[Exam 4] Chapter 43 – Alteration in Urinary Elimination/Genitourinary Disorder Flashcards
Bladder capacity in newborn?
30 mL, 270 mL by year 1.
What size catheter will lbe used based on <2 years old, 2-5 years, 5-10 years, 10-16years
< 2 = 6 French
2-5 Years = 6-8 French
5-10 Years = 8-10 French
10-16 = 10-12 French
Bladder Exstrophy: what is this?
congenital defect resulting in the bladder being open and exposed outside of the abdomen.
Bladder Exstrophy: Nursing management involves what?
Preventing infection and skin breakdown
Bladder Exstrophy, Providing PostOp Care: What will be done after surgery to prevent infection?
Keep the infant supine and quickly change soiled diapers.
Bladder Exstrophy, Providing PostOp Care: What is done during surgery?
Surgical reconsturction of the bladder within pelvic cavity and reconstruction of urethra.
Bladder Exstrophy, Providing PostOp Care: What will be done to allow for urinary drainage?
Indwelling urethral cather or suprapubic tube .
Bladder Exstrophy, Providing PostOp Care: How to manage bladder spasms?
With oxybutynin or belladonna and opioid suppositories.
Bladder Exstrophy, Providing PostOp Care: When will blood tinged urine disappear?
Within hours to day of surgery
Bladder Exstrophy, Catheterizing of Stoma: What happens if bladder tissue is insufficient for repair?
Bladder is removed and a continent urinary resovior created. Urters connected to portion of small intestine. Stoma created on abdominal wall.
Bladder Exstrophy, Catheterizing of Stoma: How often is stoma catheterized?
About 4x per day to empty the reservoir of urine. Urine appears mucus like and often cloudier.
Hypospadias/Epispadias: What is hypospadias?
Urethral defect in which the opening is on the ventral surface of the penis rather than the end
Hypospadias/Epispadias: What is epispadias?
Urethral defect in which the opening is on the dorsal side ofthe penis (up)
Hypospadias/Epispadias: When is this repaired?
By about 1 year of age
Hypospadias/Epispadias: What happens during surgery?
Meatus is moved to the glans penis and the urethra is reconstructed as needed.
Hypospadias/Epispadias, Nursing Assess: What else may occur with hypospadias?
Cryptorchidism (undescended testicles)
Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: When will circumscision occur?
After the surgery, as the excess skin may be needed
Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: How to prevent strain on urethral incision?
Ensure that the urinary drainage tube remains carefully taped with penis in upright posiiton..
Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: What is double diapering?
Method used to protect the urethra and stend or catheter after surgery. Alsokeeps area clean from infection.
Hypospadias/Epispadias, Nursing Mx, Providing PostOp Care: What should the child not do for three weeks?
Roughhousing, ride-on toys or any activity involving straddling
UTI: What symptoms will infants display?
Fever, irritability, vomiting, failure to thrive, or jaundice.
UTI: What symptoms will children display?
Fever and vomiting, but also dysuria, frequency, hesistancy, and urgency
UTI - Patho: What normally causes this?
E. Coli
UTI - Patho: What contributes to bacterial grwoth?
Decreased fluid intake, and also having urine remain after voiding.
UTI - Therapeutic Mx: How is this treated?
Oral or IV antibiotics. 7-14 day course is often prescribed.
UTI - Health Hx: What signs may be shown?
Fever, N/V, Chills, Abdomen
Lethargy, Jaundice, Poor Feeding
UTI - Health Hx: RF for this?
Previous UTI, VUR, Constipation, Urine Holding.
UTI - Health Hx: Observe for what signs in neonate or young infant?
Jaundice or increased respiratory rate.
UTI - Health Hx: How will urine appear?
Visible blood, cloudiness, dark color, sediment, mucus, or foul odor
UTI - Labs: Which ones may be done?
Urinalysis
Urine Culture
Renal Ultrasound.
UTI - Nursing Mx, Eradicating Infection: When would IV Antibiotics be prescribed?
For child who has protracted vomiting or suspected pyelonephritits.
UTI - Nursing Mx, Eradicating Infection: What is used to reduce fever and relieve abdomen paink?
Antipyretics like acetaminophen or ibuprofen for fever
Heating pad or warm compress for flank pain.
Enuresis: What is this?
Continued incontinence of urine past age of toilet training. Usually gone by 6 years.
Enuresis: This may occur secondary to which disorders?
Diabetes mellitus, sickle cell anemia, ectopic ureter, or urethral obsturction.
Enuresis: Most common cause of daytime enuresis?
Dysfunctional voiding or holding of urine
Enuresis: Nocturnal enuresis may be realted to what
high fluid intake in the evening, obstructive sleep apnea, or sexual abuse
Enuresis, Nursing Assess: What questions should you ask parents?
ABout urine holding behaviors like squatting/dancing
And amount of fluid consumed before bedtime
Enuresis, Nursing Assess: Risk factors of this?
Family disruption
Chronic constipation
Excessive famly demands rt toileting patterns
Enuresis, Nursing Mx: Child should be encouraged to increase what?
Amount of fluid consumed during the day in order to increase frequency to void. Set schedule of when to void.
Enuresis, Nursing Mx, Educating about Nocturnal Enuresis: Encourage parents to limit what
Chocolate and caffeine, and to limit fluids beofre going to bed.
Enuresis, Nursing Mx, Decreasing Nighttime Voiding: Teach family to use what?
Enuresis alarm system . Work by sounding an alarm when first few drops of urine appear. Child awakens and stops the urine flow.
Enuresis, Nursing Mx, Decreasing Nighttime Voiding: What medications can be prescribed?
Oxybutynin, imipramine, and desmopressin
Nephrotic Syndrome: What is this?
Occurs as result of increased glomerular basement membranes permeability, which allows abnormal loss of protein in the urine.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS): When is the onset?
By 6 years
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS): Complications of this?
Anemia, infection, poor growth, peritonitis, thrombosis and renal failure
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Why is there increased glomerular permeability?
Because of passage of larger plasma proteins through glomerular basement membrane. Excess loss of protein in urine and decrease protein and albumin in blood stream
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Hypoalbuminemia results in what?
Change in osmotic pressure, and fluid shifts from the bloodstream into the interstital tissue (causing edema). Triggers kdiineys to respond by conserving sodium, leading to edema.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: What does liver do?
Liver senses protein loss, and increases lipoproteins. Hyperlipidemia then develops as excess lipids cannot be excreted in urine.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: These children are at increased risk for what
clotting because of decreased intravascular volume.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Increased risk for what?
development of serious infection
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Patho: Steroid resistant nephrotic syndrome results in what
acute renal failure
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Therapeutic Mx: What does this usually involve use of?
Corticosteroids.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Therapeutic Mx: What is used in severely edematous child?
IV Albumin, along with diuretics.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Therapeutic Mx: What type of immunosuppressive therapy may be needed?
Cyclophosphamide, cyclosporina A
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Common signs of this?
N/V, Recent Weight Gain, History of Periorbital Edema, Weakness/Fatigue
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Rf for this?
Intrauterine growth retardation, young age, male sex
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Observe the child for what?
Edema. (periorbital, generalized). Edema becomes more generalized as disease progresses.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: How will blood pressure be?
May be elevated. May be normal or decrease when progressing to renal failure.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Health Hx: Urine dipstick will reveal what?
Proteinuria.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What is adminsitered to promote diuresis??
Corticosteroids. Make sure to taper or weaning doses.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What diuretic usually adminsitered
Furosemide.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What electrolyte imbalance may occur?
Hypokalemia.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: Measure pulse rate and BP every 4hours why
to detect hypovolemia, resultign from excesive fluid shifts.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Promoting Diuresis: What happens in servere hypoalbuminemia?
IV Albumin may be adminsitered. Causes it to shift back into blood stream. Adminsiter with furosemide.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Prevent Infection: What is done?
Administer pneumoccocal vaccine.
Administer prophylactic antiiotics.
Don’t admiinister live vaccines until at least 2 weeks after corticosteroid use ceases.
Idiopathic Nephrotic Syndrome, Minimal Change Nephrotic Syndrome (MCNS) - Encouraging Nutrition: What restrictions will occur?
Fluid restriction for children wtih massive dema. Especialyl sdoium. Eat foods high in protein
Acute Post-Streptococcal GLomerulonephritis (APSGN): What is this?
Immune process injures the glomeruli. Causes inflammation, which alters glomerular structure and function. Occurs ifter infection.
Acute Post-Streptococcal GLomerulonephritis (APSGN): What is this caused by?
Antibody-antigen reaction secondary to infection.
Acute Post-Streptococcal GLomerulonephritis (APSGN): Complication of this?
Progression to uremia and renal Failure.
Acute Post-Streptococcal GLomerulonephritis (APSGN): treatment?
No specific treatment. Must maintain fluid volume and manage hyertension
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: Signs can include?
Fever, Lethargy, Headache, Decreased Urine Output, Abdominal Pain.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: How will BP be?
Elevated.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: What to inspect physically?
Edema, and increased work of breathing.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: Urine dipstick will reveal what
proteinuria as well as hematuria.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Health Hx: How will gross hematuria appear?
tea colored, cola covered, or even dirty green colored.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: What should be administerd?
Antihypertensives like nifedipine and diuretics
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: What restrictions will occur during initial edematous phase?
Maintain sodium and fluid restrictions. Weight them daily.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: How will child act during acute phase?
Are generally faituged ad choose bed rest.
Acute Post-Streptococcal GLomerulonephritis (APSGN) - Nursing Mx: What may happen if this doesnt get fixed?
Dialysis may be necessary
Cryptorchidism: What is this?
Undescended testicles, occurs when one or both do not descent into scrotal sac. Usually descend in 7th month.
Cryptorchidism: What may cuase this?
Mechanical, hormonal, chromosomal, or enzymatic
Cryptorchidism: Complciations of this?
Sterility and increased risk for testicular cancer.
Cryptorchidism: How to fix this?/
Surgical management. Orchiopey performed to realse spermtic cord, and testes pulled into scrotum.
Cryptorchidism: Risk factors for this?
Prematurity, first-born child, cesarean birth and low birth weigiht
Cryptorchidism, Nursing Mx: When should they descend by?
By 6 months of age, and if not, they should be referred for surgical repair
The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child’s future care?
“Care will be no different than that of any other infant.” “My infant will only need this one surgery.” “My child will wear diapers all his life.” “We will need to care for the urinary diversion.”
“We will need to care for the urinary diversion.”
A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action?
Obtain a sterile urine sample after completion of antibiotics. Teach appropriate toileting hygiene. Prepare the child for surgery to reimplant the ureters. Administer antibiotics intramuscularly.
Teach appropriate toileting hygiene.
When the nurse is caring for a child with hemolytic-uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention?
Test urine for specific gravity. Weigh child daily. Weigh the wet diapers. Measure abdominal girth daily.
Weigh the child daily
