Exam 3 Genitourinary Disorders Flashcards
Genitourinary Disorders (4)
UTI
Acute Glomerulonephritis
Nephrotic Syndrome
Wilm’s Tumor
Urinary Tract Infection
1) Lower Urinary Tract (2)
2) Upper Urinary Tract (4)
1) Urethra, Bladder
2) Ureters, Renal Pelvis, Calyces, Renal Parenchyma
Upper UTI - AKA _____ _____ can lead to (3)
Acute Pyelonephritis
1) Renal Scarring
2) HTN
3) End-Stage Renal Disease
Bacterial causes of UTI’s (6)
- E. coli (80%)
- Proteus pseudomonas
- Klebsiella
- Staph. Aureus
- Haemophilus
- Coagulase-negative staphylococcus
Single Most Important Contributing factor to UTI =
So we want to tell toddlers to do what?
Why are females more at risk?
= Urinary stasis (incomplete emptying of bladder)
= Double Void
= have a SHORTER URETHRA
UTI structural/functional causes
1) ____ (bladder urine into ureters)
2) ______ abnormalities
3) _____ of ____ ______
4) Bladder ______
1) Reflux
2) Anatomic
3) Dysfunction of Voiding Mechanism
4) Compression
Clinical Manifestations of UTI in infancy P P P F F F F V
- Poor feeding
- Pallor
- Persistent diaper rash
- Fever
- Foul-smelling urine
- Frequent urination
- Failure to thrive
- Vomiting
Clinical Manifestations of UTI in Childhood
1) Where is the pain located?
- ____/____ of urination, D____, H____, E____, I_____
- ____ appetite, v____, excessive ____
- G____ failure, Facial _____
- P___, F____
1) Suprapubic (lower abdominal pain)
- frequency, urgency of urination, dysuria, hematuria, enuresis (bedwetting), incontinence
- Poor appetite, vomiting, excessive thirst
- Growth failure, Facial Swelling
- Pallor, Fatigue
Diagnostics of UTI
1) Urine Culture (3)
2) Urinalysis (3)
3) May need (2)
1) (sterile)
- Clean catch (not sterile) 1st choice bc least invasive
- Sterile catheterization
- Suprapubic aspiration (lidocaine to site first)
2) Leukocytes, Nitrates, Blood
3) Renal Ultrasound, or VCUG (Voiding cystourethrogram)
Tx for UTI =
- If < 2 yo what needs to happen? Risk for (2)
- If VUR = __________ may need?
= PO Antibiotics
- Hospitalization + IV antibiotics, Risk for bacteremia, sepsis
- Vesicoureteral Reflux, may need surgical correction bc indicates anatomical obstruction
Nephrotic Syndrome =
= most common presentation of glomerular injury in children
Causes of Nephrotic Syndrome (3)
1) Idiopathic
2) Congenital/Genetic
3) Secondary to Lupus
Characteristics of Nephrotic Syndrome (4)*
1) Proteinuria
2) Frothy and Foamy urine
3) Hypoalbuminemia
4) Hyperlipidemia
Nephrotic Syndrome
- ______* especially when?
- Weight ____ (___)
- Abdominal _____
- D______ (bc?)
- A______
- Easily ______
- _____ urine volume
- Facial edema (especially seen when you wake up, will go away once start walking for a bit)
- Gain (edema)
- Swelling
- Diarrhea - dt edema in intestinal mucosa
- Anorexia
- Fatigued (dt fluid overload)
- Decreased urine volume
Diagnostics for Nephrotic Syndrome
1) Urinalysis will show __+ of what?
2) 24 hour urine protein = > ___mg/kg/day = consistent with nephrotic syndrome
3) Serum albumin will be high or low?
4) Serum protein will be high or low?
5) Renal ____
1) 3+
2) > 50 mg/kg/day
3) low
4) low
5) Biopsy
Tx for Nephrotic Syndrome Goals
1) Reduce =
2) Reduce =
3) Keep child as ____ as they are comfortable with
1) Excretion of urinary protein
2) Fluid retention
3) active
Nephrotic Syndrome Dietary Restriction =
- ____ Restrictions = w ____ in severe cases
= Low Salt Intake
- Fluid, diuretics
Medication for Nephrotic Syndrome*
Dosage
- __ mg/kg/day for __ weeks followed by
- __ mg/kg/day for ___ weeks
SE (7) for long term steroid tx
Corticosteroids*
- 2 mg, 6 wks
- 1.5 mg, 4 wks
Weight gain, Infection, Growth Retardation, Increased Appetite, Rounding of Face, Hypertension, Hyperglycemia
Nursing Management for Nephrotic Syndrome
1) Monitor for ___ retention and excretion, strict ___’s
2) ____ examination for ___ via __ _____
3) Daily ____, measurement of ____ girth
4) Monitor ____ ___ (dt increased risk for infection)
1) Fluid, I/O’s
2) Urine, protein, UA dipstick
3) Weights, abdominal
4) Vital Signs
Parent Education for Nephrotic Syndrome
1) ___/___ children will relapse -> ___ ___ minimizes damage to kidney
2) __/__ of nephrotic syndrome
3) urine ____ at home
1) 2/3, early detection
2) S/S
3) dipsticks
Acute Glomerulonephritis Causes- Post infection dt (3)
Most common type in children is?
1) Streptococcal*
2) Pneumococcal
3) Viral
Acute Post Streptococcal Glomerulonephritis (APSGN)
Acute Post Streptococcal Glomerulonephritis
Occurs __-__ days after strep infection/dental work in certain strains that cause __-___ to deposit in glomerular ___ membrane -> glomeruli become ____, ___ the c___ l___
Peak Age = __-__ y
Uncommon in < ___ y
What seasons?
- 10-21, immune complexes, basement, edematous, occludes the capillary lumen
6-7 yo
< 2 y uncommon
More common in winter and spring
Clinical Manifestations of AG
1) ______*** __+, due to?
2) E____ due to? How does it progress?
3) L____
4) D____
5) H_____
6) P_____
How do you know the severity of renal disease?
1) HEMATURIA** 3+ dt bleeding in upper urinary tract -> smokey, cola/tea colored urine
2) Edema - generalized edema dt decreased GFR, Begins w periorbita edema -> LE -> ascites
3) Loss of Appetite
4) Decreased Urine Output
5) Hypertension
6) Proteinuria
Severity increases with increased amount of protein
Dietary Restrictions for AG
- Moderate ____, fluid _____
- moderate salt, fluid restriction
Regular Measurements to assess progression of AG disease
- ___ signs, body ____, __/__’s
- vital, weight, I/O’s
Teaching for AG
- Do children die from this often?
- Specific ____ is acquired -> reoccurances are ___
- almost all children w APSGN recover completely
- immunity, uncommon
Wilm’s Tumor =
- ___ common renal malignancy in children
- Peak age of diagnosis is ___ yo
- more frequent in females or males?
- Associated with GU a_____ and s____
= AKA nephroblastoma - malignant renal and intra-abdominal tumor of childhood
- Most
- 3 yo
- males
- anomalies, syndromes
Clinical Manifestations of Wilm’s Tumor
1) ____ abdominal girth
2) Abdominal ___/___ is ___ and ___ tender on ___ side*
3) H____*
4) H_____
5) F____
6) Weight _____
1) Increased
2) swelling/mass is firm and non tender on one side
3) Hypertension
4) Hematuria
5) Fatigue
6) Loss
Tx for Wilm’s Tumor =
= Surgical removal followed by chemotherapy
+/- radiation
NEVER ____ Wilm’s Tumor, why?
- PALPATE, bc manipulation of tumor may cause spread of cancer cells to adjacent sites
Pre/Post op Wilm’s tumor, Monitor what? why?
BP closely! bc at increased risk for HTN
Child and Family Teaching for Wilm’s Tumor
- How soon is surgery performed after diagnosis?
- ____ is started immediately after surgery
- 24-48 hours
- chemotherapy
