Genitourinary Dysfunction

Question 1

____ accounts of 80% of UTIs

Answer 1

E. coli

Question 2

Enuresis

Answer 2

Repeated involuntary urination in a child who should have already established bladder control (usually by 5 years of age)
Primary - occurs in children who have never attained urinary continence
Secondary - occurs in children who have attained urinary continence

Question 3

Vesicoureteral reflux

Answer 3

Back flow of urine in the urinary tract when voiding
Usually presents with UTI or hydronephrosis
Primary reflux - results from congenital abnormalities in insertion of ureters into bladder
Secondary reflux - results from infection and ureterovesicular junction incompetency related to edema - neurogenic bladder or progressive dilation of ureters after surgical urinary diversion

Question 4

Vesicoureteral reflux signs

Answer 4

Dysuria, urinary frequency, urgency, hesitation, retention
Cloudy, dark, or blood-tinged urine
FTT

Question 5

VUR treatment

Answer 5

Low dose antibiotic
3 hour voiding plan
Prevent constipation - high fiber diet

Question 6

Nephrotic syndrome

Answer 6

Manifestation of different glomerular diseases that result in loss of protein through the kidneys
Minimal change nephrotic syndrome - idiopathic in origin, may be caused by a viral upper respiratory tract infection
Secondary - usually occurs after glomerular damage of known or presumed cause
Congenital - autosomal recessive

Question 7

Nephrotic syndrome signs

Answer 7

Anorexia, pallor, diarrhea, abdominal pain, decreased UOP, foamy or frothy urine
Periorbital, pedal, pretibial edema progresses to generalized edema
Weight increase, ascites, pleural effusion, labial or scrotal swelling, shiny skin with prominent veins, normal or decrease BP, increased susceptibility to infection

Question 8

Nephrotic syndrome treatment

Answer 8

Assess for fluid volume deficit
Prevent infection
Corticosteroids, diuretic
Promote skin integrity
High protein, high calorie diet without added salt
No live vaccines until child goes to school

Question 9

Acute glomerulonephritis

Answer 9

Immune complex disease that results from immune injury - antigens interact with antigens
Occurs post-infection, usually due to streptococcal infection within last 10-14 days

Question 10

Acute glomerulonephritis signs

Answer 10

Irritability, anorexia, pallor, high BP, periorbital and generalized edema, weight gain, electrolyte imbalance, oliguria, hematuria

Question 11

Acute glomerulonephritis treatment

Answer 11

Assess fluid status
Monitor BP and HR
Antihypertensives, anticonvulsants, antibiotics
Limit sodium, limit potassium in periods of oliguria
Needs monthly follow up for 6 months, then every 3 months

Question 12

Hypospadias

Answer 12

Urethral opening is located below the glans penis or anywhere along the ventral surface (underside)
Avoid circumcision until repaired