GU Flashcards
-Electrolyte and water deficits in balanced proportions
-Serum sodium remains in normal limits (130–150 mEq/L)
-Hypovolemic shock is our greatest concern
Isotonic dehydration (common)
-Electrolyte deficit exceeds water deficit
-Serum sodium concentration is < 130 mEq/L
-Physical signs more severe with smaller fluid losses
Hypotonic dehydration
-Most dangerous type; water loss in excess of electrolyte loss
-Sodium serum concentration > 150 mEq/L
-Seizures likely to occur
Hypertonic dehydration
Ways fluid is lost or fluid intake is reduced
-Vomiting, diarrhea, fever, hyperventilation, burns, trauma/shock, hemorrhage, diabetes
Dehydration can cause
-sudden, rapid ECF loss
-Imbalance in electrolytes
-loss of ICF
-cellular dysfunction
-hypovolemic shock
-death
An infection of the urinary system caused by a bacteria, fungus or virus
Can start distally (cystitis)
Can be in the upper tract (pyelonephritis)
Urinary tract infection
S/Sx of UTI
Infant: poor feeding, fever, vomiting, diarrhea, colic irritability, dribbling urine
Older children: abdominal pain, flank pain, classic dysuria, vomiting, diarrhea, fever
Risk factors for UTI
Lack of circumcision in male infants
Constipation
Dysfunctional voiding pattern
Indwelling catheters or intermittent catheterization
Recent sexual intercourse
Vesicoureteral Reflux
Voiding cystourethrogram (VCUG)
fluoroscopy is used to visualize the urinary tract and bladder
Used to diagnose UTI
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.
Vesicoureteral Reflux
As vesicoureteral reflux becomes severe __________ function is affected.
kidney
Inflammation of the glomeruli causing interference w/glomeruli filtering.
Typically following a Strep infection
Can be Acute, Intermittent, and Chronic
Glomerulonephritis
S/Sx of glomerulonephritis
-gross hematuria: tea-colored or red urine
-edema (periorbital)
-HTN and HA
-ascites (severe disease)
What labs are used to diagnose glomerulonephritis?
Labs:
Serum ASO titer
Serum complement C3-positive
Urinalysis (+hematuria, proteinuria)
BUN, Creatinine-May be elevated
Antistreptolysin (ASO) is for
strep infection
Inflammation and capillary wall destruction of the glomeruli caused by an endotoxin.
Caused by E. Coli & Shigella dysenteriae
Hemolytic Uremic Syndrome (HUS)
S/sx of Hemolytic Uremic Syndrome (HUS)
-Gastroenteritis (vomiting, bloody diarrhea)
-Clinical Triad: Thrombocytopenia (Purpura), Anemia (HIGH retic count), Acute renal failure (HTN)
-Liver and/or pancreatic involvement
Elevated BUN and serum creatinine
Azotemia
Treatment for Hemolytic Uremic Syndrome (HUS)
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
Excessive proteinuria that leads to Hypoalbuminemia & Hyperlipidemia
Causes include immune responses, infections, malignant, vascular changes
Nephrotic syndrome
S/sx of Nephrotic syndrome
Edema: Periorbital to dependent
Decreased UO/Oliguria
Weight gain (can also have ascites)
HTN
Anorexia, fatigue
Vomiting & diarrhea
Growth failure, muscle wasting if prolonged
Diagnosis of Nephrotic syndrome
Urinalysis (UA)
Labs: CBC (H&H and platelets normal or increased)
Kidney biopsy may be required
Treatment for Nephrotic syndrome
-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
Testicular torsion is a surgical emergency that must be completed within
4-8 hours
Testicle rotates, twisting the spermatic cord that brings blood to scrotum
Testicular torsion
S/sx of testicle torsion
Neonate: Dusky scrotum, mass, no pain from motion.
Older males: Severe/persistent pain-begins gradually; H/O trauma/exertion; Fever, N/V
When do testicles typically descend?
by month 7 of gestation
Cryptorchidism
Undescended or Ectopic Testicles
-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
Cryptorchidism
Functional disorder of urinary tract
enuresis
Child has never had a dry night
Maturational delay, small functional bladder
No psychological cause
Primary enuresis
Child who has been reliably dry for at least 6 months begins bed-wetting
Stress, infections, sleep disorders
Secondary enuresis
Useful techniques/teaching for pts with enuresis
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
Demopressin can help treat symptoms associated with
enuresis
