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Pediatrics > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Dev diff in GI sys

A
  • nephrons less mature and effecient
  • glomerular filtration and abs rates low bc kidneys of newborns are immature
  • dec ability to conc urine and reabs AAs
  • loop of Henle shorter which dec ability to reabs Na and water making very dilute urine for first 3M of life
  • H+ excretion red; acid secretion dec, bicarb levels are lower–more vulnerable to acidosis
  • bladder in abdomen until 3-4M
  • vulnerable to electrolyte overload
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2
Q

S/s GU disease in newborns

A
  • poor feeding
  • resp distress
  • poor urinary sys
  • jaundice
  • sz
  • dehydration
  • vomiting
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3
Q

s/s GU disease in infants

A
  • poor feeding
  • pallor
  • fever
  • failure to gain wt
  • persistent diaper rash
  • sz
  • dehydration
  • vomit
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4
Q

s/s GU disease in children

A
  • enuresis
  • freq or painful urination
  • smelly urine
  • enlarged bladder or kidneys
  • pallor
  • poor appetite
  • hematuria
  • ab or back pain
  • tetany (common in chronic condx)
  • HTN
  • edema
  • growth failure
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5
Q

NC for GU disease

A
  • accurate measure of BP, wt, I&O
  • prep kids and parents for tests (can be painful like inserting dye into bladder)
  • collection of specimens (maybe wee bag or in/out cath)
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6
Q

Best way to measure urine output in non-potty trained kids besides a catheter

A

Weigh diapers

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7
Q

Desired urinalysis results

A
  • clear and yellow
  • Sp gr 1.01-1.03 (how dilute it is)
  • pH 4.5-8
  • Glucose—negative (pos–GN or DM)
  • Protein—negative
  • Ketone—negative
  • RBCs <1
  • WBCs <1 (higher means infection)
  • casts–moderate clear protein
  • nitrite–negative (positive is nitrates–bacteria in urine (infection))
  • volume 1-2 mL/kg/hr
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8
Q

Normal serum lab values

A
  • uric acid (2-5.5)–kidneys ability to clear products of metabolism
  • BUN (5-18)
  • creatinine (0.3-07)
    BUN and creatinine indicate how well kidneys are working
    ***should draw BUN and creatinine about the same time daily
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9
Q

Diagnostics eval of GU disease

A
  • urine culture and sensitivity
  • IV pyelography
  • voiding cystourethrography (inject dye into bladder to watch urine path)
  • renal ultrasound
  • kidney, ureters, bladder (KUB)–flat image of abdomen
  • cystoscopy
  • renal biopsy–high risk of bleed, NPO, stay flat after
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10
Q

GU physical assessment

A
  • hx (UTIs, etc)
  • fam hx
  • respirations
  • HTN
  • fever
  • growth retardation
  • signs of circ congestion
  • ab distention
  • early signs of uremic encephalopathy (lethargy and confusion)
  • hypospadias or epispadias
  • ear abnormalities since ears and kidneys dev around same time in kids
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11
Q

Hypospadias

A

Urethral opening does not extend to tip of penis
- urethra on underside of penis
- vary in severity
- unknown cause
- may be sign of ambiguous genitalia

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12
Q

Epispadias

A

Urethra goes up instead of to tip of penis
- more common

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13
Q

Hypospadias complications

A
  • inc risk of UTI
  • may interfere with procreation if not fixed
  • body image disturbance
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14
Q

Hypospadias tx goal and management

A
  • surgical repair in stages
  • goals of correction–enable child to void in standing position, fix physical appearance, preserve fxn of sex organ
  • ideal time is 6-18M bc kids don’t realize diff in their body yet
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15
Q

Hypospadias NC

A
  • examine every newborn carefully
  • delay circumcision bc may use foreskin in surg cosmetically
  • psych prep of parent and child
  • postop: pressure dressing (check tip freq, don’t change dressing but check for bleeding), catheter/stent care, double diaper, teach home care
  • avoid tub baths until stent is removed
  • don’t carry baby on hip or ride straddle toy bc don’t want to put pressure on site
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16
Q

Cryptorchidism

A

one or both testicles fail to descend into scrotum

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17
Q

Cryptorchidism types

A
  • undescended - testes somewhere along normal pathway of descent
  • ectopic - testes located outside normal pathway
  • retractile - testes manipulated into scrotum
  • absent - testes is absent
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18
Q

Cryptorchidism therapeutic management

A
  • ultrasonography or surgical exploration to locate testes
  • AAP reccs tx before age 1
  • admin HCG (low success)
  • Orchiopexy b/t 6-24M (avoid pressure on site, watch for bleeding)
  • health teaching–inc risk of testicular cancer in 3rd and 4th decade of life
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19
Q

Obstructive uropathy

A

obstruction at any level of the upper or lower urinary tract
- blockage of urine flow makes dilation of the affected kidney (hydronephrosis)

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20
Q

Obstructive uropathy CM

A
  • recurrent UTI
  • incontinence
  • fever
  • flank or ab pain
  • smelly urine
  • hematuria
  • dysuria
  • polyuria, polydipsia, urgency
  • anemia
  • FTT
  • nocturnal enuresis
21
Q

Obstructive uropathy management

A
  • surgical correct if needed
  • monitor BP
  • may need defect fixed
  • prep for procedure
  • post-op watch
  • protect and care for catheter
  • teach home care (wound and cath care)
22
Q

Vesicoureteral reflux (VUR) and complications

A
  • regurgitation of urine from bladder into ureters and kidneys
  • graded 1-5
  • inc pressure can lead to HTN, renal insufficiency, failure, or scarring
  • primary reflux is familiar and usually outgrown
23
Q

Vesicoureteral reflex types

A
  • Primary reflux–result of incompetent valvular mech at ureterovesical jxn
  • Secondary reflux–from acquired condition like UTI or holding it in
24
Q

signs of VUR

A
  • repetitive UTIs
  • 1 UTI in boys
  • fam hx of VUR (screen early using VCUG)
25
Q

VUR tx

A
  • antibiotics until reflux resolves (long-term course)
  • grade 4/5 almost always (sometimes 3) get surg; reimplantation of ureter
26
Q

VUR NC, preop

A
  • infx prevention (compliance with abx (best before bed)
    teach child to empty bladder completely (esp before bed), teach good hygiene
  • have siblings screened
  • age appropriate prep for procedures
27
Q

VUR NC post-op

A
  • care for cath and stent
  • administer analgesics for incision pain and antispasmodics for bladder spasms
  • teach home care; prophylactic abx for 1-2 post-surg
28
Q

Hernias

A

Protrusion of a part of organs thru an abnormal opening
- danger arises when: protrusion is constricted, circ impaired, interference with fxn or dev of other structures
- common herniation areas in kids include (diaphragmatic, ab wall, inguinal canal)

29
Q

Diaphragmatic hernia

A

Hole in diaphragm that allows ab contents to be sucked up into cavity
- severity depends on how early it happened (affects heart more if happens earlier)

30
Q

Congenital diaphragmatic hernia s/s

A
  • s/s often is detected in utero
  • s/s after birth–resp distress, cyanosis, scaphoid ab, impaired CO
31
Q

Congenital diaphragmatic hernia tx

A
  • intubation
  • GI decompression
  • IVF
  • will need surg ASAP after stabilizing
32
Q

Congenital diaphragmatic hernia surg NC

A
  • monitor resp and fluid, acidosis, thermoreg, cardiac output, sedation, gastric decompression
  • tube in stomach for decompression
  • promote bonding and reassurance
  • postop–continue ventilation (slowly weaned), watch for acidosis, I&O, GI decompression, TPN and liquids, thermoregulation, sedation, pain control, CO
33
Q

Umbilical hernia

A

Incomplete fusion of the umbilical ring where umbilical vessels exit ab wall
- usually ok in 3-5Y
- can be fixed in surg but usually not needed (just monitor)
- inc in size with cough, bearing down
- parents should press down on it and feel air and fluid–go to ER

34
Q

Inguinal hernia

A

Opening on lower abdominal wall, leaving opening for abdominal contents to poke through
- hernia more visible with cry, strain, having BM
- need surgery

35
Q

Most important NC for inguinal and umbilical hernia

A

Press on area and should feel air and fluid; if feel something else, go to ER

36
Q

Urinary tract infection

A

Bacterial infx including urethritis (urethra), cystitis (bladder), and pyelonephritis (kidneys)

37
Q

UTI epidemiology

A
  • E. coli most causes in females
  • more common in females bc short urethra
  • uncircumcised males more likely
  • very common in kids before age 6
38
Q

UTI risk factors

A
  • constipation
  • soak in bubble bath (bubbles can irritate urethra)
  • pinworms
  • dysfxn voiding; urinary stasis
  • dec fluid intake
  • VUR
  • urologic abnormalities
  • indwelling catheterizaion
  • neurogenic bladder (often poor muscle tone, prob with CNS)
  • sex abuse and intercourse (investigate cause with more than one UTI)
39
Q

UTI CM: infants

A
  • fever
  • irritable
  • poor appetite—FTT
  • wt loss
  • smelly urine
  • v/d
  • cry w/ urination
  • NOT urgency—can’t discern that
40
Q

UTI CM in kids

A
  • dysuria
  • freq, urgency, incontinence
  • foul smelling urine, maybe hematuria
  • ab pain
  • fever
41
Q

UTI diagnostics

A
  • urine screening (+ nitrites, + RBCs, + WBCs)
  • urine culture > 100k colonies of a single bac
42
Q

UTI therapeutics

A
  • cure infx
  • ID predispose fx (tight underwear, poor wiping, sex activity)
  • prevent recurrent infx
43
Q

UTI NC

A
  • specimen handling
  • adequate admin of abx
  • push fluids
  • promote comfort
  • adequate follow-up cultures
  • teach preventative measures like promote freq bladder emptying, hydration, avoid tight pants, avoid colas and caffeine, chx period products freq
44
Q

Enuresis

A

involuntary passage of urine by a child over age of 5
- primary or secondary
- diurnal or nocturnal

45
Q

Enuresis etiology

A

Primary
- fam tendency
- dec bladder capacity (age + 2 in oz)
- heavy sleep
- nocturnal polyuria theory
- dev or maturational lag
- sleep dx
Secondary
- psych fx (divorce, bully)
- abuse
- UTI
- diabetes
- sickle cell anemia

46
Q

Enuresis dx/tx

A
  • hx and physical
  • urine sample (check for UTI)
  • hx of bed wetting
  • wait for maturation (most kids outgrow by age 10)
  • tx the cause
  • retention/control exercise
  • drug therapy: oxybutynin, imipramine, DDAVP for special situations like sleepovers ($$$)
  • moisture alarm–beeps or vibrates
  • behavior mods–positive reinforcement is key
47
Q

Enuresis NC

A
  • don’t punish child
  • child not lazy or doing on purpose
  • recc books (Dry ALL night, waking up dry)
  • limit choc and caffeine
  • limit fluids after dinner
  • use bed pads and 2 sets of sheets
  • use pull ups only on sleepovers–wick moisture away but we want kids to get used to getting up after feeling moisture
  • void schedule and gradually inc to get kids used to peeing not in bed
  • teach use of alarms
  • support and encouragement
48
Q

What is normal urine output

A

1-2 mL/kg/hr

49
Q

Desired urine pH

A

4.5-8

Pediatrics (26 decks)

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