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Peds > Genitourinary > Flashcards

Genitourinary Flashcards

Exam 2

1
Q

Anatomy and physiology of GU

A

Kidney:

Urethra:

Reproductive organs:

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2
Q

Anatomy and physiology: Kidney

A

Kidney: large in relation to the stomach; prone to injury.

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3
Q

Anatomy and physiology: Urethra

A

Urethra: shorter; risk for bacteria into bladder (UTI).

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4
Q

Anatomy and physiology: Glomerular filtration rate:

A

slower in infant; risk for dehydration.

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5
Q

Anatomy and physiology: Bladder capacity:

A

Bladder capacity: 30 mL in newborn; increases to adult size by 1 year.

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6
Q

Anatomy and physiology: How are reproductive organs?

A

Reproductive organs: immature at birth until adolescence.

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7
Q

Anatomy and physiology:

What occurs in genitourinary tract?

A

Urine Formation

Excretion of waste products

Regulation of electrolytes- Blood Pressure

Control of water balance

Control of acid-Base balance

Regulation of Red Blood cell Production

Synthesis of vitamin D to active form

Regulation of calcium and phosphorus

Renal Clearance

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8
Q

Significant Data When Assessing Past Medical History for GU Disorders:

A

Past medical history

Neonatal history

Family history

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9
Q

Significant Data When Assessing Past Medical History for GU Disorders:

Past Medical History

A

Maternal polyhydramnios, oligohydramnios,
diabetes,
hypertension, or
alcohol or cocaine ingestion.

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10
Q

Significant Data When Assessing Past Medical History for GU Disorders:

Neonatal history

A

Presence of a single umbilical artery,

abdominal mass,

chromosome abnormality, or

congenital malformation.

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11
Q

Significant Data When Assessing Past Medical History for GU Disorders

Family history

A

Renal disease or uropathology,

chronic UTIs,

renal calculi,

or a history of parental enuresis.

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12
Q

Fluid and Electrolyte Balance:

Who is at a greater risk of fluid and electrolyte imbalance?

A

Children at greater risk for fluid and electrolyte imbalance

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13
Q

Fluid and Electrolyte Balance:

Why do children have a greater risk for fluid and electrolyte imbalance

A

Have a proportionately greater amount of body water

Require more fluid intake

Excrete more fluid

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14
Q

Fluid and Electrolyte Balance:

Caring for child with fluid and/or electrolyte imbalance
What to monitor?

A

Monitor for signs of:
Fluid deficit
Fluid excess
Electrolyte imbalance

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15
Q

What does emergent care require (F and E balance)

A

Emergent care sometimes required with IV replacement of fluids and electrolytes

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16
Q

Fluid and Electrolyte Balance

Fluid Balance:

A

Fluid balance: intake and output of fluid in 24-hour period is approximately the same

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17
Q

Fluid and Electrolyte Balance

Fluid deficit occurs when fluids are lost by:

A

Diaphoresis
Vomiting
Diarrhea
Hemorrhage

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18
Q

Fluid and Electrolyte Balance: How does fluid overload occur?

A

Fluid overload occurs from conditions that create impaired fluid excretion

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19
Q

Fluid and Electrolyte Balance: Conditions that cause impaired fluid excretion?

A

Kidney disease

Congestive heart failure

Administration of excessive amount of intravenous fluids

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20
Q

Types of Dehydration:

A

Isotonic dehydration

Hypotonic dehydration

Hypertonic dehydration

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21
Q

Types of Dehydration: Isotonic dehydration

A

Electrolyte and water deficits in balanced proportions

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22
Q

Types of Dehydration: Isotonic dehydration

How are serum sodium levels?

A

Serum sodium remains in normal limits (130–150 mEq/L)

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23
Q

What is the most common type of dehydration?

A

Isotonic dehydration

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24
Q

What is the greatest concern with isotonic dehydration?

A

Hypovolemic shock is greatest concern

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25
Q

Types of Dehydration: Hypotonic Dehydration

A

Electrolyte deficit exceeds water deficit

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26
Q

Types of Dehydration: Hypotonic Dehydration
How is serum sodium levels?

A

Serum sodium concentration is < 130 mEq/L

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27
Q

Types of Dehydration: Hypotonic Dehydration

How are physical signs?

A

Physical signs more severe with smaller fluid losses

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28
Q

Types of Dehydration: Hypertonic dehydration

What is likely to occur?

What are serum sodium levels?

A

Sodium serum concentration > 150 mEq/L

Seizures likely to occur

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29
Q

Types of Dehydration: What is the most dangerous type of dehydration?

A

Most dangerous type; water loss in excess of electrolyte loss

Hypertonic dehydration

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30
Q

Urinary and Renal Disorders:

What are structural disorders include:

A

Bladder exstrophy
Obstructive uropathy
Hydronephrosis
Vesicoureteral reflux

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31
Q

Kidney formation disorders:

Renal developmental abnormalities account for what percent of ESRD in children?

A

Renal developmental abnormalities account for 30-50% of End Stage Renal Disease (ESRD) in children.

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32
Q

Kidney formation disorders: About half cases are secondary to what?

A

About half of these cases are secondary to abnormalities of the lower urinary tract.

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33
Q

Kidney formation disorders:

Are collectively known as?

A

These disorders are collectively known as congenital anomalies of the kidney and urinary tract (CAKUT)

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34
Q

Obstructive uropATHIES include?

A

Uretero-pelvic junction (UPJ)

Uretero-vesical junction (UVJ)

Ureterocele

Posterior urethral valves (PUV) - Males only

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35
Q

Vesicoureteral reflux

A

Urine normally flows downward from kidneys; in vesicoureteral reflux (VUR), urine backflows from bladder to ureters, and sometimes back to kidneys; this occurs at vesicoureteral junction

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36
Q

What are signs and symptoms of VUR?

A

Most common presentation: recurrent UTI
Flank pain, abdominal pain, and enuresis may coexist
Fever
Nausea/vomiting
UTI symptoms

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36
Q

What is a common cause of UTIs in children?

A

VUR is a common cause of UTIs in children

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37
Q

Urinary tract infections: What are they caused by?

A

Caused by bacterium, virus, or fungus

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37
Q

Urinary tract infections: Where do they start?

A

Most often start distally and ascend at urethral area, causing urethritis or cystitis

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38
Q

Urinary and Renal Disorders include:

A

UTI
Hematuria
Proteinuria
Acute glomerulonephritis
Nephrotic syndrome
Enuresis
Hemolytic-uremic syndrome
Renal failure (acute and chronic)

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39
Q

Urinary tract infections: If origin in the upper tract, what may result?

A

If origin in upper tract, ureteritis and pyelitis or pyelonephritis may result

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40
Q

Cystitis

A

Cystitis = lower UTI involving the urethra and or the bladder

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41
Q

Pyelonephritis

A

upper UTI that involves the ureters, renal pelvis – usually affects both kidneys

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42
Q

Urinary tract infections:

How is a diagnosis made?

A

Based on urine culture and sensitivities

Also indicated by suprapubic aspiration (SPA) or catheterization with 50,000/mL bacterial growth

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43
Q

Urinary tract infections:

With intensely ill children, what is a choice?

A

With intensely ill child, catheterization or SPA is choice in all age groups to detect UTIs

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44
Q

Urinary tract infections:

Administer medications:

What types of meds are used for UTIs?

A

IV fluids or antibiotics may be required

Parenteral and oral antibiotics are used to treat UTIs

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45
Q

Urinary tract infections:

What type of antibiotics are recommended for children with toxic symptoms, dehydration, vomitting or noncompliance?

A

Parenteral antibiotics are recommended for children with toxic symptoms, dehydration, vomiting, or noncompliance

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46
Q

Urinary tract infections:

What kind of antibiotics are given and how long are they given to toxic children or those with pyelonephritis?

A

IV antibiotics are usually given for 14 days to toxic children or those with pyelonephritis

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47
Q

Urinary tract infections:

What kind of antibiotics are given for uncomplicated cases?

A

Oral antibiotics for uncomplicated cases

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48
Q

Uti symptoms - developmentally:

Neonates:

A

Failure to thrive

Jaundice

Hypothermia

Vomitting or diarrhea

Cyanosis

Abdominal distention

Lethargy

Sepsis

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49
Q

Uti symptoms - developmentally:

Infants:

A

Poor feeding

Fever (esp. related to pyelonephritis)

Vomitting or diarrhea

Malodor

Dribbling urine

Ab pain/colic irritability

Malaise

Poor weight gain

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50
Q

Uti symptoms - developmentally:

Toddler/Preschool

A

Abdominal pain
Vomiting or diarrhea
Flank pain
Fever (especially pyelonephritis)
Malodor
Altered voiding pattern
Diaper rash
Enuresis
Malaise

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51
Q

Uti symptoms - developmentally:

School Age/Adolescent

A

Enuresis
Malodor
Classic dysuria with frequency, urgency, and discomfort
Fever/chills (especially related to pyelonephritis)
Abdominal pain
Flank pain
Malaise
Vomiting or diarrhea

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52
Q

Urinary tract infections - education

What is key?

A

Education/discharge instructions- Prevention is key!

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53
Q

Urinary tract infections - education

What are you teaching?

A

Teach signs of infection

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54
Q

Urinary tract infections - education

What are you emphasizing the importance of?

A

Emphasize importance of hand washing

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55
Q

Urinary tract infections - education

What are you teaching techniques for?

A

Teach wipe technique – front to back, cotton underwear

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56
Q

Urinary tract infections - education

What are you teaching teenagers?

A

Teenagers- avoid tight jeans, urinate frequently

(females void after intercourse and change tampons/pads frequently.)

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57
Q

Urinary tract infections - education

What should you teach is an increased cause of infection?

A

Explain fecal soiling and constipation as an increased cause of infection

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58
Q

Urinary tract infections - education

What should you encourage?

A

Encourage collaboration with health-care provider to prevent constipation:

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59
Q

Urinary tract infections - education

How would you prevent constipation?

A

Increased dietary and fluid intake

Administration of stool softeners and laxatives

Teaching child to establish normal bowel habits

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60
Q

Hematuria:

What can be the first sign of renal disease?

A

Although rare, microscopic hematuria can be the first sign of renal disease

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61
Q

Hematuria:

What does gross hematuria in children indicate?

A

Gross hematuria in children is more serious, indicating a possibility of:

IgA nephropathy

hypercalciuria with or without calculi,

post-streptococcal glomerulonephritis,

renal trauma,

coagulopathy,

hydronephrosis,

epididymitis,

and tumor

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62
Q

Hematuria

What are signs and symptoms?

A

Microscopic blood in urine

Macroscopic blood in urine

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63
Q

Hematuria:

Microscopic blood in urine

A

(Not visible to the naked eye)

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64
Q

Hematuria:
Macroscopic blood in urine

A

(Gross hematuria)

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65
Q

Proteinuria: What is it associated with?

A

Disorder associated with upright activities during daytime hours

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66
Q

Proteinuria:

What test may be used to discover loss of proteins?

A

Routine office urinalysis may discover loss of proteins, such as albumin or globulins, in urine

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67
Q

Proteinuria:

What is diagnosis based on?

A

Diagnosis Based on serial first-voided (first urine of morning) specimens for urinalysis at least 3 times over 2-week span

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68
Q

Proteinuria:

How does it range?

A

Proteinuria ranges from simple and reversible etiologies to complex, life-threatening causes

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69
Q

Proteinuria:

What is else is it associated with?

A

Proteinuria is associated with progressive renal disease

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70
Q

Proteinuria:

May be a cause of what?

A

Proteinuria may be a cause of renal injury

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71
Q

Proteinuria: May be a risk factor for what?

A

Proteinuria may be a risk factor for cardiovascular disease

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72
Q

Proteinuria:

What are signs and symptoms?

A

Commonly asymptomatic

Dipstick shows 1+ (30 mg/dL) or higher level of proteinuria

Proteinuria may also be noted in infected urine, often along with leukocytes, hematuria, and positive nitrates

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73
Q

Proteinuria:

Signs and symptoms: What does dipstick show?

A

Dipstick shows 1+ (30 mg/dL) or higher level of proteinuria

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74
Q

Acute glomerulonephritis

A

Inflammation of the glomeruli

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75
Q

Acute glomerulonephritis:

What does interference with glomeruli filtering lead to?

A

Interference with the glomeruli filtering waste products from the blood gives rise to acute and chronic clinical manifestations

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76
Q

Acute glomerulonephritis:

Very dangerous Signs and Symptoms?

A

OLIGURIA
EDEMA
HYPERTENSION
CIRULATORY OVERLOAD
HEMATURIA
PROTEINURIA

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76
Q

Acute glomerulonephritis: Signs and Symptoms?

A

Gross hematuria, either tea-colored or red urine

Edema, which may be seen in periorbital region

Child may develop hypertension and headache

Severe disease causes ascites, due to fluid shifting

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77
Q

Acute glomerulonephritis:

Diagnosis: Most children are healthy until what?

A

Most children are healthy until the strep infection of throat or skin– edema is moderate and difficult to detect.

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78
Q

Acute glomerulonephritis: How long does it take renal disease to manifest?

A

Renal disease manifests weeks after the infection

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79
Q

Acute glomerulonephritis: What must be present in urinalysis?

A

U/A-hematuria and proteinuria – increased BUN, Cr, increased BP

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80
Q

Acute glomerulonephritis:

What does ASO titer indicate?

A

Serum antistreptolysin titer (ASO titer) will indicate exposure to bacteria if child has not had diagnosed streptococcal infection in past 2 weeks

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81
Q

Acute glomerulonephritis:

How is Serum complement?

A

Serum complement (C3) may be positive

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82
Q

Acute glomerulonephritis:
How long is urine microscopic hematuria present?

A

Urine microscopic hematuria may still be noted up to 1 year after disease resolves

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83
Q

Acute glomerulonephritis:
What labs assess renal function?

A

Laboratory tests (BUN, creatinine) assess renal function

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84
Q

Acute glomerulonephritis: If children does not fully recover, what may develop? What would be required?

A

If child does not fully recover, nephrotic syndrome may develop, and renal biopsy may be required

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85
Q

Acute glomerulonephritis: Collaborative care (cont’d)
What would be done about infectious sources?

A

Treat infectious sources (e.g. streptococcus) with appropriate antibiotics

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86
Q

Acute glomerulonephritis:

Collaborative care (cont’d)
What do fluid imbalances require?

A

Fluid imbalances require monitoring of fluid intake and output, as well as possible treatment with diuretic medications and antihypertensive drugs

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87
Q

Acute glomerulonephritis:

What may severe glomerulonephritis require?

A

Severe glomerulonephritis may require peritoneal dialysis or hemodialysis

88
Q

Acute glomerulonephritis:

What may be useful to manage the acute process?

A

Corticosteroids may be useful to manage the acute process

89
Q

Acute glomerulonephritis: Other than meds, what is needed to treat this?

A

Rest
Daily weights *best indicator to monitor fluid status

90
Q

Acute glomerulonephritis: What is the prognosis?

A

Good Prognosis

91
Q

Acute glomerulonephritis: What is the best indicator of fluid status?

A

Daily weights *best indicator to monitor fluid status

92
Q

Most common cause of acute renal failure (ARF) in children:

A

Hemolytic uremic syndrome (HUS)

93
Q

Hemolytic uremic syndrome (HUS): What is it most commonly associated with?

A

most commonly associated with children ingesting beef contaminated with Escherichia coli, although other organisms have been implicated

94
Q

Hemolytic uremic syndrome (HUS):

Signs and Symptoms: What are classic signs?

A

Thrombocytopenia
Anemia
Acute renal failure

95
Q

Hemolytic uremic syndrome (HUS):

Other signs and symptoms include

A

Gastroenteritis with abdominal pain, vomiting, and bloody diarrhea
Potential upper respiratory infection
Hematuria
Proteinuria
Pallor
Lethargy
Irritability
Decreasing urine output
Hepatosplenomegaly
Dehydration
Possible seizures
Consciousness alteration
Anemia with high reticulocyte count
Thrombocytopenia

96
Q

Hemolytic uremic syndrome (HUS)- What is the hallmark sign?

A

Bloody diarrhea

97
Q

Henoch-Schönlein Purpura:
What does it include?

A

Henoch-Schönlein purpura (HSP) includes a range of mild to severe glomerulonephritis and renal insufficiency

98
Q

Henoch-Schönlein Purpura:
What is it classified as?

A

Classified as vasculitis due to component of inflammation in the arteries

99
Q

Henoch-Schönlein Purpura:
What does it typically follow?

A

Typically follows an upper respiratory tract infection

100
Q

Henoch-Schönlein Purpura:
What are signs and symptoms?

A

Hematuria

Hypertension

Bloody diarrhea

Crampy abdominal pain

Rash with palpable purpura (raised purpura), features found especially on the lower extremities and buttocks

Joint pain and swelling

Scrotal swelling in males

101
Q

Henoch-Schönlein Purpura:
Where are Rash with palpable purpura usually found?

A

features found especially on the lower extremities and buttocks

102
Q

Henoch-Schönlein Purpura: How is diagnosis made?

A

Based on clinical findings;

history of classic symptoms of rash,

gastrointestinal complaints or hematuria,

and arthritis are present

103
Q

Henoch-Schönlein Purpura: Diagnosis is dependent on what?

A

History?

104
Q

Henoch-Schönlein Purpura: What are lab results?

A

Elevated serum IgA level, sedimentation rate, platelet count, and WBC counts may be present

Urinalysis may show hematuria

Stool guaiac test may be positive

105
Q

Nephrotic Syndrome: WHat is it?

A

Congenital, Idiopathic, Secondary

106
Q

Nephrotic Syndrome: Why could it be congenital, idiopathic or secondary?

A

Congenital (rare) before 1 year old,

Idiopathic (most common Minimal Change Disease) by age 6,

Secondary (SLE, DM, HSP)

107
Q

Nephrotic Syndrome: what is it characterized by?

A

Proteinuria
Hypoalbuminemia
Edema
Hypercholesterolemia

108
Q

Nephrotic Syndrome: Risks include?

A

Anemia
Infection – because of altered immunity
Poor growth
Ascites
Peritonitis
Thrombosis
Renal failure

109
Q

Nephrotic Syndrome: What are the three classic signs?

A

Proteinuria, hypoalbuminemia, edema.

110
Q

What happens in Nephrotic Syndrome:

How does proteinuria occur?

A

The glomerular membrane that is usually impermeable to albumin and other proteins becomes permeable to proteins which leak through the membrane and are lost in the urine = proteinuria

This in turn reduces the serum albumin level leading to hypoalbuminemia This leads to edema especially in the abdomen (ascites). This shift in fluid causes hypovolemia. Hypovolemia triggers the RAA system causing vasoconstriction.

111
Q

What happens in Nephrotic Syndrome:

How does hypoalbuminemia occur?

A

Proteinuria –> This in turn reduces the serum albumin level leading to hypoalbuminemia

112
Q

What happens in Nephrotic Syndrome:

How does edema occur?

A

hypoalbuminemia–> This leads to edema especially in the abdomen (ascites).

This shift in fluid causes hypovolemia. Hypovolemia triggers the RAA system causing vasoconstriction.

113
Q

What happens in Nephrotic Syndrome:

Edema leads to what? What does that lead to?

A

This shift in fluid causes hypovolemia. Hypovolemia triggers the RAA system causing vasoconstriction.

114
Q

Nephrotic Syndrome: What is used to diagnose?

A

Urinalysis may show

115
Q

Nephrotic Syndrome: What may urinalysis show?

A

Protein levels of 2+ or greater
Hyaline or granular casts
Microhematuria
High specific gravity

116
Q

Nephrotic Syndrome: How are cholesterol, serum albumin levels?

A

Cholesterol levels may be elevated

Serum albumin levels may be low

117
Q

Nephrotic Syndrome: What may be required?

A

Kidney biopsy may be required

118
Q

Nephrotic Syndrome: What may be needed if disease is severe?

A

Hospitalization may be needed if the disease is severe

119
Q

Nephrotic Syndrome: What should you monitor?

A

Fluid and electrolyte balance
Weight
Degree of edema

120
Q

Nephrotic Syndrome:

What must you be aware of?

A

Be aware of disease manifestations and need for possible kidney biopsy

121
Q

Nephrotic Syndrome: How should you treat?

A

Treat with diuretics and albumin replacement if indicated early on

122
Q

Enuresis: What are the types of enuresis?

A

Primary enuresis:

Secondary enuresis:

Diurnal enuresis:

Nocturnal enuresis:

123
Q

Primary enuresis:

A

enuresis in the child who has never achieved voluntary bladder control.

124
Q

Secondary enuresis:

A

Secondary enuresis: urinary incontinence in the child who previously demonstrated bladder control over a period of at least 3 to 6 consecutive months.

125
Q

Diurnal enuresis:

A

daytime loss of urinary control.

126
Q

Nocturnal enuresis:

A

nighttime bedwetting.

127
Q

Renal trauma:

In what percent of abdominal trauma situations is it present?

A

Kidney trauma is present in 8–10% of abdominal trauma situations

128
Q

Renal trauma:

What does History of injury relate to?

A

History of injury relates to blunt and penetrating abdominal injury

129
Q

Renal trauma:

What does kidney injury occur more often from?

A

Kidney injury occurs more often from blunt trauma; kidneys

130
Q

Renal trauma:

What are kidneys known for rupturing from?

A

kidneys are known for rupturing from blunt trauma.

131
Q

Renal trauma: Penetrating trauma injuries are often caused by:

A

Penetrating trauma injuries are often caused by animal bites, gunshot wounds, or stabbings

132
Q

Renal trauma:
With critical injuries involving renal trauma, children show the following and signs and symptoms:

A

Grey Turner’s sign (ecchymosis localized in flank area and flank tenderness)

Palpable mass

Hematuria

133
Q

Acute kidney injury (AKI)- WHat does it result in?

A

resulting in a treatable condition manifesting as an increase in nitrogenous waste products and lack of homeostasis regulation by the kidney

134
Q

Acute kidney injury (AKI): Signs and symptoms;

Pre-renal causes are associated with:

A

hypovolemia signs

135
Q

Acute kidney injury (AKI):

Signs and symptoms relative to extracellular fluid indications from decreased renal circulation from vasodilation or cardiovascular disease include:

A

Edema
Ascites
Weight gain
Increased central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP)

136
Q

Acute kidney injury (AKI): Signs and symptoms

Pre-renal causes are associated with hypovolemia signs and are evidenced by:

A

Tachycardia
Dry mucous membranes
Poor peripheral perfusion
Poor skin turgor
Flat jugular veins
Weight loss

137
Q

Acute kidney injury (AKI):

Intrarenal or intrinsic AKI is evidenced by:

A

Peripheral edema
Rales
Cardiac gallop
Potential presence of a rash and arthritis, suggesting systemic lupus erythematosus or Henoch-Schönlein purpura

138
Q

Acute kidney injury (AKI):

Post-renal findings include

A

Palpable flank masses, which might indicate renal vein thrombosis, tumors, cystic disease, or urinary tract obstruction

139
Q

Aki diagnosis: How is it made?

A

Take careful history, analysis of symptoms, and physical examination to determine if cause is prerenal, intrarenal, or postrenal

140
Q

Aki diagnosis: How does collecting previous history help?

A

Previous history helps to determine any previous infections, such as acute glomerulonephritis or neurogenic bladder

141
Q

Aki diagnosis: What can be uncovered?

A

Genetic problems (e.g., horseshoe-shaped kidney, only one kidney) can be uncovered

142
Q

AKI diagnosis: What are common lab tests

A

Common laboratory data include
urinalysis,
blood chemistry,
blood urea nitrogen,
serum creatinine, and
pH

143
Q

Aki diagnosis: How else can it be diagnosed? (having to do with toxins?)

A

Can also be diagnosed by finding toxins in blood caused by exposure to heavy metals or organic solvents, which can cause acute tubular necrosis

144
Q

AKI diagnosis:
Other epidemiological nephrotoxic agents include treatment with

A

aminoglycosides, amphotericin B, contrast, or chemotherapeutic agents

145
Q

AKI diagnosis:
What can renal biopsy be used for?

A

Renal biopsy can be used to determine causation

146
Q

Chronic kidney disease:

What terms have replaced it? Who does it exclude?Why?

A

The term chronic kidney disease (CKD) has replaced the term chronic renal failure or chronic renal insufficiency,

but excludes children under 2 years whose quick response to treatment cannot be estimated by the glomerular filtration rate alone

147
Q

Chronic kidney disease:

How is GFR for kids greater than 2?

A

For those > 2 years, the glomerular filtration rate progressively deteriorates through four separate stages

148
Q

Chronic kidney disease:

Signs and symptoms?

A

Failure to thrive or anorexia
Nausea
Vomiting
Loss of appetite
Lethargy
Headaches
High blood pressure
Reduced urine output
Polyuria and polydipsia
Bedwetting

149
Q

ESRD and Renal Replacement Therapy:

A

Condition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products.

150
Q

ESRD and Renal Replacement Therapy :

How can ESRD present?

A

May be acute or chronic

151
Q

ESRD and Renal Replacement Therapy :
How is acute renal failure when it progresses?

A

When acute renal failure continues to progress, it becomes chronic (also known as end-stage renal disease [ESRD]).

152
Q

ESRD and Renal Replacement Therapy :

What is treatment for ESRD?

A

Dialysis and kidney transplantation are treatment modalities used for ESRD.

153
Q

ESRD and Renal Replacement Therapy:

What is RRT?

A

Renal replacement therapy (RRT) is the treatment option for end-stage renal disease (ESRD) and is also used for acute kidney injury

154
Q

ESRD and Renal Replacement Therapy:

Signs and symptoms

A

Swelling and edema
Anemia
Weakness and fatigue
Shortness of breath
Changes in urination
Rash or itchy, dry skin
Elevated BUN and creatinine
Uremia: build-up of waste
Altered electrolytes
Hypertension
Tachycardia
Tachypnea

155
Q

Dialysis and transplant:

What are the types of dialysis available? What is another treatment?

A

Peritoneal Dialysis

Hemodialysis

Transplant

156
Q

Dialysis and transplant:

Peritoneal Dialysis

A

Uses child’s abdominal cavity as a semipermeable membrane to help remove excess fluids and waste products.

157
Q

Dialysis and transplant:

Hemodialysis

A

Removes toxins and excess fluid from the blood by pumping the child’s blood through a hemodialysis machine and then reinfusing the blood into the child.

158
Q

Hemofiltration:

A

In the pediatric setting, hemofiltration, or CRRT, is a process that removes water by filtration through an extracorporeal system

159
Q

Hemofiltration:

What should you do prior to Hemofiltration?

A

Collaborate with the health-care provider about:

Goals of stabilizing fluid balance

Assessing BUN, creatinine, glucose, and PTT

Check patency of all circuits carefully, look for clots

Monitor analysis of PTT and clotting studies every 1 to 3 hours

160
Q

Hemofiltration:

What should you do when hemofiltration begins?

A

Monitor vital signs and fluid balance every 30 minutes

Assess ultrafiltration rate every hour with replacement fluid set by nephrologist

161
Q

Hemofiltration:

Education/discharge instructions
What should you teach parents?

A

Teach parents to monitor for complications related to continuous arteriovenous hemofiltration (CAVH)

162
Q

Hemofiltration:

What do you need to teach parents to monitor for related to CAHV?

A

Fluid and electrolyte imbalances

Bleeding/thromboembolic events (e.g., anemia and hypovolemia)

163
Q

Hemofiltration:

Education/discharge instructions
What do you need to emphasize importance of?

A

Emphasize importance of nutritional needs and involvement of a dietitian

164
Q

Peritoneal Dialysis : What does it utilize?

A

Peritoneal dialysis (PD) utilizes the peritoneal membrane to filter and purify blood

165
Q

Peritoneal Dialysis : What is put in the child’s abdomen?

A

Dialysis solution, consisting of dextrose sugar and other minerals in water, is instilled into the child’s abdomen through an abdominal catheter

166
Q

Peritoneal Dialysis: Signs and symptoms of complications

A

Potential peritonitis
Catheter dysfunction and obstruction
Pain
Pulmonary complications
Fluid and electrolyte imbalance

167
Q

Hemodialysis- WHat is the purpose?

A

To prevent accumulation of unwanted fluid and toxins, hemodialysis (HD) removes unwanted products by extracorporeal circulation through a dialyzer

168
Q

For U.S. adolescents and children with ESRD, what dialysis is preferred?

A

For U.S. adolescents and children with ESRD, HD is preferred

169
Q

hemodialysis:
Side effects

A

Hypotension (low blood pressure)
Weakness, dizziness, and nausea from the hypotension
Muscle cramps secondary to electrolyte imbalances

170
Q

hemodialysis: Collaborative care

A

Keep AV fistula, AV graft, or venous catheter clean and safe

Keep access site clean and use only for hemodialysis

Maintain fluid and dietary restrictions between dialysis sessions

171
Q

hemodialysis:
Keep access site clean and use only for hemodialysis: how?

A

Child cannot wear jewelry near site
Child cannot have a blood pressure taken on affected arm
Do not bruise site

172
Q

Renal transplant: WHo is referred for it?

A

Children with progressive renal disease leading toward ESRD are referred for a kidney transplant evaluation

173
Q

Renal transplant: Collaborative care
2- to 3-day inpatient evaluation prior to transplant

A

Obtain complete history and physical
Perform psychosocial assessment
Notify financial counselor
Perform lab tests:

Perform diagnostic tests:

Perform thorough nursing assessment related to possible infection, imbalance of fluid and electrolytes, and rejection

Maintain proper nutrition with protein-restricted diet to avoid overloading kidneys

174
Q

Renal transplant: Collaborative care
2- to 3-day inpatient evaluation prior to transplant

Perform lab tests:

A

Cross match, HLA/PRA markers, ABO, tissue typing
CBC, PT/PTT, INR, CMP
Hepatitis B, C, CMV, EBV, HSV, VZV, HIV, VDRL
Hemoglobin A1C
PPD

175
Q

Renal transplant: 2- to 3-day inpatient evaluation prior to transplant (cont’d)

Perform diagnostic tests:

A

Chest x-ray, ECG, 2-D echo, abdominal CT, abdominal US, and vascular studies
Cardiology stress test and/or cardiac catheterization
Urological system evaluation
Pulmonary function tests
Co-morbidity clearance and consulting

176
Q

Renal transplant: 2- to 3-day inpatient evaluation prior to transplant (cont’d)

Candidate phase:

A

patient is waiting to be put on transplant list

Reinforce treatment options provided to patient/family and complete medical history of child and parents

177
Q

Renal transplant: 2- to 3-day inpatient evaluation prior to transplant (cont’d)

Candidate phase: What is being done?

A

Encourage good nutritional support pre- and post-transplant in collaboration with dietitian
Conduct comprehensive physical assessment of child
Coordinate multiple diagnostic studies to be completed and ensure that any problems are corrected prior to listing child as transplant candidate
Ensure that living donor is healthy and compatibility ensured through HLA matching
Conduct a psychosocial assessment of parent and child to ensure compliance
Assess that histocompatibility testing is done
Organize care and schedule tests needed prior to transplant
Answer questions; reinforce lifestyle commitments and changes
Administer standard immunizations minimum of 6 weeks prior to transplant
Measure viral titers prior to transplantation to ensure vaccination adequacy

178
Q

Renal transplant:

Collaborative care (cont’d)
Renal transplant phase: WHat is it?

A

actual transplant, pre- and post-operative

Provide education about medications and treatments

Monitor respiratory and cardiac functions with immediate detection and referral to transplant team if any abnormalities

179
Q

Renal transplant:
Renal transplant phase: actual transplant, pre- and post-operative (cont’d)

Monitor for:

A

Bleeding
Infection or indications that kidney is functioning abnormally
Oliguria
Wound infection
Increased blood pressure

180
Q

Renal transplant:
Renal transplant phase: actual transplant, pre- and post-operative (cont’d)

Monitor for:

A

Monitor fluid status for either hypovolemia or hypervolemia
Monitor:
Hourly intake urine and output
Serum electrolytes and liver enzymes
Vital signs and central venous pressure
Administer IV fluids, diuretics, and, if needed, dialysis or continuous venovenous hemofiltration
Monitor laboratory studies
Assess for surgical complications
Assess for urologic complications
Monitor for obstruction
Monitor for urine leakage
Administer immunosuppression medications

181
Q

Female Reproductive Organ Disorders:

A

Labial adhesions
Vulvovaginitis
Pelvic inflammatory disease
Sexually transmitted infections
Menstrual disorders

182
Q

Labial adhesions-

A

Fusion of the labia minora due to inflammation, infection, trauma, estrogen deficit

183
Q

Labial adhesions- who is it common in?

A

Most common in girls 3 months to 6 years old

184
Q

Labial adhesions: Signs and symptoms

A

Thin film develops over labia, from posterior to anterior aspect

Vaginal introitus and urethral meatus are not visible

Dysuria

Urinary incontinence

185
Q

Labial adhesions: Diagnosis

A

Based on signs and symptoms and common associated problems

186
Q

Labial adhesions: Diagnosis
Based on signs and symptoms and common associated problems-include:

A

Dysuria
Incontinence if urine is trapped; dribbling after voiding in toilet-trained girls

187
Q

Vulvovaginitis

A

Inflammation of the vulva and vagina

Bacterial or yeast overgrowth.

188
Q

Vulvovaginitis- caused by what

A

Chemical factors such as bubble bath, soaps, or perfumes found in personal care products.

Poor hygiene.

Tight clothing may cause a heat rash in the perineal area.

189
Q

Vulvovaginitis: What may lead to irritation of superficial skin?

A

Persistent scratching of the irritated area may result in the complication of superficial skin infection.

190
Q

Vulvovaginitis- most common cause?

A

Candidiasis, a yeast organism, is the most common source of this disorder

191
Q

Vulvovaginitis: Signs and symptoms

A

Discharge can vary
Glutinous gray-white
Purulent
Blood-tinged
Foul-smelling and brown or green
Thick white curd

192
Q

Vulvovaginitis- Diagnosis

A

Diagnosis is based on patient history, clinical findings, and pH testing of vaginal secretions
Pseudohyphae (branching yeast organisms) may be found on microscopy where pH is < 4.5
Clue cells (large epithelial cells with bacteria) may indicate bacterial vaginosis; trichomonads may indicate trichomoniasis
Other organisms may be found on Pap smears in adolescents (Candida or trichomonads)

193
Q

Manifestations of Pelvic Inflammatory Disease (PID)

Long-term complications

A

Chronic pelvic pain,
ectopic pregnancy, and
infertility related to scarring.

193
Q

Manifestations of Pelvic Inflammatory Disease (PID)

A

Fever
Abdominal pain
Pain with intercourse
Dysmenorrhea (painful menstrual cycles)
Abnormal uterine bleeding
Long-term complications

193
Q

Vulvovaginitis - Treatment

A

If caused by vaginal candidiasis, medicate with over-the-counter antifungal cream applied topically
Miconazole (Monistat)
Clotrimazole (Gyne-Lotrimin)

194
Q

Vulvovaginitis - Treatment

If caused by vaginal candidiasis, medicate with over-the-counter antifungal cream applied topically

A

Miconazole (Monistat)
Clotrimazole (Gyne-Lotrimin)

195
Q

Amenorrhea

A

The absence of menses; categorized as primary or secondary

196
Q

Amenorrhea = primary

A

Delayed puberty
Tanner stages of sexual characteristic development show delay

197
Q

Amenorrhea = secondary

A

Signs and symptoms of pregnancy
Mastalgia (breast tenderness) or breast enlargement
Nausea and vomiting
Urinary frequency
Enlarged uterus
Chadwick’s sign

198
Q

Male Reproductive system issues

A

Phimosis and paraphimosis
Hypospadias and Epispadias
Cryptorchidism
Hydrocele and varicocele
Testicular torsion
Epididymitis
Sexually transmitted infections

199
Q

Phimosis

A

Condition in which the foreskin is so tight it cannot be retracted over the glans penis

200
Q

Phimosis can be a result of what?

A

Can be result of infection or inflammation underneath foreskin, or can be congenital

201
Q

Phimosis Signs and symptoms

A

Possible infection or inflammation of penis
Presence of paraphimosis
Dysuria
Pain
Abnormal, intermittent urine stream
Inability to retract foreskin
Pinpoint opening of foreskin

202
Q

Paraphimosis

A

Condition in which the foreskin is retracted and cannot be returned to its normal position

203
Q

Paraphimosis who is is common in?

A

More common in adolescents and can occur after masturbation, forceful retraction, or sexual abuse

204
Q

Paraphimosis s/s

A

Bluish discoloration of glans and foreskin
Edema of glans and foreskin
Risk of necrosis of penis

205
Q

Paraphimosis- how is diagnosis made?

A

Diagnosis
Based on:
Patient history
Physical examination findings

206
Q

Hypospadias and Epispadias

A

Congenital conditions, possibly genetic, characterized by an abnormal positioning of the urethral meatus

207
Q

Hypospadias

A

the meatus is inferior to its usual position

208
Q

Epispadias

A

In epispadias, the meatus is superior to its usual position; surgical correction with possible penile urethral lengthening may be necessary

209
Q

Signs and symptoms of hypospadias include:

A

Opening of urethra below tip on bottom side of penis
Incomplete foreskin
Curvature of penis during erection
Abnormal position of scrotum in relation to penis

210
Q

Cryptorchidism

A

Absent, undescended, or ectopic testicles

211
Q

WHat is the most common male congenital anomaly?

A

Most common male congenital anomaly, noted in 2–4% of all newborn males

212
Q

Cryptorchidism results from what?

A

May result from hormonal, anatomical, or chromosomal variations; prematurity increases the chances.

213
Q

Cryptorchidism

A

Signs and symptoms:
A retractile testis has descended but retracts with exam and physical stimulation

An ectopic testis is outside of the normal pathway (e.g., in the groin, abdominal wall, or perineum)

After 1 year of age, it is uncommon for the testes to spontaneously descend
In 85% of cases, the undescended testis is unilateral and on the right

214
Q

Cryptorchidism - treatment?

A

Explain orchiopexy

Surgical repair usually done at age 6–12 months

215
Q

circumcision Benefits

A

Decreased incidence of UTI, sexually transmitted infections, AIDS, and penile cancer, and in female partners a decreased occurrence of cervical cancer.

216
Q

circumcision. Complications

A

Alterations in the urinary meatus, unintentional removal of excessive amounts of foreskin, or damage to the glans penis.

217
Q

Varicocele

A

Abnormal dilations in the testicular veins, normally unilateral and affecting the left testicle

218
Q
A

Peds (15 decks)

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