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Peds Exam 3b > GU > Flashcards

GU Flashcards

1
Q

pre-op hypospadias care

A

should be detected in newborn assessment
increased risk of UTI until fixed
may interfere with procreation

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2
Q

post-op care hypospadias care

A

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

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3
Q

surgery for hypospadias

A

skin removed during circumcision is used to repair penis

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4
Q

goals of surgical care of hypospaidas

A

prevent body image problems
enable child to void in standing position
improve physical appearance of genitalia
preserve functionality of sex organ

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5
Q

Vesicoureteral Reflux (VUR)

A

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

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6
Q

how to treat VUR stage 1-3 (early)

A

prophylactic antibiotics related to urinary stasis

take all abx as prescribed

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7
Q

how to treat VUR stage 3 (late)-5

A

surgical repair to fix reflux

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8
Q

primary VUR

A

result of incompetent valvular mechanism at the ureterovesicular junction

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9
Q

secondary VUR

A

result of a condition such a UTI

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10
Q

diagnosis and treatment of VUR

A

VCUG
antibiotics until reflux resolves
surgery, necessary when abx dont work or severe reflux (3-5)

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11
Q

pre-op nursing considerations for VUR

A

prevent infection (take all abx, empty bladder completely, good hygiene)
screen siblings
age appropriate prep for procedures

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12
Q

post-op nursing considerations for VUR

A

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

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13
Q

inguinal hernias

A

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

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14
Q

diaphragmatic hernia

A

opening between thorax and abdominal cavity

abdominal contents enter thoracic cavity, compressing lungs and even effecting fetal lung development

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15
Q

s/s of diaphragmatic hernia

A

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

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16
Q

pre-op nursing management of diaphragmatic hernia

A

monitor respiratory and fluid status, acidosis, thermoregulation, cardiac output, sedation, gastric decompression

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17
Q

post-op nursing management of diaphragmatic hernia

A

continued ventilation
monitor of acidosis, fluid status, GI decompression, thermoregulation, sedation, pain control, cardiac output, parental bonding

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18
Q

umbilical hernia

A

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

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19
Q

UTI’s

A

most common in females, less common in males
uncircumcised males more likely to have UTI as young infant
E.Coli causes most in females

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20
Q

risk factors of UTI’s

A 
Constipation
bubble baths
pinworms
dysfunctional voiding, urinary stasis
decreased fluid intake
VUR
urologic abnormalities
indwelling catheter
neurogenic bladder
sex abuse
sexual intercourse
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21
Q

UTI clinical manifestations in infants

A 
fever
weight loss
FTT
Vomiting
diarrhea
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22
Q

UTI clinical manifestations in children

A 
dysuria
frequency, urgency, incontinence
foul smelling urine
possibly hematuria
abdominal pain
fever
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23
Q

what does a positive UTI urine test show?

A

nitrites
rbc
wbc
urine culture is positive if shows >100,000 colonies of single bacteria

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24
Q

UTI prevention

A 
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
25
Q

enuresis

A

involuntary passage of urine by child >5 yrs

26
Q

primary enuresis

A 
Kids have NEVER been dry
familial tendency, decreased bladder capacity
maturity lag
sleep disorder
nocturnal polyuria
27
Q

secondary enuresis

A

psychological factors
child has been potty trained and starts wetting bed out of the blue
caused by bullying, abuse, sickle cell anemia, DM, constipation

28
Q

diagnosis of enuresis

A

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)

29
Q

Hemolytic- uremic syndrome (HUS)

A

combo of hemolytic anemia and thrombocytopenia that occurs with acute renal failure
most often in children 6 months-5 yrs

30
Q

how does HUS progress?

A

watery diarrhea that progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia

31
Q

causes of HUS

A 
undercooked meat
unpasteurized milk/ dairy
unclean water
unclean lettuce
idiopathic
inherited 
drug related
malignancies
32
Q

pathophysiology of HUS

A

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

33
Q

source of infection in HUS

A

undercooked ground beef (most common)

consuming animal feces, unpasteurized dairy and fruit products, fresh vegetables.

34
Q

s/s of HUS

A 
vomiting (mimics GI bug)
marked pallor
oliguria or anuria (kidneys start to shut down)
edema
fatigue
elevated BP
altered LOC
35
Q

are antibiotics helpful with HUS?

A

NO!!! self limiting, it will run its course

36
Q

HUS lab findings

A

elevated BUN/Creatine
mod to severe anemia
UA positive for blood, protein, pus, and casts

37
Q

how long does bacteria shed in the stool of HUS

A

17 days

38
Q

complications of HUS

A 
chronic renal failure
seizures and coma
pancreatitis
intussusception
rectal prolapse
cardiomyopathy
CHF
ARDS
39
Q

nursing considerations for HUS

A 
contact precautions
fluid volume status
encourage adequate nutrition within dietary restrictions
monitor for bleeding
teach prevention
40
Q

Diet for HUS

A

pasteurized dairy/milk
clean water
clean fruit/veggies
well cooked meats

41
Q

Acute post-streptococcal Glomerulonephritis (APSG)

A

acute post strep infection that has damaged the kidneys

42
Q

clinical manifestations of APSG

A

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

43
Q

diagnosis of APSG

A

UA shows gross hematuria, MILD proteinuria, elevated specific gravity
negative urine culture
normal electrolytes, elevated ASO titer (recent strep infection)

44
Q

therapeutic management of APSG

A

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)

45
Q

how do children show us they are getting better with APSG?

A

increased urine output

46
Q

APSG nursing interventions

A

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

47
Q

nephrotic syndrome

A

MASSIVE proteinuria, hypoproteinemia, hyperlipidemia, and edemia

48
Q

clinical manifestations for nephrosis

A 
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
49
Q

diagnosis of nephrosis

A

ua, serology, renal biopsy

50
Q

therapeutic management of nephrosis

A

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

51
Q

nursing considerations nephrosis

A

fluid volume excess r/t accumulation of fluid in tissues and third spacing
potential intravascular fluid volume deficit r/t protein and fluid loss

52
Q

main take away of glomerulonephritis

A 
\+ 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
53
Q

main take away from nephrotic syndrome

A 
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
54
Q

acute renal failure

A

caused by nephrotoxic med (vancomycin) or dehydration
for nephrotoxic need to flush system with fluids
for dehydration rehydrate body with fluid

55
Q

prevention of acute renal failure

A 
treat underlying cause
manage fluid and electrolyte disturbances
decrease BP
provide supportive therapy
Drugs: mannitol, albumin, furosemide
draw pea/ trough vancomycin levels
56
Q

chronic renal failure

A

occurs over time >6m
treated with dialysis usually peritoneal in kids
can effect bone development
watch for osteodystrophy

57
Q

prevention of osteodystrophy in chronic renal failure

A

calcium carbonate

aluminum hydroxide gel

58
Q

treatment of CHF

A

supportive therapy
dialysis
transplant

Peds Exam 3b (3 decks)

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