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Module 5 (Pediatrics) > GU Dysfunction > Flashcards

GU Dysfunction Flashcards

1
Q

Urinary Tract Disorders/Disease S/S
birth to 1 mn.

A

Poor feeding
Vomiting
Failure to gain weight
Rapid respiration (acidosis)
Respiratory distress
Spontaneous pneumothorax or pneumomediastinum
Frequent urination
Screaming on urination
Poor urine stream
Jaundice
Seizures
Dehydration
Other anomalies or stigmata
Enlarged kidneys or bladder

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2
Q

Urinary Tract Disorders/Disease S/S
1 -24 months

A

Poor feeding
Vomiting
Failure to gain weight
Excessive thirst
Frequent urination
Straining or screaming on urination
Foul-smelling urine
Pallor
Fever
Persistent diaper rash
Seizures (with or without fever)
Dehydration
Enlarged kidneys or bladder

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3
Q

Urinary Tract Disorders/Disease S/S
2-14 y/o

A

Poor appetite
Vomiting
Growth failure
Excessive thirst
Enuresis, incontinence, frequent urination
Painful urination
Swelling of face
Seizures
Pallor
Fatigue
Blood in urine
Abdominal or back pain
Edema
Hypertension
Tetany

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4
Q

Prevention of UTIs

A

prevent contamination
- front to back (after voiding and defecating)
- children should void as quickly as they feel the urge
no tight clothing or diapers (wear cotton panties )
empty bladder completely (double-voiding)
no constipation
encourage adequate fluid intake

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5
Q

What gender has the most UTIs?

A

females - shorter urethra

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6
Q

If the female is sexually active, then they are advised to

A

urinate after intercourse
low-dose antibiotics if recurrent

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7
Q

Inguinal hernia

A

Protrusion of abdominal contents through the inguinal canal into
scrotum

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8
Q

Inguinal hernia tx

A

Detected as painless inguinal swelling of variable size
Surgical closure of inguinal defect

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9
Q

Hydrocele

A

Fluid in scrotum

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10
Q

Hydrocele tx

A

Surgical repair indicated if persists past 1 year old

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11
Q

Phimosis

A

Narrowing or stenosis of the preputial opening of the foreskin

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12
Q

Phimosis tx

A

Mild cases: May not require therapy if urine flow not obstructed; steroid cream may be prescribed,
typically twice a day for one month
Severe cases: Circumcision or dorsal slit in severe, rare cases

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13
Q

Hypospadias

A

Urethral opening located behind glans penis or anywhere along
ventral surface of the penile shaft

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14
Q

Hypospadias tx

A

Enable child to void in standing position and direct stream voluntarily in usual manner
* Improve physical appearance of genitalia
* Produce a sexually adequate organ

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15
Q

Chordee

A

Ventral curvature of the penis, often associated with hypospadias

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16
Q

Chordee tx

A

Surgical release of fibrous band causing the deformity

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17
Q

Epispadias

A

Meatal opening is located on the dorsal surface of the penis

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18
Q

Epispadias tx

A

Surgical correction, usually including penile and urethral lengthening and bladder neck
reconstruction (if necessary)

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19
Q

Cryptorchidism

A

Failure of one or both testes to descend normally through the inguinal canal

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20
Q

Cryptorchidism tx

A

Detected by the inability to palpate testes within the scrotum
Medical: Administration of hormonal therapy has historically been used in some centers to induce
testicular descent but is controversial and not currently recommended
Surgical: Orchiopexy
Objectives of therapy: Place and fix viable undescended testes in a normal scrotal position or remove
nonviable testicular remnants
Allows for easier examination of the testis because there is an increased risk of testicular cancer in
undescended testes; early surgical correction may reduce the risk of cancer as well as infertility
Decrease risk of trauma and torsion
Decrease the risk of inguinal hernia by closing the inguinal canal
Potentially improved body satisfaction

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21
Q

Exstrophy of bladder

A

Eversion of the posterior bladder through the anterior bladder wall
and lower abdominal wall; associated with an open pubic arch (a severe defect)

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22
Q

Exstrophy of bladder tx

A
  • Preserve renal function
  • Attain urinary control
  • Provide adequate reconstructive repair
  • Improve sexual function
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23
Q

UTI increased risk in

A

Females > than males
Urinary Stasis
Uncircumcised males less than 3 months of age and females younger than 12 months have the highest prevalence of UTIs
unexplained fevers

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24
Q

UTIs can lead to

A

Cystitis
Pyelonephritis
urosepsis with kidneys stopping

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25
Q

Kidney damage if a UTI is less than

A

a year

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26
Q

Path reasons of UTIs

A

E. coli

Gram-negative organisms

Anatomic factors in females

Diapers

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27
Q

If the baby ever has an unexplained fever, then you need to evaluate for what

A

UTI

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28
Q

Urinary Stasis S/S (after toilet training)

A

incontinence in a toilet-trained child (Enuresis)
strong-smelling urine
urinary frequency or urgency
pain with urination (dysuria)
Fever
Hematuria

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29
Q

Urinary stasis is the

A

urine sits in the bladder bringing bacteria to infection

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30
Q

Urinary stasis caused by

A

neurological (neurogenic bladder)
spinal problem
no stopping while playing
not complete emptying all the way (neurogenic)
blood in urine for all ages
Newborn

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31
Q

Newborn urinary stasis s/s

A

fussy,
cry,
stop eating,
difficult to console,
go to the restroom in pain,
typically fever
diarrhea or jaundice,
different urine odor,
pink tint to the urine (blood)

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32
Q

Toddlers urinary stasis s/s

A

easier to say hurts when they go to the bathroom, grab themselves
Accidents if toilet trained

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33
Q

In preschoolers and up, what are the s/s of urinary stasis?

A

increased frequency and urgency

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34
Q

In UTI, the UA shows

A

nitrate, leukocytes, blood, cloudy, smell foul

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35
Q

Urine cultures are used to

A

identify bacteria and meds sensitivity to

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36
Q

Can you identify a UTI based on only s/s?
If no, then what is the definitive way to determine a UTI?

A

No
- UA, urine culture and sensitivity

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37
Q

Urine Non-sterile Specimen Collections for children

A
  • Non-sterile Cotton ball in diaper in a syringe and push down in syringe (not mixed with poop)
  • Bagged (nonsterile) attached to the kid and into the bag
  • Midstream clean catch (non-sterile) for older children
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38
Q

Before doing a midstream clean catch, what needs to be done?

A

peri care

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39
Q

What is a sterile catheter specimen used in children?

A

suprapubic tap aspiration (physician only-PICU)
bladder catheterization (straight cath)

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40
Q

pH normal range

A

4.8-7.8

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41
Q

If you have a positive in the UA, what does that mean?

A

red flag
- occasional in casts
- negative protein, glucose, ketones, leukocyte esterase, and nitrites is normal

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42
Q

UTI Tx

A

Antibiotics
increase fluids
- proper peri care
- void and frequent diaper checks
- double voiding
Preserve renal functions

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43
Q

UA final result in

A

72 hours

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44
Q

What antibiotics are used in UTIs?

A

Penicillin
Sulfonmide
Cephalosporins
- finish all

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45
Q

To avoid a UTI, what should you avoid?

A

bubble baths or with irritates (salts, )

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46
Q

If the UTIs are recurrent, what procedures need to be done?

A

bladder scan
voiding Cystourograph (Cath in bladder and inject dye, pictures from in and out) - VCG

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47
Q

Voiding Cystourograph need to know I
F THEY ARE POTTY TRAINED and with the dye

A

If potty trained, it’s okay if they have an accident on the table
Kidney functions – Output, GFR, Creatinine, and BUN
Shellfish and iodine allergies
Drink plenty of fluids to flush out all the dye

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48
Q

Prevention for a female adolescent against UTIs

A

double voiding and voiding after intercourse

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49
Q

Kidney function labs

A

Creatinine and BUN

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50
Q

Vesicoureteral Reflux (VUR)

A

The abnormal flow of urine from the bladder into the ureters
-backflow

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51
Q

Primary VUR

A

most common, congenitally misplacement of the ureters on the bladder being too low
- the ureter is too low and goes up

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52
Q

Secondary VUR

A

WITH NEUROGENIC BLADDER

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53
Q

VUR patients typically have frequent

A

kidney infections (Pyelonephritis)

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54
Q

What lab will show the SEVERITY of reflux backflow of urine in the ureters?

A

VCUG
- contrast injected into the bladder through a cath
- pics before, during, and after
Grading
LET THEM KNOW THAT ACCIDENTS ARE OKAY ON THE TABLE!

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55
Q

Grade 1 VUR

A

least ONLY in the ureters

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56
Q

Grade 2 VUR

A

in the renal pelvis
- kidney middle

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57
Q

Grade 3 VUR

A

renal pelvis
causes mild pyelonephritis

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58
Q

Grade 4 VUR

A

moderate pyelonephritis

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59
Q

Grade 5 VUR

A

Most
Severe hydronephrosis causing ureter to twist causing obstruction

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60
Q

Grade 1-3 VUR Tx

A

Conservative - bladder grows over (age 5) and move to the right spots in less reflux

Daily low-dose antibiotic therapy

Annual VCUG

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61
Q

Grade 4-5 VUR Tx

A

typ. do not resolve by themselves
Surgical -
Ureteral reimplantation
- from side to top of the bladder

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62
Q

Indications for surgery in VUR if a grade 1-3

A

severe forms of VUR
- risk of damaged kidney permanent
not resolved by 4-5 y/o
renal scarring
significant anatomic abnormality
Noncompliance with medical therapy
antibiotic intolerance
infrequent access to the health care system

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63
Q

How to prevent VUR?

A

PREVENT BACTERIA FROM REACHING KIDNEYS
- increase fluids (water, no spicy foods or caffeine)
- avoid unnecessary cath
- Double voiding
- Dailyprophylactic antibiotics
Routine cultures (2-3 months) and PRN if fever

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64
Q

The bladder will grow into place at what age?

A

5 y/o

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65
Q

Obstructive Uropathy

A

Structural or functional abnormality of the urinary system that obstructs the normal flow of urine, producing renal disorders.
1 or both kidneys
congenital/acquired

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66
Q

Obstructive uropathy is more prevalent in

A

boys

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67
Q

Obstructive uropathy obstruction can occur

A

at any level of the urinary tract

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68
Q

Congenital obstructive uropathy

A

anatomic conditions
neurological conditions
functional condition

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69
Q

Obstructive Uroppathy Patho

A

obstruction
damage to distal nephrons
altered ability to concentrate urine
increased urine flow
decreased excretion of acid
urine pools
Hydronephrosis
UTI
repeat to damage distal nephrons

70
Q

Inguinal Hernia

A

Protrusion of abdominal contents through inguinal canal into scrotum
-5% newborns and 11% preterm

71
Q

Tx of inguinal hernia

A

surgical closure of defect

72
Q

Is an inguinal hernia painful?

A

no, generally painless
- unless stragulation or vascular compromise becomes painful

73
Q

Hydrocele

A

fluid in scrotum
- perioneal fluid overproduction or defect with absorption

74
Q

Hydrocele is usally solved by

A

self

75
Q

Hydrocele if not resolved in 1 year then it needs

A

surgical repair (hydrocelectomy)

76
Q

If the scrotum glows through with a flashlight, then it is what

A

Hydrocele - fluid

77
Q

If the scrotum does not glow through with a flashlight, then it is what

A

Mass

78
Q

If the newborn or preterm has a hydrocele, what was the typical cause?

A

peritoneal fluid

79
Q

If the older child has a hydrocele, what was the typical cause?

A

trauma

80
Q

Post-Op of Hydrocelectomy

A

swelling is normal and surgery in the perineal area
- child can not ride on straddle toys for 2-4 weeks for healing
- limit strenuous activity for a month (difficult in toddlers)

81
Q

What toys need to be avoided after hydrocelectomy?

A

no riding on straddle toys for 2-4 weeks due to healing
- limit strenous activity for a month

82
Q

Phimosis

A

Narrowing or stenosis of the opening of the foreskin

Inability to retract the foreskin (tight rubber band around the tip)

83
Q

Tx of Phismosis

A

Mild not forcible: manual foreskin retraction
- resolves with growth and occasional flow decrease (balloon foreskin)
Moderate: Steroid cream BID for 1 month
severe: circumcision or vertical division of foreskin

84
Q

What type of cleaning is used in Phimosis for routine baths?

A

sterile

85
Q

Phimosis Teachings

A

do not force the foreskin as it can cause damage
sterile cleansing with bathing

86
Q

Hypospadias

A

Urethral opening located below or behind the glans penis or anywhere along the ventral surface of the penile shaft

87
Q

Hypospadias Tx

A

surgical correction

88
Q

What warning needs to be given to parents of a child with hypospadias?

A

can not have a circumcision until after the repair bc dr will possibly use the foreskin to seal the area

89
Q

Why does the surgery of hypospadias need to be done quickly?

A

allow the child to void standing up and adulthood adequate sexual organ
before 6-12 months before developing body image

90
Q

What needs to be avoided with Hypospadias?

A

avoid straddling and peri clean the area

91
Q

Cryptorchidism

A

Failure of one or both testes to descend normally through the inguinal canal into the scrotum

92
Q

Cryptorchidism Tx

A

orchiopexy
- Surgical = releases the teste into the scrotum
- might have a button on post-op then remove when done

93
Q

If Cryptorchidism is not corrected, then

A

increase for malignancy and infertility

94
Q

Nursing considerations for external defects of children

A

Routine preop/postop care (child life explained)

Tub baths discouraged for a few days to week

Possibly catheter care

Activity restriction – no straddle, lifting, vigorous play, (spell out because of concrete thinking), infection s/s and skin care

Parental support - Infection s/s

95
Q

Avoid what activities during external defects of children post-op

A

no straddle, lifting, vigorous play, (spell out because of concrete thinking), infection s/s and skin care

96
Q

Nephrotic Syndrome aka

A

Glomerular Dzs

97
Q

Nephrotic Syndrome characterized by

A

increased glomerular permeability to plasma protein, which results in massive urinary protein loss.

98
Q

What protein is lost in the urine when not working correctly?
-In Nephrotic Syndrome-

A

Albumin
- massive protein loss in urine

99
Q

Nephrotic Syndrome is caused by

A

Idiopathic 80%
Idiopathic Nephrosis,
MCNS, (minimal chnage nephrotic syndrome)
Lupus,
toxins (secondary)
congenital

100
Q

What gender most likely has Nephrotic Syndrome?

A

males 2x
(also RSV correlation)

101
Q

Nephrotic Syndrome is seen between these years

A

Peak 2-3 y/o and can see up to 7 y/o

102
Q

Nephrotic Syndrome is these major s/s

A

proteinuria
hypoalbuminemia (low protein in the blood)
hyperlipidemia (high fat in the blood)
edema

103
Q

Protienuria is greater than ___ + on dipstick

A

2

104
Q

Nephrotic Syndrome Patho

A

The glomerular membrane becomes permeable to proteins, especially albumin
Proteins lost in the urine (Hypoproteinemia and massive proteinuria)
serum albumin level decrease (hypoalbuminemia)
osmotic pressure in the cap decreases
vascular pressure exceeds the pull of osmotic pressure
fluid accumulates in intestinal spaces 1(edema)
shift fluid from plasma to interstitial spaces reduces vascular vol (hypovolemia)
RAAS stimulated
ADH and aldosterone secreted
Reabsorption of Na and water in an attempt to increase intravascular vol

105
Q

S/S of Nephrotic Syndrome

A

Weight gain in a seemingly well child
- facial and periorbital
Edema
pattern
gaining fluid weight but losing true body weight
- ascites
- pleural effusion

Massive proteinuria
Hypoalbuminemia
Hyperlipidemia
Anorexia (low appetite)
Irritability
Decreased activity - self-limit

106
Q

Edema s/s

A

ascites
pleural effusion (Fever, chest pain, dyspnea, and nonproductive cough)

107
Q

Hyperlipidemia is seen in Nephrotic Syndrome by

A
108
Q

Nephrotic Syndrome has a high risk of infection and

A

losing immunoglobulins (for immune response)
-** avoiding infectious areas and staying in clean space**
- avoid crowds

109
Q

What is a hallmark of massive proteinuria (Nephrotic Syndrome)

A

venous thrombosis

110
Q

Nephrotic Syndrome UA indications

A

Decreased volume (RETAIN FLUID)
dark and frothy
Froth = proteins
Massive Proteinuria
greater than 2+
May have a few RBCs
- Not gross/large blood in the urine

111
Q

Froth in urine is

A

proteins

112
Q

Nephrotic Syndrome relationship to volume

A

retain volume

113
Q

Is the GFR impacted by Nephrotic Syndrome?

A

no, but do Creatinine and BUN

114
Q

Nephrotic Syndrome Tx

A
  • 1st line: corticosteroids (prednisone) for 6 weeks
  • Cyclophosphamide or cyclosporine (immunosuppressants)
    = cannot tolerate prednisone or who have repeated relapses, too many side effects
  • Possibly furosemide to provide temporary relief from edema
  • Possibly 25% albumin
    decreases edema
    increases plasma and protein
115
Q

If the child does not tolerate steroids, repeated relapses, or too many side effects, then they can use what for nephrotic syndrome?

A

Cyclophosphamide or cyclosporine (immunosuppressants)

116
Q

Relapse of Nephrotic Syndrome triggers

A

allergies, immunizations, bacterial or viral infection
2/3 of children will have a relapse
Dx early bc routine dipstick (2+ protein in urine)
Repeat but shorter length high dose steroid therapy

117
Q

Nursing Considerations for Nephrotic Syndrome while in the hospital/labs

A

Strict I&Os plus daily weight
- fluid restriction
- cotton ball method not potty
Thermoregulation - keep warm
Prevention of infection (hygiene, avoiding sick contact)
- minimize complications
Assessment of edema (skincare)
- abdominal circumference
- level/location(s) of swelling
- degree of pitting
- lung assess
Loss of appetite/diet (Na restricted diet)
Long-term steroid use
Home care for relapse(s)

118
Q

How do you evaluate for edema in children?

A

abdominal circumference
- level/location(s) of swelling
- degree of pitting
- lung assess

119
Q

Why are collection bags generally not used for UA?

A

skin breakdown and avoid infections
- cotton ball preferred

120
Q

Edema s/s

A

Wt gain, insomnia, irritability, unwanted male apttern hair growth in females, growth retardation, HTN, GI bleed, bone demineralization, risk of infection, raises Blood sugar

121
Q

acute glomerulonephritis is characterized by

A

inflammatory injury in the glomerulus, most caused by an immunological reaction
unknown patho

122
Q

What is the most common cause of acute glomerulonephritis?

A

strep (winter and spring)
Impetigo (pyoderma) - summer and fall
10-21 days onset

123
Q

acute glomerulonephritis caused by

A

Immunological/Autoimmune diseases
Following strep infection of the pharynx or skin
- Acute: 2-3 after infection
- Chronic: after the acute phase or slowly over time
History of pharyngitis or tonsillitis 2-3 weeks before symptoms

124
Q

acute glomerulonephritis patho

A

Immune complexes depsoti in glomerular basement membrane
increase glomerular membrane permeablity to RBCs and proteins (gross hematuria and proteinuria)
glomeruli edematous and infiltrated with leukocytes
cap lumen occluded
decreased cap flow and decrease in plasma filtration
excessive accumulation of water and retention of Na
interstiital fluid and plasma vol expand
circulatory congestion (edema, HTN)

125
Q

acute glomerulonephritis s/s

A

HA, tired, low appetite
Edema - especially periorbital
Morning than later
Mild if unfamiliar may seem normal

Urine:
**cloudy, tea/cola-colored
parallel proteinuria & hematuria
Blood and protein (2+ and 2+)
Increase BUN and creatinine abnormal increase
- negative strep test
Azotemia
ASO titer – measure against antibodies for the strep

HTN

126
Q

What is the main difference between acute glomerulonephritis and nephrotic syndrome?

A

acute glomerulonephritis has massive blood in urine
both have large proteins in the urine

127
Q

Azotemia

A

abnormal increase of BUN and Creatinine

128
Q

Dietary restrictions of acute glomerulonephritis

A

moderate sodium restriction (regular diet with no added salt)
possible fluid restriction
restriction of foods with substantial potassium during period of oliguria (prevent hyperkalemia - HTN)
- antihypertensive and diuretics for HTN

129
Q

If the acute glomerulonephritis pt has HTN and decreased output then

A

stay at hospital

130
Q

Nursing Considerations for acute glomerulonephritis

A

strict I&Os, daily weight
BP
Monitor for dehydration in fluid-restricted pts
Offer appealing meal choices with restrictions for NA and K
Allow for frequent rest periods and voluntary restricted activity
Parental education r/t follow-up & home care

131
Q

Why does the BP need to be monitored for an acute glomerulonephritis pt?

A

Normotensive or with a range of urine can be treated at home
Hypertension or decreased urine output stay in the hospital

132
Q

acute glomerulonephritis pt is not allowed to do this until UA is normal?

A

no contact sports

133
Q

What electrolytes are restricted for glomerulonephritis?

A

Na and K
and water

134
Q

If untreated glomerulonephritis goes into acute renal failure, do they go on dialysis

A

do not usually go on dialysis - because the kidneys are not excessively damaged

135
Q

What is the 1st sign of kidney failure with an acute glomerulonephritis pt?

A

decrease urine output

136
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
Cause

A

AG: STREP
NS:idiopathic

137
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
Additional symptoms

A

AG: anorexia, lethargy, HA
NS: fatigue, facial and generalized edema, ascites

138
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
edema

A

AG: mild to moderate mainly periorbital
NS: severe ascites

139
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
BP

A

AG: mild to severe
NS: generally normotensive

140
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
URINE APPEARANCE

A

AG: cloudy, tea/cola-colored
NS: dark, frothy

141
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
URINE PROTEIN

A

AG: mild to moderate (parallels hematuria)
NS: massive proteinuria (3+ higher)

142
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
URINE BLOOD

A

AG: up to gross amounts
NS: few RBCs

143
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
ASO TITER

A

AG: postive
NS: negative

144
Q

Acute Glomerulonephritis vs Nephrotic Syndrome
Tx

A

AG: supportive, moderate dietary restrict, antiHTN, and diuretics, abx for cause
NS: corticosteroids, diet restrict, possible diuretics and albumin

145
Q

Severe AGN can lead to

A

nephrotic syndrome

146
Q

Enuresis

A

Intentional or involuntary passage of urine into bed (usually at night) in children who are beyond the age when voluntary bladder control should normally have been acquired

147
Q

Primary Enuresis

A

: bedwetting in children who have never been dry for an extended period
- small bladder, persistent UTIs, severe stress, developmental delays

148
Q

Secondary Enuresis

A

the onset of wetting after a period of established urinary continence
- stress or events (moved)
The older the more concentrated on toilet training established

149
Q

Factors of Primary Enuresis

A

small bladder, persistent UTIs, severe stress, developmental delays

150
Q

Factors of Secondary Enuresis

A

stress or events
The older the more concentrated on toilet training established

151
Q

Behavioral Tx Enuresis

A

1st must rule out organic cause(s)
Restrict or eliminate fluids after dinner
Avoidance of caffeine & sugar-containing drinks after 1600
Purposeful interruption of sleep to void
Motivational therapy
- Parents wake them up in the middle of sleep to go to the restroom
- Bribing with rewards
Bed alarm (in PJs)

152
Q

How long does the child need to use the bed alarm for enuresis?

A

Continue until 14 days of consistent dry nights

153
Q

Medicationl Tx Enuresis

A

Imipramine (Tofranil) and desmopressin
tricyclic antidepressants – cardiac toxic if overdosed,
anticholinergics
All side effects = dry mouth, HA, constipation

154
Q

Hemolytic Uremic Syndrome (HUS)

A

uncommon, acute renal disease that occurs primarily in infants and small children between the ages of 6 months and 5 years

155
Q

Hemolytic Uremic Syndrome (HUS) associated with

A

bacterial toxins, virus, and chemicals

156
Q

HUS clinical features “Triad”

A

Hemolytic anemia
Thrombocytopenia
Renal injury

157
Q

Hemolytic Uremic Syndrome (HUS) patho

A

toxin damages endothelial lining of glomerular arteriloes
glomerular arterioles swollen and occluded with deposits of platelets and fibrin clots (hypovolemia)
TRBCs damaged attempt to move through partially occluded vessels (Acute hemolytic anemia)
damaged cells are removed by the spleen (thrombocytopenia)

158
Q

HUS S/S

A

Preceded by illness
- gastroenteritis
- upper respiratory infection
Vomiting
Irritability
Lethargy
Pallor – low RBCs
Hemorrhagic manifestations
- small dots on hands
Oliguria or anuria
CNS involvement
- SMALL BLEEDING OR BRUISING IN NOSE OR MOUTH
- signs until a week after infection (unable to fight infection)

159
Q

The s/s of HUS may not become apparent until a week after

A

digestive problems have occurred

160
Q

HUS Tx

A

need aggressive tx and early (prevent renal failure)
Goals of therapy are early diagnosis & aggressive care of renal failure & hemolytic anemia
consistently effective treatment is dialysis
- any child anuric 24hrs or oliguric with uremia or HTN & seizures
FFP
Plasmapheresis
PRBC

161
Q

HUS - any child anuric 24hrs or oliguric with uremia or HTN & seizures TYPE OF TX

A

dialysis

162
Q

HUS pt needs to go on dailysis if

A

no urine output for 24 hours, combo of HTN, seizures, and
FFP, F f platelets, PRBCs does not work

163
Q

If a HUS patient gets acute renal failure what percentage will survive?

A

95% other 5% die
10-50% will have residual kidney impairment

164
Q

HUS Nursing Considerations

A

Strict I&Os
Management of dialysis (ICU)
Thermoregulation
Reduction of anxiety (calm environment)
Closely monitor for fluid overload – prevent circulatory overload

165
Q

Which of the following patients can be discharged from the ED without the need for a urinalysis to evaluate for a UTI?

A) A 4-month-old female who presents with irritability and poor appetite: her current vital signs includes T 101.5 F axillary and HR 120 bpm.
B) An 8-year-old male who presents with a finger laceration. His mother states he had surgical re-implantation of his ureters 2 years ago.
C) A 12-year-old female complaining of pain to her lower right back. She denies any burning or frequency at this time. She has an oral temperature of 101.5 F.
D) A 4-year-old female who states “it hurts to pee”. Her parent states that she has been asking to urinate every 30 minutes. Vital signs are within normal range.

A

B) An 8-year-old male who presents with a finger laceration. His mother states he had surgical re-implantation of his ureters 2 years ago.
- Although this child has had a history of urinary infections, the child is currently not displaying any signs and therefore does not need a urinalysis at this time.

166
Q

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse’s best response?

“Circumcision is a fading practice and is contraindicated in most children.”

“Circumcision in children with hypospadias is recommended because it helps prevent infection.”

“Circumcision is an option, but it cannot be done at this time.”

“Circumcision can never be performed in a child with hypospadias. “

A

Circumcision is an option, but it cannot be done at this time.”
- It is usually recommended that circumcision be delayed in the child with hypospadias because the foreskin may be needed for repair of the defect.

167
Q

A nurse is assessing an infant who has a suspected urinary tract infection. Which of the following are anticipated findings?
Select all that apply.

Increase in hunger

Irritability

Decrease in urination

Vomiting

Fever

A

Irritability
Vomiting
Fever

168
Q

A child is admitted to the pediatric unit with nephrotic syndrome. Which of the following laboratory results should the nurse expect to see?

Thrombocytopenia

Hypoalbuminemia

Neutropenia

Hypermagnesemia

A

Hypoalbuminemia

169
Q

A child is admitted to the pediatric unit with a diagnosis of HUS. The child is very pale and lethargic. Stools have progressed from watery to bloody diarrhea. Blood work indicates low hemoglobin and hematocrit levels. The child has not had any urine output in 24 hours. The nurse should expect which of the following to be added to the plan of care?

Administration of blood products and initiation of dialysis.

Administration of blood products and close observation of the child’s hemodynamic status.

Administration of blood products followed by diuretic therapy to force urinary output.

Administration of clotting factors to diminish blood loss and continued monitoring of urinary output.

A

Administration of blood products and initiation of dialysis.
- Blood products are given to control the anemia. Because the child is symptomatic, dialysis is the treatment of choice.

170
Q

A child is diagnosed with acute glomerular nephritis (AGN). Which of the following changes would the nurse expect to see in the child’s laboratory results?

Urine white blood cells: elevated

Urine specific gravity: decreased

Urine creatinine clearance: increased

Urine red blood cells: elevated

A

Urine red blood cells: elevated

171
Q

A 10-year old child diagnosed with acute post streptococcal glomerular nephritis is being discharged home. Which of the following statements made by the child indicates that the child understood the teaching?
Select all that apply.

“I can’t eat any potato chips or other salty foods.”

“I can’t go to school for a week because I am contagious.”

I won’t be able to go to soccer practice for a long time.”

“I’m going to have to go to the doctor’s office a lot during the next few weeks.”

A

“I can’t eat any potato chips or other salty foods.”
I won’t be able to go to soccer practice for a long time.”
“I’m going to have to go to the doctor’s office a lot during the next few weeks.”

Module 5 (Pediatrics) (27 decks)

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