GU Flashcards
pre-op hypospadias care
should be detected in newborn assessment
increased risk of UTI until fixed
may interfere with procreation
post-op care hypospadias care
no straddle toys or carrying infant on the hip
stent will be in place after surgery
double diaper wrap catheter to drain into second diaper
pressure dressing, check tip of penis frequently, do not change dressing
surgery for hypospadias
skin removed during circumcision is used to repair penis
goals of surgical care of hypospaidas
prevent body image problems
enable child to void in standing position
improve physical appearance of genitalia
preserve functionality of sex organ
Vesicoureteral Reflux (VUR)
reflux of urine from bladder into uterus and kidneys
graded 1-5
can lead to HTN, renal insufficiency or failure
primary reflux is familial and usually outgrown
how to treat VUR stage 1-3 (early)
prophylactic antibiotics related to urinary stasis
take all abx as prescribed
how to treat VUR stage 3 (late)-5
surgical repair to fix reflux
primary VUR
result of incompetent valvular mechanism at the ureterovesicular junction
secondary VUR
result of a condition such a UTI
diagnosis and treatment of VUR
VCUG
antibiotics until reflux resolves
surgery, necessary when abx dont work or severe reflux (3-5)
pre-op nursing considerations for VUR
prevent infection (take all abx, empty bladder completely, good hygiene)
screen siblings
age appropriate prep for procedures
post-op nursing considerations for VUR
catheter and stent care (no swimming, sandboxes, or straddling)
pain meds for incision pain and antispasmodics for bladder spasm
prophylactic abx for 1-2 months following surgery
inguinal hernias
should be able to be pressed flat and smooth and should not feel any intestines
asymptomatic and painless
more visible when child cries, strains, coughs, or stands for long periods of time
needs surgical correction
diaphragmatic hernia
opening between thorax and abdominal cavity
abdominal contents enter thoracic cavity, compressing lungs and even effecting fetal lung development
s/s of diaphragmatic hernia
often detected in utero
after birth- respiratory distress, cyanosis, scaphoid abdomen and impaired cardiac output
needs immediate medical attention, intubation, GI decompression, IV fluids and surgery to repair
pre-op nursing management of diaphragmatic hernia
monitor respiratory and fluid status, acidosis, thermoregulation, cardiac output, sedation, gastric decompression
post-op nursing management of diaphragmatic hernia
continued ventilation
monitor of acidosis, fluid status, GI decompression, thermoregulation, sedation, pain control, cardiac output, parental bonding
umbilical hernia
teach parents to assess at home should be able to push flat and feel squishy
if you feel intestines go to ER
usually self resolves in 3-5 years without medical tx or home remedies
UTI’s
most common in females, less common in males
uncircumcised males more likely to have UTI as young infant
E.Coli causes most in females
risk factors of UTI’s
Constipation bubble baths pinworms dysfunctional voiding, urinary stasis decreased fluid intake VUR urologic abnormalities indwelling catheter neurogenic bladder sex abuse sexual intercourse
UTI clinical manifestations in infants
fever weight loss FTT Vomiting diarrhea
UTI clinical manifestations in children
dysuria frequency, urgency, incontinence foul smelling urine possibly hematuria abdominal pain fever
what does a positive UTI urine test show?
nitrites
rbc
wbc
urine culture is positive if shows >100,000 colonies of single bacteria
UTI prevention
no bubble baths, tub baths are fine take ABX properly push fluids drink water avoid caffeine and cola encourage cranberry juice empty bladder wipe front and back cotton undies avoid tight fitting clothes void after intercourse
enuresis
involuntary passage of urine by child >5 yrs
primary enuresis
Kids have NEVER been dry familial tendency, decreased bladder capacity maturity lag sleep disorder nocturnal polyuria
secondary enuresis
psychological factors
child has been potty trained and starts wetting bed out of the blue
caused by bullying, abuse, sickle cell anemia, DM, constipation
diagnosis of enuresis
urine sample
good H&P
wait for maturation- most children outgrow by age 10
retention/ control exercises
drug therapy (oxybutinin (ditropan), imipramine (neurologic side effects), DDAVP (nasal spray or tablet)
moisture alarm
behavior modification (POSITIVE reinforcement is key)
Hemolytic- uremic syndrome (HUS)
combo of hemolytic anemia and thrombocytopenia that occurs with acute renal failure
most often in children 6 months-5 yrs
how does HUS progress?
watery diarrhea that progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia
causes of HUS
undercooked meat unpasteurized milk/ dairy unclean water unclean lettuce idiopathic inherited drug related malignancies
pathophysiology of HUS
occlusion of the glomerular capillary loops and glomerulosclerosis, resulting in renal failure
RBC’s and platelets are damaged as they move through the occluded blood vessels
source of infection in HUS
undercooked ground beef (most common)
consuming animal feces, unpasteurized dairy and fruit products, fresh vegetables.
s/s of HUS
vomiting (mimics GI bug) marked pallor oliguria or anuria (kidneys start to shut down) edema fatigue elevated BP altered LOC
are antibiotics helpful with HUS?
NO!!! self limiting, it will run its course
HUS lab findings
elevated BUN/Creatine
mod to severe anemia
UA positive for blood, protein, pus, and casts
how long does bacteria shed in the stool of HUS
17 days
complications of HUS
chronic renal failure seizures and coma pancreatitis intussusception rectal prolapse cardiomyopathy CHF ARDS
nursing considerations for HUS
contact precautions fluid volume status encourage adequate nutrition within dietary restrictions monitor for bleeding teach prevention
Diet for HUS
pasteurized dairy/milk
clean water
clean fruit/veggies
well cooked meats
Acute post-streptococcal Glomerulonephritis (APSG)
acute post strep infection that has damaged the kidneys
clinical manifestations of APSG
edema with weight gain
flank or abdominal pain with CVA tenderness
urine is cloudy and smoky brown/tea colored and decreased in volume
hypertension and s/s of circulatory overload
diagnosis of APSG
UA shows gross hematuria, MILD proteinuria, elevated specific gravity
negative urine culture
normal electrolytes, elevated ASO titer (recent strep infection)
therapeutic management of APSG
bed rest during acute phase ( 1-2 weeks)
diet- NO ADDED SALT, low protein (if BUN is elevated)
control Hypertension
antibiotics if evidence of current strep infection (fever)
how do children show us they are getting better with APSG?
increased urine output
APSG nursing interventions
fluid volume excess r/t to decreased glomerular filtration rate
daily weight
strict I and O
monitor BP, electrolyte imbalance, s/s of cardiomyopathy
administer diuretics safely
infection prevention
nephrotic syndrome
MASSIVE proteinuria, hypoproteinemia, hyperlipidemia, and edemia
clinical manifestations for nephrosis
massive proteinuria sudden, rapid weight gain generalized edema pleural effusion decreased urine output diarrhea anorexia muejrcke lines b/p normal or slightly elevated frequent infections fatigue
diagnosis of nephrosis
ua, serology, renal biopsy
therapeutic management of nephrosis
bed rest during edema, resume regular activity during remission
NO SALT added diet, high protein during edema, regular during remission
drugs- corticosteroids, immunosuppressants, loop diuretics, salt poor, albumin
nursing considerations nephrosis
fluid volume excess r/t accumulation of fluid in tissues and third spacing
potential intravascular fluid volume deficit r/t protein and fluid loss
main take away of glomerulonephritis
\+ ASO titer hypertension periorbital and peripheral edema circulatory congestion mild proteinuria gross hematuria norm. to slightly elevated K+ mild decrease serum protein normal serum lipids 5-7 yrs old
main take away from nephrotic syndrome
negative ASO normal BP generalized/severe edema no circulatory congestion MASSIVE proteinuria microscopic/no hematuria normal potassium marked decrease serum protein elevated serum lipids 2-3 yrs old
acute renal failure
caused by nephrotoxic med (vancomycin) or dehydration
for nephrotoxic need to flush system with fluids
for dehydration rehydrate body with fluid
prevention of acute renal failure
treat underlying cause manage fluid and electrolyte disturbances decrease BP provide supportive therapy Drugs: mannitol, albumin, furosemide draw pea/ trough vancomycin levels
chronic renal failure
occurs over time >6m
treated with dialysis usually peritoneal in kids
can effect bone development
watch for osteodystrophy
prevention of osteodystrophy in chronic renal failure
calcium carbonate
aluminum hydroxide gel
treatment of CHF
supportive therapy
dialysis
transplant
