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PEDS > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Children under the age of ____ do not usually have bladder control

A

two

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2
Q

what is different about the kidneys in the first two years of life

A

the kidneys are less efficient at regulating electrolyte and acid-base balance (infants are more prone to fluid overload)

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3
Q

why is fluid more important to the body chemistry of infants and small children

A

because it constitutes a larger portion of their body weight

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4
Q

what is the bladder capacity of infants

A

Small bladder capacity (20-50 mL at birth to 700 mL in adulthood)

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5
Q

expected urine output of infants

A

Infants – 2 mL/kg/hr

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6
Q

expected urine output of children

A

Children – 0.5 to 1 mL/kg/hr

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7
Q

expected urine output of adolescents

A

Adolescents – 40 to 80 mL per hour

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8
Q

diagnostic tests of genitourinary

A 
Urinalysis
Urine culture and sensitivity
Blood – BUN, creatinine, osmolality
X-ray – KUB
Cystoscopy
CT scan
Voiding cystourethrogram (VCUG)
Renal ultrasound
Intravenous pyelogram (IVP)
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9
Q

The only way to collect sterile urine…

A

via catheterization!

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10
Q

Nursing management of children with renal disorders

A

Educate and prepare children and parents for tests and collection of urine, blood specimens, and diagnostic tests
Maintain accurate intake and output
Monitor blood pressure measurements

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11
Q

what may be an indicator of renal disorder

A

abnormal BP

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12
Q

what are most UTIs caused by

A

E.coli

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13
Q

what are UTIs characterized by

A

Characterized by bacteria in the urine along with signs and symptoms of infection

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14
Q

______ without a focus is suggestive of UTI

A

Fever (38C, 100.4F)

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15
Q

who is most at risk for UTIs

A

girls, d/t short urethra

infants/toddlers are generally more at risk d/t diapers and cannot wipe properly when first potty trained

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16
Q

when is further testing needed for UTIs and what is the testing

A
  • needed on all boys with UTIs and all girls under the age of 5, after the first documented UTI.
  • Usually a renal ultrasound and VCUG (after infection as cleared)
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17
Q

manifestations of UTI in infants

A 
Fever
Irritability
Dysuria (crying when voiding)
Change in urine color or odor
Poor weight gain
Feeding difficulties
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18
Q

manifestations of UTI in children

A 
Abdominal pain or suprapubic pain
Urinary frequency and urgency
Dysuria
Fever
New onset of enuresis
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19
Q

s/s of pyelonephritis in children

A

same symptoms as UTI but also complain of back pain, have costovertebral angle tenderness, nausea & vomiting, and appear sick

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20
Q

what does pyelonephritis tend to indicate

A

that the infection is more severe (need to be hospitalized for IV medications since oral were not effective)

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21
Q

UTI treatment

A

Usually 7 to 14 days of antibiotic therapy
Common agents: penicillins (amoxicillin)
trimethoprim/sulfamethoxazole (bactrim)
cephalosporins (cefaclor/ceclor)
nitrofurantoin (macrobid/macrodantin)

22
Q

treatment for pyelonephritis

A

require parenteral antibiotics followed by oral therapy

23
Q

children with UTIs should always….

A

be “tested for cure” – urine Culture & Sensitivity (C&S)

24
Q

are baths okay for children

A

yes as long as it is not a bubble bath, changes the pH in girls

25
Q

UTI nursing diagnoses

A

Impaired Urinary elimination related to recurrent urinary infections
Urinary Retention related to infrequent voiding habits or vesicoureteral reflux
Deficient Knowledge related to lack of knowledge of preventive measures
Risk for Deficient Fluid Volume related to fever and inadequate intake

26
Q

nursing activities for UTI pt

A

Monitor child’s therapeutic response to and untoward effects of medication
Educate parents & child to avoid bubble baths
Educate about proper perineal cleaning
Encourage intake of fluids according to norms

27
Q

what are the fluid intake norms

A

First 10 kg – 100 ml/kg/24 hour
Second 10 kg – 150 ml/kg/24 hour
Above 20 kg – 170 ml/kg/24 hour

28
Q

sometimes children can have irritation of the urethra…

A

and not a bacterial infection

can be d/t bubble bath or using perfumed soap

29
Q

what are Hypospadias and Epispadias

A

Both are congenital anomalies involving an abnormal location of the urethral meatus

30
Q

describe hypospadias

A

Most cases of hypospadias are mild, with the meatus slightly off center from the tip of the penis; in severe cases

31
Q

how are Hypospadias and Epispadias diagnosed

A

Diagnosis is made by prenatal ultrasound or by examination at birth

32
Q

how to repair Hypospadias and Epispadias

A

Repair is made surgically usually during 1st year of life

Do surgical repair as soon as possible to prevent UTIs

33
Q

what is Vesicoureteral Reflux (VUR)

A

A valve-like structure is at the junction of the ureter and bladder to prevent urine from refluxing into the ureters, when a defect occurs in the valve then reflux results.
Usually a congenital abnormality

34
Q

how is VUR diagnosed

A

Diagnosed by Renal ultrasound and Voiding cystourethrogram (VCUG)

35
Q

two contributing factors to UTIs

A

1) bacteria in the urine can be carried up to the kidney and cause pyelonephritis and renal damage
2) urine that has refluxed into the ureter can return to the bladder and leave urine residual which is a medium for bacterial growth

36
Q

how do you prevent bacteria from traveling up to the kidneys

A

do NOT hold urine for a while when you feel the urge to go

37
Q

VUR classifications

A

Grade I – reflux into the ureter only with no dilation
Grade II – reflux into the ureter, pelvis, and calyces with no dilation
Grade III – mild dilation or ureter and renal pelvis
Grade IV – moderate dilation or ureter, pelvis, and calyces
Grade V – gross dilation of ureter, pelvis, and calyces

38
Q

treatment of VUR grades 1-3

A

Grade I, II, & III require no surgery only prophylactic antibiotic therapy – followed closely and screened for UTI every few months and as needed if febrile

39
Q

treatment of VUR grades 4-5

A

Grade IV & V require surgical intervention to reimplant the ureters into the bladder

40
Q

what is enuresis

A

A condition in which the child is unable to control bladder function when voluntary control should be present
Primary nocturnal enuresis
Primary and secondary

41
Q

usually children have complete bladder control by when

A

5

42
Q

when should you introduce potty training

A

2 or 3

43
Q

describe enuresis that is continued

A

If continued enuresis by 9, put measures into place

Genetic- likely to be in families (ask family how long they had it, will relieve itself)

44
Q

nursing diagnoses for enuresis

A
  • Impaired Urinary Elimination related to inability to control voiding during the day or at night
  • Overflow urinary incontinence related to ignoring urge to void during activities
  • Risk for Situational Low Self-Esteem related to embarrassment over lack of bladder control
  • Readiness for Enhance Knowledge (enuresis management) related to motivation of the child
45
Q

what is nephrotic syndrome

A

A kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema, hypoproteinemia, hyperlipidemia, and altered immunity
**Kidneys are not working as they should

46
Q

describe primary nephrotic syndrome

A

minimal change nephrotic syndrome – results from a disorder within the glomerulus of the kidney
***most common one seen in children

47
Q

describe secondary nephrotic syndrome

A

acquired secondary to a disease such as hepatitis, systemic lupus erythematosus, metal poisoning, cancer, etc.)

48
Q

what is the most common metal poisoning in children

A

lead

49
Q

nephrotic syndrome manifestations

A 
Edema
Increased weight
Facial puffiness (esp. around the eyes)
Fatigue
Anorexia
Susceptibility to infection, i.e. respiratory
Irritability
50
Q

treatment of nephrotic syndrome

A
  • Corticosteroids – usually prednisone 2mg/kg/day two or three times a day – continued until child is in remission (0 to trace of protein in urine for 5 to 7 days)
  • Steroids are always slowly tapered before discontinuing
  • Diuretics if needed
  • No-added-salt diet and fluid restriction
51
Q

what is important to remember about nephrotic syndrome

A
  • Once no more protein in urine or symptoms, start tapering off corticosteroids (cannot stop immediately)
  • *If kidneys not working well, do not drink excessive water (fluid restriction)

PEDS (24 decks)

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