GU Flashcards
general nc
weight, I+O, BP (manual)
lots of prep for child and parent for test
specimen collection - newborn (cotton balls, bags, in and out cath is best)
hypospadias tm
sx (stages) - void standing, improve physical appearance, preserve functionality (procreate)
ideal time for sx is 6-18 mo - time for anesthesia safe and before they know theres something wrong
hypospadias nc
examine newborn carefully, delay circumcision if any question (need foreskin), psych prep of parent and child
hypospadias post op nc
pressure dressing - check tip frequently, dont change dressing
catheter/stent care: closed drainage
double diaper (drain stent, if open system)
teach home care (no tub bath with external stent or cath (48hrs), no sandbox, no straddle toys, dont carry on hip)
cryptorchidism tm
ultrasonography or sx exploration - locate
treatment <1yr
med: HCG - not really US
sx: 6-24 mo
teach: increased risk of testicular cancer 30s - 40s
check during well child exams, will sometimes come out in warm env
obstructive uropathy tm
sx correction if needed(strictures), monitor BP, prep parents and children, close obs for post op complications, protect and care for catheters (pain), teach home care (cath care)
if constipated - just clean out
vesicoureteral reflux (VUR) tm
voiding cystourethrogram (VCUG) - protect kidneys from scaring
med: abx until they go to sx or until they grow out of condition - give abx at night (most stasis)
sx: when abx dont work or severe reflux - reimplant ureters
VUR nc preop
prevent infection - abx compliance - night, empty bladder completely - send to bathroom several times, teach good hygiene - uti hygiene
screen siblings - familial tendency
age appropriate prep for sx
VUR nc postop
care for catheters and stents (no tub bath, clean, bag below bladder, pericare, empty freq, closed system), admin analgesics (spasms with internal stent) and antispasmodics, teach home care: prophylactic abx for 1-2 mo until body adjusts
hernia tm
immediate med attention: intubation, GI decompression, IV fluids, will need sx
can usually be fixed prenatally
hernia nc preop
monitor resp and fluid status, will monitor heart, acidosis, thermoregulation (warm), CO, sedation, gastric decompression (ng)
nicu
hernia nc postop
continue ventilation, moinitor acidosis, fluid status, DI decompression, thermoregulation, sedation, pain control, CO, parental bonding
UTI tm
cure infection, identify predisposing factor, prevent recurrent
uti nc
appropriate and careful specimen collection and handling, abx admin (bactrin, no amoxicillin), push fluids, promote comfort, adequate followup cultures, teach prevention
no bubble bath (tub good), no tight fitting clothes, empty bladder, schedules times, lots of fluid, pee after sex, change sanitary pads freq, cotton underwear, wipe front to back, finish abx, pain meds
return to clinic 7-10 days later - reflux if recurrent, check
enuresis tm
urine sample (urinalysis), wait for maturation (most outgrow by 10), retention/control exercise, moisture alarm, behavior mod (+ reinforcement)
assess home life, get fingerstick
keigle exercise, exercise, abd tone
drugs (sleepovers, not consistent basis): oxybutinin, imipramine, DDVAP
moisture alarm
behavior mod (+ reinforcement)
enuresis nc
not lazy, not intentional; dont punish, recommend books, limit irritants (chocolate and caffeine), limit fluid intake after dinner and void before bed get them up when theyre sleeping to go potty, bed pads and 2 sets of sheets, pull ups on sleepovers only (wick away moisture), alarm use, support and encouragement (grace chart, + reinforcement)
HUS tm
maintain fluid balance, correct htn, acidosis, e abnormalities; replenish rbc, dialysis if needed
HUS nc
contact, close attention to fluid volume status, fam support, encourage adequate nutrition within dietary restrictions, monitor for bleeding, teach prevention
nephrosis tm
reduce protein excretion (steroids 6-10 days, oral), reduce tissue fluid retention (albumin, lasix), prevent infections, anemia, poor growth, peritonitis, thrombosis, renal fail
bed rest with edema, unrestricted during remission
no added salt, high protein during edema, regular during remission
drugs: corticosteroids, immunosuppressant, loop diuretics, salt poor albumin
nephrosis nc
fluid volume excess - accumulation of fluid in tissues and third spaces
IV fluid volume deficit - protein and fluid loss
infection - decreases resistance, steroids, fluid overload
impaired skin integrity - edema, lowered body defenses
altered nutrition - less than body requirements, loss of appetite and protein
ineffective breathing pattern - ascites (edema)
body image
activity intol
altered fam processes
knowledge deficit
APSG tm
bed rest during acute (1-2 wk, usually self limited), no salt, low protein if BUN elevated, control htn (manual bp q 4 hrs, maybe prn meds), abx if fever, isolate from other sick kids
get better = higher UOP
APSG nc - fluid volume excess
daily weight, accurate I+O, urine specific gravity, monitor hematuria, BP, e imbalance, s of cardiopulmonary congestion, safe diuretics admin, prevent infection
APSG nc - injury (renal fail, encephalopathy, seizure)
buildup of toxins they are not peeing out
s/s of renal fail
careful neuro eval
seizure precautions
APSG nc - knowledge deficit
teach p: how to take BP, diet, monitor urine output and color
ARF tm
prevent, treat underlying cause (dehyd or nepHrotoxic meds - vancomyocin: peak and trough, stop med and give lots of fluids), F+E disturbance, decrease BP, supportive
drugs: mannitol, albumin, furosemide
ARF nc
VS and I+O, regulate fluid intake, nutrition, monitor for complications, support and comfort
when urine output is restored, diuresis may be significant
CFR tm
support therapy, dialysis, transplant
CRF supportive therapy
diet: decrease excretory demands, minimize metabolic bone disease, minimize fluid and electrolyte disturbance (Ca low and P high), maintain sufficient cals, need adequate protein (eat foods high in biologic value, but low P)
vits
prevent osteodystrophy: CaCO2, aluminum hydroxide gel
met acidosis, growth failure, anemia, htn, infections
CRF dialysis
peritoneal: osmosis and diffusion
hemodialysis
CRF renal transplant
preferred in children
more compatible with normal life than dialysis
living related donor or cadaver donor
drug induced immunosuppression
rejection!!!
CRF nc
fluid and e imbalance (acidosis), activity unrestricted, nutrition, prevent osteodystrophy, body image, assess for worsening uremia or met acidosis, altered fam processes, no fleet enemas (can increase P)
hypospadias
urethral opening on ventral surface
can cause urinary stasis - UTIs, body image disturbance
epispadias = less common, usually accompanied by another problem
obstructive neuropathy cm
recurrent uti, incont, fever, flank or abd pain, foul smelling urine, hematuria, dysruia, polyuria, polydipsia, urgency, anemia, ftt, nocturnal enuresis
obstructive neuropathy
obstruction at any level of urinary tract
blockage of urine produces dilation of affected kidney (hydronephrosis)
cryptorchidism
one or both testicles fail to descend into scrotum, often associated with hypospadias
VUR
regurgitation of urine from bladder into ureters and kidneys - stasis
lead to repeated uti (long term kidney damage - dialysis kidney failure), htn, renal insufficiency or failure
familial is usually outgrown
hernia
protrusion of portion of organ or organs through abd opening
diaphragmatic hernia
hole in diaphragm
late in dev = better outcome (heart and lungs able to grow to better size)
uti
usually ecoli, hypospadias, F, no prosthetic secretions, uncircumsized
uti s/s - infants
weight loss! v!
fever, ftt, d
uti s/s - children
dysuria!
freq, urgency, incont, foul smell, hematuria, abd pain, fever
enuresis
involuntary passage of urine by child > 5
primary or secondary
constipation (KUB), uti, dm
HUS
hemolytic anemia and thrombocytopenia that occurs with acute renal failure
watery diarrhea -> hemorrhagic colitis - > hemolytic anemia and thrombocytopenia
from toxin ingestion (usually ecoli)
low rbc and platelets
HUS s/s
confused with gastroenteritis
v, marked pallor, oliguria or anuria, edema, fatigue, elevated bp, abd pain and tenderness, neurologic changes, irritable, altered LOC, seizures, posturing, coma
nephrotic syndrome
massive proteinuria, hypoproteinemia, hyperlipidemia, edema (no protein in blood)
in blood: protein low, cholesterol up
s/s gu disease - newborns
poor feed, resp distress, poor stream, jaundice, seizures, dehyd, v
s/s gu disease - infants
poor feed, pallor, no weight gain, fever, persistent diaper rash, seizures, dehyd, v
s/s gu disease - children
freq, painful, enlarged kidney or bladder, thirst, foul smell, poor appetite, pallor fatigue, enuresis, edema, hematuria, abd or back pain, htn, tetany, growth failure
VCUG test
insert cath, inject dye, watch child urinate under xray to test for reflux causing recurrent UTI leading to scarring
girls: 2-3+ utis
boys: 1-2+ utis
uncomfortable, need to be still, lots of prep
assessment
ear and kidneys dev at same time
VUR - assessment
recurrent uti in F
single uti = teach, if 2 then send for vcug (prostate secretions)
fam hx
conduct VCUG
diaphragmatic hernia s/s
usually detect in utero
resp distress, cyanosis, scaphoid abd, impaired CO
listen to heart in different area (right side)
umbilical hernia
abd wall
bigger when poop, cry, strain, angry
can push flat - feel air and fluid (intestines = emergency, ischemia)
usually resolve on own
can resolve with sx
inguinal hernia
severe - lower abd wall, intestines more likely to come out
parents need to push on it, if they feel intestines, go straight to ED
asymp, painless (if pain = ED)
HUS lab findings
urinalysis: + blood, protein, pis, casts
serum: elevated BUN and creatinine (kidney failure), mod - severe anemia, mild - severe thrombocytopenia, leukocytosis with L shift, hypoNa, hyperK, hyperP
HUS complications
chronic renal fail, seizures and coma, pancreatitis, intussusception, rectal prolapse, cardiomyopathy, congestive heart failure, acute resp distress syndrome
HUS tm
treat s
maintain fluid balance, correct htn, acidosis, e abnormalities; replenish rbc, dialysis prn (CRT - not as hard or permanent, longer)
no abx - doest work
HUS nc
contact - can shed for weeks
attention to fluid (I+O), fam support (dont know if child will get better or when, lots of complications), adequate nutrition w/n restrictions (low Na, fluid restrict), monitor for bleed (platelets low), teach prevention (cook meat - temp not color, pasturized food, wash fruits and veggies, no well water, HH)
nephrosis cm
massive proteinuria, sudden, rapid weight gain, edema (generalized), pleural effusion, decreased UOP, d, anorexia, pallor, muechrecke lines (nails), bp normal or slightly decreased, freq infections, fatigue, hypoalbuminemia, hld, mild hematuria
peritonitis - measure abd girth
nephrosis diagnosis
urinalysis, serology
renal biopsy: info about glomerular status and type of nephrotic syndrome
acute glomerulonephritis
immune processes injure glomeruli
range from minimal to severe
strep
APSG cm
fever (active infection only), lethargy, fatigue, malaise, weakness, HA, anorexia or v, puffy face, urine discolored (coke and frothy) with decreased volume, edema and weight gain, pallor, flank or abd pain, htn and s/s of circulatory overload
will have protein in urine - not as much as nephrosis
HA!!! - htn, pain meds, monitor
APSG diagnosis
urinalysis: gross hematuria, mild proteinuria, specific gravity elevated
culture: - (not infection)
serology: normal e (watch K), elevated ASO titer, BUN, creatinine, and sed rate (ESR), rbc may be low
