EXAM 3: GENITAL/URINARY

Question 1

What population of children suffers the most from UTIs

Answer 1

uncircumcised boys younger than 3 months

Question 2

What Sx is s major indicator of pyelonephritis

Answer 2

fever

Question 3

What is Cystitis

Answer 3

inflammation of the bladder

Question 4

What is Urosepsis

Answer 4

bacterial illness; urinary pathogens in blood

Question 5

What pathogen is responsible for 80% of UTIs

Answer 5

Escherichia coli

Question 6

The single most important contributing factor to UTI formation is

Answer 6

stasis

Question 7

Describe Vesicoureteral Reflux

Answer 7

Retrograde flow of urine from bladder to upper urinary tract

Primary
Congenital abnormal insertion of ureters into the bladder

Secondary
Result of an acquired condition

Reflux increases chance for febrile UTI and can lead to scarring

Reflux with infection—Most common cause for pyelonephritis

Surgical management
Prevention with antibiotics

Question 8

Any child who exhibits the following should be evaluated for a UTI:

Answer 8

Incontinence in a toilet-trained child

Strong or foul-smelling urine

Frequency or urgency

Dysuria

Gross hematuria

Question 9

MANIFESTATIONS OF UTI in a neonate/infant

Answer 9

Poor feeding, vomiting
FTT
Excessive thirst
Frequent urination
Foul-smelling urine
Pallor, fever
Persistent diaper rash
Increased RR

Question 10

What causes obstructive uropathy

Answer 10

kidney stones, urethral stricture, prostate/uterus issues

Question 11

What is is called when the foreskin doesn’t move down penis and stays

Answer 11

PHIMOSIS

Question 12

What is is called when theres a bunch of fluid in the scrotum that makes the testicles blow up like a baloon

Answer 12

Hydrocele

if it doesnt go away after a year, surgery

Question 13

What is it called when the testes dont descend

Answer 13

Cryptorchidism

theres Abdominal, canalicular, ectopic

Anorchism is absence of testis

Will need surgert

Question 14

What is it called when the male’s pee hole isn’t where its supposed to e

Answer 14

Hypo/epispadias

Question 15

What are 6 symptoms of nephrotic syndrome

Answer 15

edema in face, pale skin fissure, hyperlipidemia, proteinuria, vomiting, tachycardia

HIGH PROTIEURIA
HYPOALBUMINEMIA

Question 16

What’s the difference between primary and secondary nephrotic syndrome (and congenital)

Answer 16

Primary disease
Also known as
“Idiopathic nephrosis”
“Childhood nephrosis”
“Minimal change nephrotic syndrome” (MCNS)

Secondary nephrotic syndrome
In association with glomerular damage

Congenital nephrotic syndrome
Autosomal recessive disorder

Question 17

Describe the PATHOPHYSIOLOGY OF NEPHROTIC SYNDROME

Answer 17

Glomerular membrane
Normally impermeable to large proteins
Becomes permeable to proteins, especially albumin
Albumin lost in urine (hyperalbuminuria)
Serum albumin decreased (hypoalbuminemia)
Fluid shifts from plasma to interstitial spaces

Question 18

Nursing care for nephrotic syndrome

Answer 18

Low-to-moderate protein intake
Sodium restriction when a lot of edema is present

Medications
Steroids, immunosuppressants, diuretics

Question 19

What are signs that nephrotic syndrome has been controlled

Answer 19

Protein-free urine
Acute infections prevented
Edema absent or minimal
Nutrition maintained
Metabolic abnormalities controlled

Question 20

What is the difference between chronic and ACUTE GLOMERULONEPHRITIS

Answer 20

Acute: Sx suddenly, resolve w/ Tx

Chronic: if acute isnt treated and/or when disease develops slowly that leads to IRREVERSIBLE INJURY TO KIDNEYS

Question 21

What is the difference between [primary and secondary GLOMERULONEPHRITIS

Answer 21

Primary is where the infection starts in the glomeruli

Secondary is where glomeruli are infected by a systemic infection (Strep, Lupus, Sickle cell disease)

Question 22

What are th Sx of ACUTE GLOMERULONEPHRITIS

Answer 22

Oliguria, edema (periorbital), hypertension

Hematuria

Bleeding in upper urinary tract causes urine to appear smoky

Proteinuria
Increased amount of protein reflects increased severity of renal disease

Question 23

Diagnostic evaluation of acute glomerulonephritis

Answer 23

History of strep infection, mild cold, or nothing
Urinalysis—Proteinuria and hematuria
Azotemia—Elevated BUN and creatinine levels
Serum antibodies
X-rays—Cardiac enlargement, pleural effusion
Renal biopsy

Question 25

Nursing considerations for glomunephritis

Answer 25

Manage edema
Daily weight measurements
Accurate input and output
Daily abdominal girth measurements

Nutrition
Low sodium
Fluid restriction

Susceptibility to infections

Question 26

Describe Hemolytic-uremic syndrome

Answer 26

Uncommon acute renal disease occurring in infants and small children

Etiology—Thought to be related to bacterial toxins

Symptoms
Hemolytic anemia, thrombocytopenia, renal injury, CNS symptoms
Hemolytic-uremic syndrome ()

Pathophysiology
Endothelial lining of glomerular arterioles become swollen and occluded, damaging RBCs as they pass
Damaged RBCs are removed by the spleen

Diagnostic evaluation
Anemia, thrombocytopenia, renal failure

Therapeutic management
Supportive care
Dialysis if needed
Hemolytic-Uremic Syndrome ()

Prognosis
Recovery rate of 95%

Question 27

Describe RENAL FAILURE

Answer 27

Inability of kidney to
Excrete waste
Concentrate urine
Conserve electrolyte
s
Can occur suddenly or slowly

Azotemia
Accumulation of nitrogenous waste in blood

Uremia
Retention of the nitrogenous wastes has resulted in toxic symptoms

Question 28

Difference between acute and chronic renal failure

Answer 28

Acute renal failure (ARF)
Inadequate perfusion
Kidney disease
Urinary tract obstruction

Chronic renal failure (CRF)
More than 50% of the functional renal capacity is destroyed
Few normal nephrons remain
Kidneys no longer able to maintain fluid and electrolyte balance
Clinical syndrome called “uremia”

Question 29

Describe DIALYSIS

Answer 29

The process of separating colloid and crystalline substances through a semipermeable membrane

Methods
Peritoneal dialysis-preferred method in children

Hemodialysis

Hemofiltration

Question 30

Difference between primary and secondary amenorrhea

Answer 30

Primary Amenorrhea
-No secondary sex characteristics and no menarche by 14-15 yo
-OR-
-Secondary sex characteristics present but no menarche by 16 yo
-No uterine bleeding after attaining sexual maturity

Secondary Amenorrhea
-Absence of menses for >6 mos or > 3 cycles
-Most common cause Pregnancy!
-Other causes: eating disorders, stress, severe wt loss