EXAM 3: GENITAL/URINARY Flashcards
What population of children suffers the most from UTIs
uncircumcised boys younger than 3 months
What Sx is s major indicator of pyelonephritis
fever
What is Cystitis
inflammation of the bladder
What is Urosepsis
bacterial illness; urinary pathogens in blood
What pathogen is responsible for 80% of UTIs
Escherichia coli
The single most important contributing factor to UTI formation is
stasis
Describe Vesicoureteral Reflux
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
Any child who exhibits the following should be evaluated for a UTI:
Incontinence in a toilet-trained child
Strong or foul-smelling urine
Frequency or urgency
Dysuria
Gross hematuria
MANIFESTATIONS OF UTI in a neonate/infant
Poor feeding, vomiting
FTT
Excessive thirst
Frequent urination
Foul-smelling urine
Pallor, fever
Persistent diaper rash
Increased RR
What causes obstructive uropathy
kidney stones, urethral stricture, prostate/uterus issues
What is is called when the foreskin doesn’t move down penis and stays
PHIMOSIS
What is is called when theres a bunch of fluid in the scrotum that makes the testicles blow up like a baloon
Hydrocele
if it doesnt go away after a year, surgery
What is it called when the testes dont descend
Cryptorchidism
theres Abdominal, canalicular, ectopic
Anorchism is absence of testis
Will need surgert
What is it called when the male’s pee hole isn’t where its supposed to e
Hypo/epispadias
What are 6 symptoms of nephrotic syndrome
edema in face, pale skin fissure, hyperlipidemia, proteinuria, vomiting, tachycardia
HIGH PROTIEURIA
HYPOALBUMINEMIA
What’s the difference between primary and secondary nephrotic syndrome (and congenital)
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
Describe the PATHOPHYSIOLOGY OF NEPHROTIC SYNDROME
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
Nursing care for nephrotic syndrome
Low-to-moderate protein intake
Sodium restriction when a lot of edema is present
Medications
Steroids, immunosuppressants, diuretics
What are signs that nephrotic syndrome has been controlled
Protein-free urine
Acute infections prevented
Edema absent or minimal
Nutrition maintained
Metabolic abnormalities controlled
What is the difference between chronic and ACUTE GLOMERULONEPHRITIS
Acute: Sx suddenly, resolve w/ Tx
Chronic: if acute isnt treated and/or when disease develops slowly that leads to IRREVERSIBLE INJURY TO KIDNEYS
What is the difference between [primary and secondary GLOMERULONEPHRITIS
Primary is where the infection starts in the glomeruli
Secondary is where glomeruli are infected by a systemic infection (Strep, Lupus, Sickle cell disease)
What are th Sx of ACUTE GLOMERULONEPHRITIS
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
Diagnostic evaluation of acute glomerulonephritis
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
Nursing considerations for glomunephritis
Manage edema
Daily weight measurements
Accurate input and output
Daily abdominal girth measurements
Nutrition
Low sodium
Fluid restriction
Susceptibility to infections
Describe Hemolytic-uremic syndrome
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%
Describe RENAL FAILURE
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
Difference between acute and chronic renal failure
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”
Describe DIALYSIS
The process of separating colloid and crystalline substances through a semipermeable membrane
Methods
Peritoneal dialysis-preferred method in children
Hemodialysis
Hemofiltration
Difference between primary and secondary amenorrhea
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
