Genitourinary Flashcards
Pediatric differences
- immature kidneys until age 2
- decreased bladder capacity ( age +2 = oz the bladder can hold )
- nerve development = bladder control
Urinary tract Infection
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 )
Pyelonephritis ( kidney infection )
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 )
Hypospadias vs Epispadias
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
Vesicoureteral Reflux
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
Enuresis
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 )
Nephrotic Syndrome
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
Acute Postinfectious Glomerulonephritis (APIGN)
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
Acute Kidney Injury (AKI)
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 )
Phimosis
Patho: foreskin cant be retracted
- normal until age 3
- steroid cream to allow retraction
Paraphimosis
Patho: foreskin cant be returned to normal position
- MEDICAL EMERGENCY
- Blood flow obstructed= ischemic
- TX: surgery
Testicular Torsion
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
Pelvic Inflammatory Disease (PID)
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
Circumcision
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
Contraindication of circumcision
- Epispadias ( will use skin to fix it )
- Hypospadias ( will use skin to fix it )
- hemophilia (bleeding disorder )
