoalbuminemia, hyperlipidemia, hemoconcentration
  • kidney biopsy
20
Q

How is nephrotic syndrome treated?

10 treatments

A
  • monitor I&Os
  • daily weights
  • monitor edema – measurement of abdominal girth
  • prevent infections
  • diet restriction – restrict Na during edema phase
  • fluid restriction
  • skin assessment – risk for breakdown
  • assess for respiratory distress
  • monitor for HTN
  • meds:
    – corticosteroids – reduce inflammation
    – diuretics – not too quickly –> shock
    – albumin
    – cyclophosphamide
21
Q

What is acute postinfectious glomerulonephritis (APGN)?

A
  • inflammation of the glomeruli of kidneys d/t immune reaction and obstruction
  • occurs usually after GABHS infections
  • more common in boys, and more common in children 2 - 6 y.o.
22
Q

What are the s/s of APGN?

7 s/s

A
  • asymptomatic
  • abrupt flank or midabdominal pain
  • irritability
  • fever
  • cloudy, tea-colored urine – d/t hematouria
  • edema
  • HTN
23
Q

What is renal failure? What is the difference between acute and chronic?

A

– renal failure: kidney cannot excrete wastes and concentrate urine

– acute (AKI):
* sudden loss of renal function – days to weeks
* may be reversible

– chronic (CKD):
* develops gradually
* irreversible
* caused by developmental abnormalities of kidney or urinary tract
* usually ends with end-stage renal disease (ESRD)
* usually requires dialysis

24
Q

How is acute renal failure treated compared to chronic renal failure?

A

– acute:
* treatment depends on cause
* diuretics
* fluid restriction
* diet – restrict protein, Na, K, P
* dialysis if poor response to meds

– chronic:
* treatment depends on course of disease
* medications
* fluid restrictions
* diet – restrict protein, Na, K, P
* dialysis once significant impairment occurs

25
Q

What are the risks for pts undergoing dialysis?

2 risks

A
  • hypotension – too rapid exchange
  • disequilibrium syndrome
26
Q

What is hemolytic uremic syndrome (HUS)?

A

condition when small blood vessels of kidneys become damaged or inflammed –> clotting –> may result in renal failure (most common cause of renal failure)

27
Q

What age group does HUS usually affect?

A

infants and young children 6 months - 5 y.o.

28
Q

What are s/s of HUS?

12 s/s

A

– 3 main s/s:
* hemolytic anemia
* thrombocytopenia
* acute renal failure

– other s/s:
* HTN
* pallor
* jaundice
* fever
* anorexia
* GI discomfort
* vomiting
* diarrhea
* edema

29
Q

How is HUS treated?

3 treatments

A
  • fluid restrictions
  • diet restrictions
  • treat complications of AKI
30
Q

What is peritoneal dialysis? What group of children usually receive peritoneal dialysis?

A

– peritoneal dialysis: catether is inserted from the abdominal wall into the peritoneal cavity; the child’s peritoneal cavity acts as the semi-permeable membrane across which water and wastes diffuse (move from bloodstream to abdominal cavity)
* abdomen is filled with dextrose dialysis solution – pulls wastes and water into abdominal cavity
* dialysis fluid is then drained

– used for younger children 5 y.o. or younger
* allows for ambulation and interaction with surroundings

31
Q

What are some potential complications of peritoneal dialysis?

4 complications

A
  • peritonitis – cloudy dialysate
  • pain during infusion of fluid – may be too rapid
  • leakage around catheter
  • respiratory symptoms – d/t abdominal fullness or leakage of fluid to chest
32
Q

What is hemodialysis? What group of children usually receive hemodialysis?

A

– hemodialysis: machine with special filter to remove body wastes and water
* blood is pumped out
* moved thru dialyzer to remove wastes and fluid across a semi-permeable membrane
* blood returned to pt

– usually used in older children 12+ y.o.
* used for advanced or permanent renal failure
* requires close monitoring
* 3x per week for 3 - 5 hrs

33
Q

What are some potential complications of hemodialysis?

9 complications

A
  • hypotension
  • HTN
  • arrhythmias
  • cramping
  • fever
  • chills
  • N/V
  • anaphylaxis
  • clotted access

NURS 332 (13 decks)

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