GU Flashcards
Variations in the pediatric GU system: infants
Tubules have less surface area = decreased water absorption
More prone to excess fluid volume and dehydration. Cannot concentrate urine very well
Immature renal system = inability to handle increased protein intake
Sodium excretion is lower = less able to adapt to Sodium loss or excess
UOP 1-2 ml/kg/hour
Variations in the Pediatric GU system: Toddler/Preschool
Control of bladder sphincters does not occur before the age of 2
Renal system is maturing/GFR is almost at adult levels
Urethra is shorter in females vs males
UOP 0.5 ml/kg/hr
Variations in the pediatric GU system: school age
Fluid and electrolyte balance is stable
Specific gravity similar to adult
Bladder capacity increases
UOP = 0.5-1 ml/kg/hr
Variations in the pediatric GU system: adolescents
Renal function now same as adult
Bladder capacity same as adult
UOP = 40-80 ml/hr
Cryptorchidism
Failure of one or both testes to descend into the scrotum
Usually descend on their own by 6-12 months of age
Causes of crytorchidism
low testosterone
absent or defective testes
structural issues
Most at risk for crytorchidism
More common in premature infants
Complications of cryptorchidism
Infertility
Testicular cancer
Poor growth of testes
Testicular torsion
Treatment of cryptorchidism
Orchiopexy- should be done before age 2 years
Blasser exstrophy
Anomaly in which the lower portion of the abdominal wall and anterior bladder wall are missing
Draining urine will be seen (glistening)
Can be associated with malformed urethra in females and epispadias in males
Must be corrected within 48-72 hours of birth
Prior to surgery cover exposed bladder with plastic wrap or sterile bag
Post-op bladder exstrophy
Maintain alignment (avoid abduction)
Maintain skin integrity
Strict monitor of I’s and O’s
Pain management
Testicular torsion
Twisting of the testes and spermatic cord, causing vascular engorgement and ischemia
Most common cause of scrotal pain in males 12 yr+
Caused most often from trauma
EMERGENCY
90% chance of saving testes if intervention occurs within 6 hours of onset
Symptoms of testicular torsion
Scrotal pain
Severe abd pain
N/V
Scrotal swelling
Treatment of testicular torsion
Surgical treatment. If delayed will lead to necrosis requiring removal of the affected testes
Hypospadias
Meatus opens on the VENTRAL surface of the penis
Very common
Usually associated with ventral curvature of the penis (chordee)
Surgery to repair by extending the urethra into a normal position
Epispadias
Meatus open on the DORSAL surface of the penis
Rare condition
Often associated with bladder exstrophy
Surgery to repair by lengthening and straightening the penis to and creating a more distal urethral opening
Hypospadias and epispadias nursing care
Educate family NO circumcision prior to surgical repair
Typically repaired after 12 mos of age
Post-op care for hypospadias/epispadias
Monitor urinary drainage and tube/stent
Care of compression dressing
Prophylactic antibiotics
Pain management/antispasmodics
Hydrocele
Fluid filled mass in the scrotum
Presents as swelling or palpable non-tender mass in inguinal or scrotal area
Typically resolve on its own by 1 year of age
Typically painless
Typically benign and NOT associated with infertility
Inguinal hernia
Occurs when abd tissue extends into the inguinal canal
Palpable non-tender mass proximal to the scrotum
One of the most common conditions in children
Surgery is required immediately if hernia becomes incarcerated
Otherwise surgery can wait and is usually done after 3 mos. of age
What is vesicoureteral reflux (VUR)
The retrograde flow of urine from the bladder to the kidneys resulting in urine reflux into the renal pelvis causing causing hydronephrosis and kidney damage
Types of VUR
Primary VUR: congential anomaly
Secondary VUR: caused by UTI or obstruction in the urinary tract
Symptoms of VUR
Dysuria
Fever
Hematuria
Frequency
Urgency
Lethargy
Anorexia
Nocturia
Flank and/or abd pain
Vomiting
VUR treatment
Prophylactic antibiotics
Surgical resection of ureter
Prevention of UTI’s/pylonephritis
Bladder emptying education
Voiding routines
Routine VCUG and cultures
VUR diagnostics
Urinalysis
Urine culture
Renal/bladder ultrasound
VCUG
UTI
Infection involving the kidneys, ureters, bladder or urethra
Escherichia coli is responsible for 90% of all UTI’s
UTI diagnostics
UA (blood, nitrites, WBC, bacteria)
Culture w/ sensitivity
UTI risk factors
Incomplete bladder emptying
Infrequent voiding
Uncircumcised males
Improper hygiene
Females
Constipation
UTI symptoms
Fever
Anorexia
V/D
Strong smelling urine
Irritability
UTI Prevention
Teach girls to wipe front to back
Keep hydrated
No bubble baths
Cotton underwear
Urinate before and after sex
No “holding it”
Pathology of acute glomerulonephritis
Infection: post skin or pharynx infection with group A strep
Immune response: inflammation of glomeruli and obstruction from strep antibodies
Increased vascular permeability: protein, RBCs, and red cell casts excreted
Symptoms of acute glomerulonephritis
Sudden onset: hematuria, proteinuria, & RBC casts
Oliguria
COLA COLORED URINE
Mild-moderate edema
Mild-severe HTN
Abd pain
Fever
Malaise
Diagnostics for acute glomerulonephritis
UA (+ protein, RBC, WBC)
Urine specific gravity (>1.020)
Serum ESR (high)
BUN/Creatinine (High)
Antistreptolysin-O Test/ASO (+)
Treatment for acute glomerulonephritis
Bedrest
Antibiotics (7-10 days)
Antihypertensives
Diuretics
Corticosteroids
Diet –> Low Sodium
Maintain fluid volume
Follow-up for acute glomerulonephritis
UA: 2, 4, 6 weeks and 4, 6, 12 months or until UA returns to normal
Serum creatinine: 2, 6, 12 months or until UA returns to normal
Complications of acute glomerulonephritis
Hypertensive encephalopathy
Pulmonary edema
CHF
Renal failure
What is nephrotic syndrome
Disorder of the glomeruli defined by the presence of:
Massive proteinuria
Severe edema
Hyperlipidemia
Hypoalbuminemia
Hypoproteinemia
Pathology of nephrotic sydrome
Initial cause unknown –>
Glomeruli become permeable to proteins –>
Massive proteinuria & hypoalbuminemia –>
Decreased osmotic pressure –>
Fluid shifts into interstitial fluid –>
Kidneys conserve Na and water –>
Massive edema –>
Liver increases lipid production –>
Hyperlipidemia
Symptoms of nephrotic syndrome
Anorexia, irritability, fatigue
Edema (periorbital, scrotal, and labial)
Oliguria, ascites, N/V
Hypertension
Treatment of nephrotic syndrome
Corticosteroids
Diuretics
Antihypertensives
Antibiotics
Potassium supplements
Restricted sodium and high protein diet
Strict I&O and daily weight
Monitor UA and BP
Pathology of Hemolytic Uremic Syndrome (HUS)
Ingestion of E. Coli
Bloody diarrhea illness
Toxin attaches to glomeruli
Hemolytic anemia thrombocytopenia
Acute renal failure
HUS symptoms
Mild proteinuria
Decreased platelets
Bloody diarrhea
Increased BUN and creatinine
Bruising
Decreased RBC
Anorexia
HUS Treatment
Contact precautions x 17 days
Strict I&O
Diuretics
Anti-hypertensives
Renal diet
Peritoneal dialysis
RBC/Platelet infusion
Prevention education
What is primary enuresis
Most common
Child has never had a dry night
D/T maturational delay and small fx of bladder
Not associated with stress
What is secondary enuresis
Child begins bedwetting after being relatively dry for 3-6 months
IS associated with stress and psychiatric issues
Also can be D/T infection or sleep disorders
What is diurnal enuresis
Daytime incontienence
Usually d/t holding urine
Can be secondary to constipation, stress, UTI, and laughing
What is nocturnal enuresis
Nighttime bedwetting
Typically subsides on it’s own by 6 years of age
Can be secondary to increase of fluid intake at night, sleep apnea, UTI, constipation, emotional stress, sexual abuse
Management of diurnal enuresis
Rule out physical causes
Beh training:
Set voiding schedule
Increase fluids during day to increase frequency
Management of nocturnal enuresis
Rule out physical causes
Limit fluid intake after dinner
Limit caffeine and chocolate
Wake to void at 11 PM
Medications
Pull-ups when away from home
Bed alarms
