GU Dysfunction Flashcards
filtration of the kidney is dependent upon
adequate blood pressure - therefore any change in BP can cause a loss in kidney function
Loop of Henle and convoluted tubules reduce fluid by
90%
ROS
Rule out sepsis
Differences Between Pediatric and Adult GU System
-loop of henle in children is not long enough yet, so infant cannot concentrate urine as efficiently
by what age is kidney function of a child like that of an adult
6-12 months
what increases the risk of UTIs in children
short urethras
Children with acute renal failure will often…
regain full kidney function.
how do we get a urine sample from an infant
straight cath
how do we get a urine sample from a toddler/preschooler
clean catch with parents help since they are potty trained
how do we get a urine sample from a school-aged child
child can take instruction well, so clean catch
how do we get a urine sample from an adolescent
give instructions and provide privacy
labs and diagnostics for GU
urinalysis
creatinine clearance: asses GFR
radioisotopes :given IV and kidneys scaned to watch filtration
urine culture
blood studies
ultrasound/MRI
xray
Intravenous Pyelogram (IVP) looks at the
UPPER urinary tract with radiopaque dye injected into a vein
when doing an Intravenous Pyelogram (IVP) what needs to be assessed
if the child has an iodine allergy
during an Intravenous Pyelogram (IVP) the child may experience
flushing of face, salty taste
voiding cystourethrogram is a study of
LOWER urinary tract
what are the steps to a Voiding cystourethrogram
-Dye inserted via catheter into bladder,
-X‐ray taken during void
-Void may be painful
-Test is not done if child has UTI
clinical manifestations of UTI
-Fever!!!!
-Vomiting
-Abdominal pain, back pain, flank pain
-Dysuria, frequency, urgency
-Hematuria
-Jaundice
a subtle fever alone in a child can indicate
a UTI
why are UTIs often seen in ages between 2 and 6
play is important in toddler and preschool age so they may not want to stop playing to urinate, or they may not want to pee in an unfamiliar place
UTI diagnostic studies
-Urinalysis: nitrates, leukocyte, esterase
-Urine culture
-Renal US
-Voiding cystourethrogram (VCUG)
UTI treatments
-antibiotic specific to organism
-FLUIDS
-tylenol for pain
Conditions that Predispose Infants and Children to UTIs
-Urinary tract obstructions
-Voiding dysfunction resulting in urinary stasis
-Anatomic differences
-Individual susceptibility to infection
-Reflux
-Urinary retention while toilet‐training
-Bacterial colonization of the prepuce of uncircumcised infants
-Sexual activity in adolescent girls
teaching for prevention of UTI
-Wear cotton underwear
-Avoid bubble baths (esp. girls)
-Urinate frequently (at least 4 times/day)
-Drink plenty of liquids (amount varies with age)
-Change diapers often
-Wipe front to back
enuresis
Bed wetting, Continued incontinence of urine past the age of toilet training (UTI can cause temporary urinary control problems)
when does nocturnal enuresis usually subside by
6 years (further investigation is needed if its later)
interventions for enuresis
-limit fluids in the evening, give rewards
-set alarm to get child up to pee in the middle of the night
-behavior modification and positive reinforcement
what is Vesicoureteral Reflux (VUR)
abnormal retrograde (backward) flow of urine from bladder into the ureters
primary VUR is caused by
incompetence in the valve
risk factors for VUR
-Recurrent UTI in the female
-Single episode of UTI in the male
-Congenital defect
-Family history of VUR
treatment for Vesicoureteral Reflux (VUR)
-Antimicrobials if UTI is present
-Increased fluids
-Hygiene/voiding practices to prevent UTI
-Prophylactic antibiotics may also used to prevent UTI
-Serial urine cultures
-Severe cases, require surgical interventions
surgery for vesicouretal reflux
ureters are resected from the bladder and replanted elsewhere in the bladder wall;
often we hold off on surgery because sometimes it can clear up on its own
Hypospadias
urethral defect with the opening is on the ventral(bottom) surface of the penis rather than at the end
Epispadias
urethral defect with the opening is on the dorsal(front) surface of the penis
treatment for Hypospadias & Epispadias
-Do not circumcise at birth
-Surgery is usually done by 18 months of age
why do we not circumcise if an infant has Hypospadias or Epispadias
so that surgeon can use this skin when correcting problem (may possibly be able to perform after repair surgery)
post op for Hypospadias & Epispadias
-Urethral drainage catheter temporarily
-Oxybutynin (Ditropan)
why is Oxybutynin (Ditropan) given after Hypospadias or Epispadias surgery
given to relieve bladder spasms
what can happen if Hypospadias & Epispadias is left untreated
-may not be able to aim urine stream
-Interferes with deposition of sperm - sterile
-Affects self-esteem and body image
oxybutynin action
works directly on the smooth muscles of the urinary tract by blocking parasympathetic nerve impulses
oxybutynin use
urinary incontinence, neurogenic and overactive bladder
oxybutynin Side effects
drowsiness, tachycardia, anticholinergic effects (constipation and urinary retention), insomnia
Phismosis
Narrowing or stenosis of prepubital opening of the foreskin, FORESKIN IS NOT ABLE TO BE RETRACTED
Phismosis is a …
Normal finding in infants - usually resolves as the child grows
treatment for Phismosis
-Steroid cream may be applied twice/day for 1 month
-Circumcision in severe cases (rare)
why do we not force retraction in Phismosis
it could cause scarring and possible paraphismosis
Paraphosmosis
retracted foreskin cannot be replaced to its normal position - edema and venous congestion created by CONSTRICTION of the tight band of foreskin - a urologic EMERGENCY
Hydrocele
Peritoneal fluid in the scrotum
communicating hydrocele
-opening between
scrotum and peritoneum
*Can change in size during the day
Noncommunicating hydrocele
-no opening between scrotum and peritoneum
-No change in size
hydrocele is common in newborns and usually resolves by
12 months of age
Cryptorchidism
Undescended testicle (one or both)
interventions for Cryptorchidism
-Use warm hands to examine infant
-Exam can be done in parents lap to aid comfort and cooperation in infant
-Testes will retract normally if infant is cold or upset
If testes do not descend:
surgery may be required (between the ages of 6 months and 2 years)
Nephrotic Syndrome
Increased glomerular membrane permeability causing an abnormal loss of protein in the urine
Nephrotic Syndrome incidence
more boys 70% before age 5, peak incidence between 2 yrs and 7 yrs.
clinical manifestions of nephrotic syndrome
-Weight gain
-Massive proteinuria
-Hypoalbuminemia
-Edema around eyes, hands and face
-Growing waistline (ascites)
-Nausea or vomiting (may be related to ascites)
-Pale tight skin from progressing edema
-Weakness or fatigue
-Irritability or fussiness
-Hypertension
intervention for ascites
sit in upright position so that it does not compress the lungs
intervention fro N/V
may need to give calorie supplementation to increase caloric intake because the child is still growing, SMALL FREQUENT FEEDING of fav foods
diagnostic testing for nephrotic syndrome
-Urinalysis
-Serum protein, electrolytes
-Renal US
nursing care for nephrotic syndrome
-Elevate head of bed and change positions often to decrease edema and to allow better breathing
-May need to restrict fluids acutely, diuretics
-Daily weights
-Measure abdominal circumference
-Strict I&O
-Skin care due to edema‐lotion, good hygiene
-Give IM in non‐edematous skin (usually higher on body)
-Restrict sodium intake
where do you measure abdominal circumference
belly button
medications for nephrotic syndrome
-Prednisone (to initiate remission)
-Diuretics
-Antibiotics
when is a child considered tl be in remission from nephrotic syndrome
when urine is zero to trace for protein for 5‐7 days
Acute Glomerulonephritis
Inflammation of the glomeruli in response to a preceding illness
causes of Acute Glomerulonephritis
Streptococcal -causes strep throat, impetigo
manifestations of Acute Glomerulonephritis
-Dark brown color of urine from old blood
-Proteinuria (mild to moderate)
-Abdominal pain
Hypertension
-Mild edema
-Lung congestion - crackles
-Decreased urine output
-Lethargy
Acute Glomerulonephritis diagnostic testing
-Serum urea and creatinine
-Serum protein
-Serum WBC count
-Urinalysis
-Renal biopsy
-Throat culture
treatment for acute glomerulonephritis
-Antihypertensives and diuretics
-Antibiotics
-Maintain sodium and fluid restrictions during initial edematous phase
-Weight daily, strict I & O
-Bed rest d/t fatigue during acute phase
-Emergency care - hemodialysis for renal failure
Hemolytic Uremic Syndrome
The swollen lining of the small blood vessels damages the red blood cells, which are then removed by the spleen, leading to anemia
Hemolytic Uremic Syndrome caused by
E. Coli
clinical manifestations of Hemolytic Uremic Syndrome
-GI symptoms: diarrhea
-Anemia
-Fever
-Abdominal pain
-Low hemoglobin
isolation precautions for e. coli
Contact isolation
diagnostics for Hemolytic Uremic Syndrome
-Hematuria
-Mild proteinuria
-Increased blood urea nitrogen (BUN)
-Increased creatinine
treatment for Hemolytic Uremic Syndrome
-Blood products (for low hemoglobin)
-May require peritoneal dialysis
what is the triad for Hemolytic Uremic Syndrome (HUS)
decreased RBC, decreased platelet count, renal failure
Hemolytic Uremic Syndrome is contagious..
up to 17 days after the resolution of diarrhea; contact precautions
Acute Renal Failure
A sudden, often reversible, decline in renal function that results in the accumulation of metabolic toxins (particularly nitrogenous wastes) as well as fluid and electrolyte imbalance.
causes of acute renal failure
-Dehydration
-Hemorrhage
-Shock
-Severe diarrhea
-Traumatic injury
-Prolonged anesthesia after heart surgery
-Antibiotics
clinical manifestations of acute renal failure
-Oliguria and/or anuria
-Azotemia (blood urea nitrogen [BUN] elevated)
-Creatinine elevated
-Hyperkalemia (weak irregular pulse, lower BP, abdominal cramps)
-Increased phosphorus levels
-Fluid retention and edema
-Hypertension, cardiac arrhythmias
treatment for acute renal failure
-Support body systems: cardiovascular, respiratory
-Treat cause
-Give insulin and glucose to help move potassium into cells to lower circulatory level
-Aluminum hydroxide gel to bind with phosphorus and prevent absorption of it
-Prevent infection
-Support nutrition
Dietary modifications in acute renal failure
-Restrict protein intake if chronic failure
-Restrict potassium and sodium intake
-Restrict phosphorus intake
-Provide maximum calories within fluid restrictions to help with growth
-Fluid restriction - as much as 1/3 of daily maintenance fluid requirement
Dialysis
diffusion through a semi-permeable membrane
if you get a cloudy return on dialysis…
peritonitis, use antibiotics
Hemodialysis
Blood is removed from the body, an external membrane is used to diffuse out urea and electrolytes before blood is returned to child.
3 hours of hemodialysis is equal to ___ hours of peritoneal dialysis
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