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OB/Peds > Exam 3 Peds GU > Flashcards

Exam 3 Peds GU Flashcards

1
Q

Anatomical and physiological differences between children and adults

A

Urinary concentration
Structural differences
Urine output
Reproductive organ maturity

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2
Q

Opening of the urethra is on the ventral surface of the penis

A

Hypospadias

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3
Q

Opening of the urethra is on the dorsal surface of the penis

A

Epispadias

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4
Q

When is hypo/epispadias surgically repaired?

A

By 1 year

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5
Q

Assessment for hypo/epispadias

A

Insepct penis for placement of urethre
Chordee
Palpate for presence of testicles

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6
Q

Routine post-operative care for hypo/epispadias

A

Foley – be sure is secured in order to not place stress on incisions
Antibiotics, pain medications, anti-spasmodics
Double diaper

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7
Q

UTI

A

Occurs due to bacteria ascending to the bladder from the urethra
Most common serious bacterial infection in children

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8
Q

Who is at the highest risk for a UTI?

A

Infants and young children
Until age 1 more common in males than females
Then more common in females than males

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9
Q

Presentation of UTIs in children

A

Poor appetite, enuresis, frequent urination, fatigue, blood in urine, painful urination, abdominal or back pain

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10
Q

Presentation of UTIs in infants

A

Poor feeding or vomiting, screaming on urination, fever, strong smelling urine, persistent diaper rash, dehydration

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11
Q

UTI pathogens

A

E. Coli (80%)
Klebsiella
Staph
Pseudomonas

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12
Q

Causes of UTIs

A 
#1 is urinary stasis
Decrease fluid intake
Alkaline urine
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13
Q

Lab and Diagnosis tests for UTIs

A

Urinalysis (UA)
Urine culture
Renal ultrasound
VCUG

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14
Q

Nursing interventions for UTIs

A

Administer antibiotics to eliminate infection
Surgery correction if cause is anatomic defect
Encourage PO intake or IVF – avoid cola or caffeine
Urinate frequently, empty bladder completely
Promote hygiene
No bubble baths, cotton underwear, to tight pants, wipe from front to back, wash area daily with soap and water
Teenagers  educate to void after intercourse
Administer antipyretics if needed, heating pad
Educate parents on how to prevent recurrent infection

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15
Q

Vesicoureteral Reflux

A

Urine from the bladder flows back up the ureters
Occurs with bladder contraction during voiding
After voiding goes back into bladder is a great place for bacterial growth until next void  leads to kidney infections

Can lead to renal scarring and hypertension

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16
Q

Signs and symptoms for assessing Vesicoureteral reflux

A 
Fever
Dysuria or hematuria
Frequency or urgency
Nocturia
Back or abdominal pain
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17
Q

Physical exam for Vesicoureteral reflux

A 
Monitor BP (could be elevated)
Palpate abdomen for hydronephrosis
History of frequent UTIs? Congenital defects?
18
Q

Nursing interventions for Vesicoureteral Reflux

A

Antibiotic prophylaxis
Proper hygiene/voiding practices
Serial urine cultures (every 2-3 months and with fevers) and annual VCUG to assess progression of reflux
Many children will outgrow over a period of years

19
Q

Goal of vesicoureteral reflux management

A

To prevent pyelonephrosis and renal scarring

20
Q

When does vesicoureteral reflux require surgical intervention?

A

For grade 3-5

21
Q

Obstructive uropathy

A

An obstruction at any level along the upper or lower urinary tract that blocks the normal flow of urine

22
Q

What can obstructive uropathy lead to?

A

Dilation of the affected kidney (hydronephrosis) and ureter
Recurrent UTI
Renal insufficiency
Progressive damage to kidney

23
Q

Common signs and symptoms of obstructive uropathy

A 
Recurrent UTI
Incontinence
Fever
Flank pain
Urinary frequency 
Hematuria
24
Q

Postop care for surgical correction of obstructive uropathy

A

Monitor UOP
Encourage PO or IVF
Pain meds or antispasmodics
Educate parents

25
Q

What to monitor with obstructive uropathy

A

Palpate abdomen for masses

Monitor BP

26
Q

A clinical state that occurs as a result of increased glomerular basement membrane permeability to plasma proteins
Allows abnormal loss of protein in the urine

A

Nephrotic Syndrome

27
Q

3 forms of nephrotic syndrome

A

Congenital
Idiopathic (80%)
Secondary

28
Q

Speculated Causes of Idiopathic nephrotic syndrome

A

Metabolic
Biochemical, physiochemical
Immune-mediated response

29
Q

Patho of nephrotic syndrome

A

Increased glomerular permeability allows passage of larger plasma proteins through the glomerular basement membrane
Results in an excess loss of protein (albumin) in the urine (proteinuria)
Have a decreased amount of protein in blood (hypoalbuminemia)
Causes a change in osmotic pressure and fluid shifts from bloodstream into interstitial fluid, edema (especially the abdominal cavity, called ascites)
Lowers blood volume (hypovolemia) which “starves” kidneys, they hold on to Na and H2O, more edema Liver senses the protein loss and increases production of lipoproteins
Results in hyperlipidemia because lipids cannot be excrete in urine
At increased risk for clotting because of decreased intravascular volume
Also at increased risk for infection or renal failure
Diagnosis:
Clinical manifestations (especially weight gain), labs

30
Q

Common signs and symptoms of nephrotic syndrome

A

Recent wt gain
History of periorbital edema when awakening then generalized edema during day
Abdominal swelling (ascites)
Pleural effusion, labia or scrotal swelling
Weakness or irritability
Decreased urine volume, frothy
Susceptible to infection

31
Q

Physical exam for nephrotic syndrome

A

Edema
BP – normal or slightly decreased
Heart and lung sounds
Palpate skin and abdomen

32
Q

Lab and Diagnostic tests for nephrotic syndrome

A

Clinical manifestations:
Urinalysis
Marked proteinuria
Mild hematuria, if any

Serum protein and albumin levels low

Serum cholesterol and triglyceride levels elevated

Eventually BUN and Cr will become elevated

Renal biopsy done if does not respond to treatment

33
Q

Management objectives for nephrotic syndrome

A

Reducing excretion of urinary protein
Reducing fluid retention
Preventing infection
Minimizing complications related to therapies

34
Q

Diet for nephrotic syndrome

A

Low salt diet, possible fluid restriction

35
Q

Meds for nephrotic syndrome

A

If edema is severe – diuretics and albumin
Infection - abx
Corticosteroids – 1st line of therapy for NS
Prednisone for 21 days then taper off
About 2/3 will relapse
Repeat course of steroid therapy or other immunosuppressive meds
May last for many years

36
Q

Continued monitoring for nephrotic syndrome

A 
Continuous monitoring of fluid retention or excretion
Strict I & O
Daily weight
Measure abd girth
In-depth skin assessment
Monitor VS
Protect against infection
Promote adequate nutrition 
Protein rich snacks
37
Q

Parent education for nephrotic syndrome

A 
Signs of relapse
Urine dipstick at home
Prevent infection but CAN go to school
Mood swings related to steroids
Emotional toll of relapse
38
Q

Acute Glomerulonephritis

A

Immune complexes are deposited in the glomerular basement membrane
Causes inflammation and edema due to leukocytes
Altered glomerular structure and function in both kidneys (cannot filter properly)
Results in excessive amounts of water and retention of Na  expands plasma and interstitial fluid volumes  circulatory congestion (HTN) and edema

39
Q

When does Acute Glomerulonephritis usually occur?

A

After an infection
Acute post streptococcal glomerulonephritis (Group A ß-hemolytic streptococcus)
Latent period of 10-21 days after infection

40
Q

Acute Glomerulonephritis clinical manifestations

A

Edema – periorbital and then spreads to extremities and abdomen
Gross hematuria – causes discoloration of urine (cloudy, smoky brown like cola or tea)
Mild proteinuria
Severely reduced urine volume
Mild to moderately elevated blood pressure (HA)
Pallor, irritability, lethargy, anorexia, child appears ill
Diagnosed with + antistreptolysin O (ASO) titer
Might have a CXR (cardiac enlargement, pulmonary congestion, pleural effusion) during the edematous phase

41
Q

Diagnosis and treatment of Acute Glomerulonephritis

A

Diagnosed with + antistreptolysin O (ASO) titer and clinical manifestations

Might have a CXR (cardiac enlargement, pulmonary congestion, pleural effusion) during the edematous phase

No treatment – just supportive measures
Diet – moderate sodium restriction, possible fluid restriction if severe edema, K restriction during oliguric phase
Measure VS, wt, strict I & O
Determine HTN early and give antihypertensives or diuretics

Give abx if strep is still positive

Daily wt is the best way to assess fluid balance
Bed rest during acute phase then allow frequent rest periods

OB/Peds (11 decks)

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