GU

Question 1

-Electrolyte and water deficits in balanced proportions
-Serum sodium remains in normal limits (130–150 mEq/L)
-Hypovolemic shock is our greatest concern

Answer 1

Isotonic dehydration (common)

Question 2

-Electrolyte deficit exceeds water deficit
-Serum sodium concentration is < 130 mEq/L
-Physical signs more severe with smaller fluid losses

Answer 2

Hypotonic dehydration

Question 3

-Most dangerous type; water loss in excess of electrolyte loss
-Sodium serum concentration > 150 mEq/L
-Seizures likely to occur

Answer 3

Hypertonic dehydration

Question 4

Ways fluid is lost or fluid intake is reduced

Answer 4

-Vomiting, diarrhea, fever, hyperventilation, burns, trauma/shock, hemorrhage, diabetes

Question 5

Dehydration can cause

Answer 5

-sudden, rapid ECF loss
-Imbalance in electrolytes
-loss of ICF
-cellular dysfunction
-hypovolemic shock
-death

Question 6

An infection of the urinary system caused by a bacteria, fungus or virus
Can start distally (cystitis)
Can be in the upper tract (pyelonephritis)

Answer 6

Urinary tract infection

Question 7

S/Sx of UTI

Answer 7

Infant: poor feeding, fever, vomiting, diarrhea, colic irritability, dribbling urine

Older children: abdominal pain, flank pain, classic dysuria, vomiting, diarrhea, fever

Question 8

Risk factors for UTI

Answer 8

Lack of circumcision in male infants
Constipation
Dysfunctional voiding pattern
Indwelling catheters or intermittent catheterization
Recent sexual intercourse
Vesicoureteral Reflux

Question 9

Voiding cystourethrogram (VCUG)

Answer 9

fluoroscopy is used to visualize the urinary tract and bladder

Used to diagnose UTI

Question 10

Structural abnormality that causes urine to backflow from bladder to the ureters and kidneys most commonly seen in infants & young children. Diagnosed after UTI/recurrent UTIs.

Answer 10

Vesicoureteral Reflux

Question 11

As vesicoureteral reflux becomes severe __________ function is affected.

Answer 11

kidney

Question 12

Inflammation of the glomeruli causing interference w/glomeruli filtering.
Typically following a Strep infection
Can be Acute, Intermittent, and Chronic

Answer 12

Glomerulonephritis

Question 13

S/Sx of glomerulonephritis

Answer 13

-gross hematuria: tea-colored or red urine
-edema (periorbital)
-HTN and HA
-ascites (severe disease)

Question 14

What labs are used to diagnose glomerulonephritis?

Answer 14

Labs:
Serum ASO titer
Serum complement C3-positive
Urinalysis (+hematuria, proteinuria)
BUN, Creatinine-May be elevated

Question 15

Antistreptolysin (ASO) is for

Answer 15

strep infection

Question 16

Inflammation and capillary wall destruction of the glomeruli caused by an endotoxin.

Caused by E. Coli & Shigella dysenteriae

Answer 16

Hemolytic Uremic Syndrome (HUS)

Question 17

S/sx of Hemolytic Uremic Syndrome (HUS)

Answer 17

-Gastroenteritis (vomiting, bloody diarrhea)
-Clinical Triad: Thrombocytopenia (Purpura), Anemia (HIGH retic count), Acute renal failure (HTN)
-Liver and/or pancreatic involvement

Question 18

Elevated BUN and serum creatinine

Answer 18

Azotemia

Question 19

Treatment for Hemolytic Uremic Syndrome (HUS)

Answer 19

Fluid and Electrolyte balance: I&O, Daily weights, ABGs, EKG, electrolytes, edema
Nutritional support
Treatment of anemia, bleeding
Control HTN, watch for CHF
Monitor LOC-Watch ICP, control seizures
Control azotemia: may need dialysis
Supportive care

Question 20

Excessive proteinuria that leads to Hypoalbuminemia & Hyperlipidemia

Causes include immune responses, infections, malignant, vascular changes

Answer 20

Nephrotic syndrome

Question 21

S/sx of Nephrotic syndrome

Answer 21

Edema: Periorbital to dependent
Decreased UO/Oliguria
Weight gain (can also have ascites)
HTN
Anorexia, fatigue
Vomiting & diarrhea
Growth failure, muscle wasting if prolonged

Question 22

Diagnosis of Nephrotic syndrome

Answer 22

Urinalysis (UA)
Labs: CBC (H&H and platelets normal or increased)
Kidney biopsy may be required

Question 23

Treatment for Nephrotic syndrome

Answer 23

-Monitor Fluid and electrolytes: Weight, I&O, edema, BUN
-Diuretics
-Albumin Replacement
-Diet: Moderate protein, Low to moderate Na, Low saturated fat
-Immunosuppression (Reduce Proteinuria): Steroids until no proteinuria for 10-14days
-U/A: protein

Question 24

Testicular torsion is a surgical emergency that must be completed within

Answer 24

4-8 hours

Question 25

Testicle rotates, twisting the spermatic cord that brings blood to scrotum

Answer 25

Testicular torsion

Question 26

S/sx of testicle torsion

Answer 26

Neonate: Dusky scrotum, mass, no pain from motion.

Older males: Severe/persistent pain-begins gradually; H/O trauma/exertion; Fever, N/V

Question 27

When do testicles typically descend?

Answer 27

by month 7 of gestation

Question 28

Cryptorchidism

Answer 28

Undescended or Ectopic Testicles

Question 29

-Common, congenital
85% Unilateral, right

-Hormonal or anatomical

-May descend spontaneously in
1st 3 months of life
Particularly in preemies
After 1yr unlikely

-Surgery-benefit for infertility (still risk)
Done at 6-12 mos.

-Long-term monitoring for cancer

Answer 29

Cryptorchidism

Question 30

Functional disorder of urinary tract

Answer 30

enuresis

Question 31

Child has never had a dry night
Maturational delay, small functional bladder
No psychological cause

Answer 31

Primary enuresis

Question 32

Child who has been reliably dry for at least 6 months begins bed-wetting
Stress, infections, sleep disorders

Answer 32

Secondary enuresis

Question 33

Useful techniques/teaching for pts with enuresis

Answer 33

Avoid fluids close to bedtime
Avoid diuretic foods (coffee, chocolate, colas)
Reward charts
Mattress pads with alarms
Watches with reminders to void
Books on staying dry
Absorbent underwear

Question 34

Demopressin can help treat symptoms associated with

Answer 34

enuresis