Genitourinary

Question 1

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

Answer 1

two

Question 2

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

Answer 2

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

Question 3

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

Answer 3

because it constitutes a larger portion of their body weight

Question 4

what is the bladder capacity of infants

Answer 4

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

Question 5

expected urine output of infants

Answer 5

Infants – 2 mL/kg/hr

Question 6

expected urine output of children

Answer 6

Children – 0.5 to 1 mL/kg/hr

Question 7

expected urine output of adolescents

Answer 7

Adolescents – 40 to 80 mL per hour

Question 8

diagnostic tests of genitourinary

Answer 8

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

Question 9

The only way to collect sterile urine…

Answer 9

via catheterization!

Question 10

Nursing management of children with renal disorders

Answer 10

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

Question 11

what may be an indicator of renal disorder

Answer 11

abnormal BP

Question 12

what are most UTIs caused by

Answer 12

E.coli

Question 13

what are UTIs characterized by

Answer 13

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

Question 14

______ without a focus is suggestive of UTI

Answer 14

Fever (38C, 100.4F)

Question 15

who is most at risk for UTIs

Answer 15

girls, d/t short urethra

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

Question 16

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

Answer 16

• 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)

Question 17

manifestations of UTI in infants

Answer 17

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

Question 18

manifestations of UTI in children

Answer 18

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

Question 19

s/s of pyelonephritis in children

Answer 19

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

Question 20

what does pyelonephritis tend to indicate

Answer 20

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

Question 21

UTI treatment

Answer 21

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

Question 22

treatment for pyelonephritis

Answer 22

require parenteral antibiotics followed by oral therapy

Question 23

children with UTIs should always….

Answer 23

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

Question 24

are baths okay for children

Answer 24

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

Question 25

UTI nursing diagnoses

Answer 25

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

Question 26

nursing activities for UTI pt

Answer 26

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

Question 27

what are the fluid intake norms

Answer 27

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

Question 28

sometimes children can have irritation of the urethra...

Answer 28

and not a bacterial infection | can be d/t bubble bath or using perfumed soap

Question 29

what are Hypospadias and Epispadias

Answer 29

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

Question 30

describe hypospadias

Answer 30

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

Question 31

how are Hypospadias and Epispadias diagnosed

Answer 31

Diagnosis is made by prenatal ultrasound or by examination at birth

Question 32

how to repair Hypospadias and Epispadias

Answer 32

Repair is made surgically usually during 1st year of life | Do surgical repair as soon as possible to prevent UTIs

Question 33

what is Vesicoureteral Reflux (VUR)

Answer 33

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

Question 34

how is VUR diagnosed

Answer 34

Diagnosed by Renal ultrasound and Voiding cystourethrogram (VCUG)

Question 35

two contributing factors to UTIs

Answer 35

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

Question 36

how do you prevent bacteria from traveling up to the kidneys

Answer 36

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

Question 37

VUR classifications

Answer 37

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

Question 38

treatment of VUR grades 1-3

Answer 38

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

Question 39

treatment of VUR grades 4-5

Answer 39

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

Question 40

what is enuresis

Answer 40

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

Question 41

usually children have complete bladder control by when

Answer 41

5

Question 42

when should you introduce potty training

Answer 42

2 or 3

Question 43

describe enuresis that is continued

Answer 43

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)

Question 44

nursing diagnoses for enuresis

Answer 44

- 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

Question 45

what is nephrotic syndrome

Answer 45

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

Question 46

describe primary nephrotic syndrome

Answer 46

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

Question 47

describe secondary nephrotic syndrome

Answer 47

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

Question 48

what is the most common metal poisoning in children

Answer 48

lead

Question 49

nephrotic syndrome manifestations

Answer 49

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

Question 50

treatment of nephrotic syndrome

Answer 50

- 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

Question 51

what is important to remember about nephrotic syndrome

Answer 51

- 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)