Genitourinary

Question 1

Pediatric differences

Answer 1

1. immature kidneys until age 2
2. decreased bladder capacity ( age +2 = oz the bladder can hold )
3. nerve development = bladder control

Question 2

Urinary tract Infection

Answer 2

Patho: urethra + bladder = cystitis

Causes: E. coli, urinary stasis , poor hygiene, irritated perineum, uncircumcised, constipation, sexual activity

S/SX: odiferous urine ( change in smell ), increased frequency, blood tinged urine, irritable, poor feeding, abd. pain

DX: UA (WBC, protein, blood), C&S (bacteria)

TX: antibiotics, PNENAZOPYRIDINE (> 6 years old , can turn urine orange )

Nursing: prevention + education (wipe front to back, cotton underwear, avoid bubble baths, avoid sugary carbonated drinks, void after sex )

Question 3

Pyelonephritis ( kidney infection )

Answer 3

Patho: untreated UTI leads to a kidney infection

S/SX: high fever, abd./flank pain , nausea, vomiting, odiferous urine

TX: IV antibiotics

Nursing: Strict i/o (b/c it can lead to kidney failure – BUN, Creat )

Question 4

Hypospadias vs Epispadias

Answer 4

Patho: urethra isnt where its supposed to be
1. ventral (lower) glans= hypo (under )
2. dorsal (upper) glans = epi (on top)

S/SX: urine doesnt come out of regular place

TX: surgical repair - stent to make new opening

Nursing: DO NOT CIRCUMCISE ( will use skin to fix it down the line ), double diapering ( no tub baths/pressure to groin ), monitor I/O, infection

Question 5

Vesicoureteral Reflux

Answer 5

Patho: retrograde flow from bladder to ureters (urine goes back up )
- reservoir for bacteria, risk for pyelonephritis

DX: renal US, VCUG ( watch the flow of urine )

TX: prophylactic antibiotics, surgical repair

Question 6

Enuresis

Answer 6

Patho: involuntary voiding after bladder control expected ( 5-6 years old )

Cause: maturation delay , stress, infections, sleep disorder
- R/O UTI, Diabetes insipidus, DM, renal disease

TX: fluid restrictions, bladder control training
- DEMOSPRESSIN ( antidiuretic )
- OXYPUTYNIN (tx overreactive bladder )
- IMIPRAMINE ( tx spasticity )

Nursing: Nocturnal (at night ), diurnal ( day ), primary (never had control ), secondary (regression )

Question 7

Nephrotic Syndrome

Answer 7

Patho: glomerular membrane allows proteins to pass
- dont know the cause

S/SX: HTN, pale, fatigue, ascites
- edema, proteinuria, hypoalbuminemia, altered immunity, hyperlipidemia
( edema from loos of protein, immunoglobulin loss = decreased immunity, liver increases lipoprotein production = increased lipids )

DX: UA, electrolytes, serum albumin, CBC, lipids

TX: Steroids (1st line), immunosuppressant therapy (2nd line), diuretics (edema), ACE inhibitor (HTN)

Nursing: monitor i/o, edema (daily wt.), labs, infection, skin

Question 8

Acute Postinfectious Glomerulonephritis (APIGN)

Answer 8

Patho: injury to the glomeruli post strep throat infection (2-3 wks after )

S/SX: decreased GFR and RBC in urine ( dark tea colored urine ), Fluid retention (edema, HTN, oliguria = decreased urine output ), encephalopathy ( HA, irritable, lethargic, seizures ), Hyperkalemia, abd./flank pain

DX: Strep titer (ASO), UA, CBC, electrolytes, renal panel

TX: sodium restriction, diuretics, antihypertensive, antibiotics

Nursing: seizure precautions, monitor VS, i/o, edema, skin, infection risk

Question 9

Acute Kidney Injury (AKI)

Answer 9

Patho: sudden loss of kidney function
1. Prerenal = decreased perfusion
2. Primary = any damage to kidney itself (glomerulonephritis )
3. Postrenal = newborn anomalies

S/SX: Pale, lethargic, oliguria ( decreased urine output ), edema, HTN, hematuria, electrolyte imbalances, HA, confusion, seizures

TX: treat the cause - fluid replacement, albumin, diuretics, dialysis, antibiotics

Nursing: infection risk, I/O, nutritional needs, skin assessment, (edema )

Question 10

Phimosis

Answer 10

Patho: foreskin cant be retracted
- normal until age 3
- steroid cream to allow retraction

Question 11

Paraphimosis

Answer 11

Patho: foreskin cant be returned to normal position
- MEDICAL EMERGENCY
- Blood flow obstructed= ischemic
- TX: surgery

Question 12

Testicular Torsion

Answer 12

Patho: testis rotates cutting off blood supply ( EMERGENCY )

S/SX: severe pain, erythema, bluish scrotum, N/V, absent cremasteric reflux ( if you rub inner thigh the testicle will go into the body )

DX: US

TX: IMMEDIATE SURGERY WITHIN 6 HOURS

Question 13

Pelvic Inflammatory Disease (PID)

Answer 13

Patho: Infection of genital tract, ascends during menses

Causes: complication of untreated STI’s

S/SX: Cervical motion tenderness, fever, Dysmenorrhea (painful period), Dysuria (difficulty urinating), Vaginal discharge (purulent ), Dyspareunia ( painful sex )

TX: antibiotics, bedrest, pain managementCi

Question 14

Circumcision

Answer 14

Removal of the foreskin ( cultural/ parental preference )

Benefits: prevents paraphimosis, ease of hygiene, prevents UTI, and penile cancer

Use: analgesics and anesthesia

Education: cleaning and recovery
- 7-10 days to heal
- vaseline gauze –> swelling –> skin will fall off

Question 15

Contraindication of circumcision

Answer 15

1. Epispadias ( will use skin to fix it )
2. Hypospadias ( will use skin to fix it )
3. hemophilia (bleeding disorder )