Genitourinary Dysfunction

Question 1

urinary tract infection

Answer 1

UTI can involve lower or upper urinary tract. Presence of significant number of microorganisms anywhere within the urinary tract, except the distal third of the urethra, which s usually colonized with bacteria.

Question 2

Terms to describe urinary tract disorders

Answer 2

bacteriuria - presence of bacteria in the urine
asymptomatic bacteriuria - significant bacteriuria with no evidence of clinical manifestations
symptomatic bacteriuria - bacteriuria accompanied by physical symptoms of UTI (dysuria, suprapubic discomfort, hematuria, fever)
recurrent UTI - repeated episode of bacteriuria or symptomatic UTI
persistent UTI - persistence of bacteriuria despite antibiotics
febrile UTI - bacteriuria accompanied by fever and other physical signs of UTI; presence of fever typically implies a pyelonephritis
cystitis - inflammation of the bladder
urethritis - inflammation of the urethra
pyelonephritis - inflammation of the upper urinary tract and kidneys
urosepsis - febrile UTI coexisting with system signs of bacteria illness

Question 3

objective of UTI treatment

Answer 3

eliminate infection, identify contributing factors to reduce risk of recurrence, prevent systemic spread of infection, preserve renal function

Question 4

vesicoureteral reflux

Answer 4

abnormal retrograde flow of bladder urine into the ureters. during voiding urine is swept up the ureters and then flows black into the empty bladder, where it acts a reservoir for bacterial growth until next void
primary reflux: congenital abnormal insertion of ureters into bladder
secondary reflux: result of acquired condition
tx: daily low dose antibiotic therapy to prevent UTI and renal scarring from reflux during UTI

Question 5

obstructive uropathy

Answer 5

structural or functional abnormalities of the urinary system that obstruct the normal flow of urine

Question 6

hydronephrosis

Answer 6

dilation of the renal pelvis from distention - caused by backup of urine above obstruction in obstructive uropathy

Question 7

hypospadias and epispadias

Answer 7

hypospadias - range of penile anomalies with an abnormally located urinary meatus. the meatus can open below the glans penis, anywhere along the ventral surface of the penis, scrotum, or perineum - classified according to location of meatus and presence or absence of chordee (ventral curvature of the penis)
epispadias - failure of urethral canalization. meatus opening located on dorsal surface of penis. severe form associated with exstrophy of bladder (eversion of posterior bladder through anterior bladder wall and lower abdominal wall)

Question 8

nephrotic syndrome

Answer 8

clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. disorders can occur as primary disease known as idiopathic nephrosis, childhood nephrosis, or minimal chance nephrotic syndrome or as a secondary disorder that occurs as a clinical manifestation after or in association with glomerular damage that has a known or presumed cause or as a congenital form inherited as an autosomal recessive disorder

Question 9

minimal change nephrotic syndrome pathophysiology

Answer 9

glomerular membrane becomes permeable to proteins, especially albumin, which gets lost in urine. this reduces serum albumin levels, causing a pressure difference in vascular and colloidal pressure resulting in edema. fluid collecting in the interstitial space (edema) reduces vascular fluid volume which stimulate renin-angiotensin system and secretion of ADH and aldosterone. this results in reabsorption of water and sodium in an attempt to increase intravascular volume. tx: 4-8 wk steroid therapy

Question 10

management of minimal change nephrotic syndrome

Answer 10

reduce excretion of urinary protein, reduce fluid retention in the tissues, prevent infection, minimize complications related to steroid therapy

Question 11

acute glomerulonephritis

Answer 11

primary event or manifestation of a systemic disorder than can range from minimal to severe. acute poststreptococcal glomerulonephritis (APSGN) most common of postinfectious renal disease in childhood. immune complexes are deposited in glomerular basement membranes cause glomeruli to become edematous and infiltrated with polymorphonuclear leukocytes, which occlude the capillary lumen. results in decreased plasma filtration which causes excessive accumulation of water and retention of sodium that expands plasma and interstitial fluid volumes - leads to edema and congestion

Question 12

hemolytic uremic syndrome (HUS)

Answer 12

uncommon, acute renal disease. most frequent causes of AKI in children. considered unusual response to bacterial or viral infections. clinical presentation is history if prodromal illness followed by sudden onset of renal failure and hemolysis (destruction of RBC)

Question 13

hemolytic uremic syndrome pathophysiology

Answer 13

endothelial lining of the small glomerular arterioles become swollen and occluded with deposits of platelets and fibrin clots. RBC are damaged as they attempt to pass through the arterioles and are removed by the spleen, causing hemolytic anemia. damaged platelets that are removed accounts for the thrombocytopenia seem in the syndrome

Question 14

hemolytic uremic syndrome diagnosis

Answer 14

triad of thrombocytopenia, hemolytic anemia, and renal failure sufficient for dx

Question 15

wilms tumour

Answer 15

nephroblastoma is most common malignant renal and intra-abdominal tumour of childhood. arises from malignant undifferentiated cluster of primordial cells capable of initiating the regeneration of an abnormal structure

Question 16

management of wilms tumour

Answer 16

surgery scheduled 24-48 hr after admission. tumour, affected kidney, and adjacent structures are removed. care taken to keep tumour intact during removal to prevent spread of cancerous cells through rest of abdomen. if both kidney involved, child treated with radiation or chemotherapy before surgery to reduce tumour size and conserve organ removal. post operative radiotherapy in children with large tumours, metastasis, residual disease, or recurrence. therapy for 6-15 months

Question 17

wilms tumour nursing care

Answer 17

absolutely do not palpate abdomen prior to surgery. short time to give lots of information (24-48 hrs).

Question 18

azotemia and uremia

Answer 18

terms related to renal failure
azotemia - accumulation of nitrogenous waste within the blood
uremia - retention of nitrogenous products produce toxic symptoms

Question 19

acute kidney injury (AKI)

Answer 19

said to exist when the kidney suddenly is unable to regulate the volume and composition of urine appropriately. principal feature of AKI is oligoanuria, reduced urine volume, associated with azotemia, metabolic acidosis, and diverse electrolyte disturbances. reversible AKI has a stage of reduce urine output, followed by increased urine output and then stabilization

Question 20

treatment of acute kidney injury

Answer 20

treatment of underlying cause, management of complications of renal failure, provision of supportive therapy within the constraints imposed by renal failure. hyperkalemia most immediate threat to life with AKI and can be minimized by eliminating potassium from food and fluid, by reducing tissue catabolism, and by correcting acidosis - measures to reduce serum potassium admin of ion exchanging resin, peritoneal dialysis or hemodialysis

Question 21

chronic kidney disease (CKD)

Answer 21

kidney able to maintain chemical composition of fluids within normal limits until more than 50% of functional renal capacity is destroyed by injury or disease. CKD occurs when diseased kidneys can no longer maintain the normal chemical structure of body fluids under normal conditions.

Question 22

CKD results in

Answer 22

retention of waste products
water and sodium retention
hyperkalemia
metabolic acidosis
calcium and phosphorus disturbance
anemia
growth disturbance

Question 23

irreversible renal failure (CKD) management

Answer 23

promote maximal renal function, maintain body fluid and electrolyte balance within safe biochemical limits, treat systemic complications, and promote as active and normal life as possible for the child. tx: dialysis and transplant for end stage renal disease

Question 24

dialysis

Answer 24

process of separating colloids and crystalline substances in solution by difference in their rate of diffusion through a semipermeable membrane.
peritoneal dialysis - abdominal cavity acts as a semipermeable membrane through which water and solutes of small molecular size move by osmosis and diffusion; can be continuous ambulatory peritoneal dialysis or continuous cycling peritoneal dialysis
hemodialysis - blood is circulated outside the body through an artificial membrane that permit a similar passage of water and solutes
hemofiltration - blood filtrate is circulated outside the body by hydrostatic pressure exerted across a semipermeable membrane with simultaneous infusion of a replacement solution