GU Flashcards
What is hypospadias?
Urethral opening is on the ventral surface of the penis
What are the pre op teachings for hypospadias?
do not circumcise
Ideal time for surgery, 6‑18 months-old WHY?
They respond better to anesthesia, before potty training begins
What are the post op teachings for hypospadias?
No straddle toys or hip holds
frequent assessments
non adherent dressings to protect the penis
stint care and double diapering
What is VUR?
Vesicoureteral Reflux (VUR) Regurgitation of urine from the bladder into the ureters and kidneys, can be a valvular problem leaving the kidney or caused by scarring from UTI'S
Who gets assessed for VUR?
Recurrent UTI in females
Single episode of UTI in males
Family history of VUR
How do we diagnose and treat VUR?
diagnose with a VCUG- voiding cystourethrogram
Treat with ABX prophylactically and for infection
stages 1-3, Stage 3 can be treated with ABX and surgery, stages 4- 5 need surgery
What are measures to prevent VUR?
Encourage compliance with antibiotics
Teach child to empty bladder completely
Teach good hygiene
Pre procedure prep for VCUG is?
Not on this powerpoint?
Should be age appropriate
What is a hernia?
Protrusion of a portion of an organ or organs though an abnormal opening.
Danger arises when:
Protrusion is constricted
Circulation is impaired
Interference with function or development of other structures
What is pre op care for congenital and inguinal hernia?
A BC…
Monitor respiratory
monitor fluid status
cardiac output
gastric decompression
acidosis
thermoregulation
sedation
What is the parent teaching for hernias?
Feel them to see if you can feel the intestines coming through. If you can it is an emergency, neer to go to the ER
What are the risk factors for a UTI?
there are 11 of them
Indwelling catheterization
Use of bubble bath
Constipation
Pinworms
Dysfunctional voiding; urinary stasis
Decreased fluid intake
VUR
Urologic abnormalities
Neurogenic bladder
Sexual abuse
Sexual intercourse
What is the teaching when getting a UTI?
What is the follow up after a UTI?
Take all of the medication
retest urine to make sure it is gone, right?
prevention
What is enuresis?
Involuntary passage of urine by a child > 5-years old (or past the age when voluntary control should be established) ‑ may be primary or secondary, diurnal or nocturnal
What causes enuresis?
Primary:
Familial tendency
decreased bladder capacity (age in years + 2 = oz)
developmental or maturational lag
sleep disorder, nocturnal polyuria theory (kidneys fail to concentrate urine during sleep due to insufficient ADH).
Secondary: Psychological factors abuse UTI Diabetes
How do we prevent enuresis?
Child is not lazy, nor does he wet the bed intentionally.
Do not punish child
Recommend books Dry ALL Night, Waking Up Dry
Provide Support & Encouragement
Limit intake of bladder irritants --chocolate and caffeine. Limit fluid intake after dinner make sure he voids before going to bed Use bed pads and 2 sets of sheets Use pull ups only on sleep over's. WHY? Teach use of alarms
How do we treat enuresis?
Wait for maturation -most children outgrow by age 10
Behavior modification – positive reinforcement is key
Retention/control exercises
Drug therapy: oxybutynin (Ditropan), Imipramine (neurologic side effects) or DDAVP (nasal spray or tablet)
Moisture alarm
What is HUS?
Hemolytic uremic syndrome -
Combination of hemolytic anemia and thrombocytopenia that occurs with acute renal failure.
Microthrombi in the glomerular arterioles lead to occlusion of the glomerular capillary loops and glomerulosclerosis, resulting in renal failure.
RBCs & Platelets are damaged as they move through partially occluded blood vessels.
What causes HUS?
Bacterial toxins, chemicals, & viruses Diarrhea Idiopathic Inherited Drug related Malignancies Most cases caused by verotoxin-producing strain of E. coli.
May also be Streptococcus pneumoniae or Shigella dysenteriae
Undercooked ground beef accounts for most cases. Also consuming animal feces, unpasteurized dairy and fruit products, fresh vegetables.
What is the treatment for HUS?
Maintain fluid balance
Correct hypertension, acidosis, and electrolyte abnormalities
Replenish circulating red blood cells
Provide dialysis if needed.
What do the labs look like with HUS?
Urinalysis: positive for blood, protein, pus, and casts. Serum: Elevated BUN & creatinine moderate to severe anemia mild to severe thrombocytopenia leukocytosis with left shift hyponatremia hyperkalemia hyperphosphatemia
What are the s/s of HUS?
Vomiting
Fatigue
Edema, pale
Oliguria or anuria
Elevated blood pressure
Neurologic changes; irritability, altered LOC, seizures, posturing, or coma
Abdominal pain and tenderness
What are the nursing interventions for HUS?
Contact precautions
Monitor for bleeding
Close attention to fluid volume status
Encourage adequate nutrition within dietary restrictions
Family Support
Teach preventative strategies
What is ASGN?
acute streptococcal glomerulonephritis - A condition in which immune processes injure the glomeruli. The disease can range from minimal to severe.
Most common type = acute post-streptococcal glomerulonephritis (APSG).
immune response related to untreated case of strep
What is the nursing care for ASGN?
Antibiotics if evidence of current Strep infection (fever)
Diet - No added salt, low protein (if BUN is elevated)
Control hypertension
bed rest during acute phase (which last 1-2 weeks)
Isolation from other kids that have infection because these kids are vulnerable to infection while they have APSG
Children show us they are getting better by having an increase in UOP.
What is the nursing care for nephritic syndrome?
watch BP
good I&O
daily WT
diet with no added salt
Reducing protein excretion
Reducing tissue fluid retention
Preventing infections and other complications such as anemia, infection, poor growth, peritonitis, thrombosis, and renal failure
Activity -bed rest during edema - unrestricted during remission
Diet – No Added Salt, high protein during edema - regular during remission
Drugs - Corticosteroids, immunosuppressant therapy, loop diuretics, salt poor, albumin
What are the s/s of nephrosis?
Decreased urine output
Massive proteinuria Mild hematuria
Hypoalbuminemia, hyperlipidemia
Sudden, rapid weight gain, Edema - generalized
B/P normal or slightly decreased
Pleural Effusion
Diarrhea Anorexia Pallor Muehrcke lines Frequent infections Fatigue
What is nephrotic syndrome?
Clinical syndrome that includes massive proteinuria, hypoproteinemia,
hyperlipidemia, and edema.
What causes acute renal failure?
Vancomycin - stop it and flush it out of the system
Pre-renal: Poor renal perfusion from dehydration, surgical shock, burns.
Intrinsic: diseases, nephrotoxic drugs
Post-renal: obstruction (tumor, obstructive uropathy)
What is the treatment for acute renal failure?
Prevention Treat underlying cause Manage fluid & electrolyte disturbances Decrease blood pressure Provide supportive therapy Drugs: Mannitol, albumin, furosemide
How do we treat chronic renal failure in kids?
peritoneal dialysis at night because it is easier on their systems
What chronic is an important problem to address with chronic kidney failure in kids?
osteodystrophy because it interferes with their bone development
How can we prevent osteodystrophy?
Calcium carbonate
Aluminum hydroxide gel
