GU/GI disorders - exam 3 Flashcards
1
Q
What is meconium
A
the dark green substance forming the first feces of a newborn infant.
2
Q
what is Hirschsprung disease?
A
- congenital aganglionic (lack of ganglionic nerve cells) in part of the colon (leads to megacolon/mechanical obstruction d/t lack of peristalsis)
- usually involves rectum and distal colon
3
Q
What are the signs and Sx of Hirschsprung disease?
A
- no meconium 24-48 hours after birth
- refusal to fee (FTT)
- vomiting, distention and constipation
- complications: enterocolitis (severe diarrhea, potentially fatal) and ribbon like stools, leads to dehydration
4
Q
How do you Dx hirschsprung disease?
A
- x-ray after a barium enema
- rectal biopsy (can confirm 100%)
5
Q
How to treat hirschsprung disease?
A
- “pull through” surgery
- temporary ostomy
- if total paralysis hirschsprung is present, ileostomy is needed
6
Q
What is intussusception
A
- Telescoping (invagination) of 1 portion of intestine into another
- cause is usu unknown, may be d/t intestinal lesions
7
Q
In what demographic is intussusception most common?
A
- in male infants (3-9 months)
- may happen up to 5 years old
8
Q
What are the signs and Sx of intussusception?
A
- Colicky abdominal pain (intermittent in beginning, constant in later ischemic stage)
- bringing knees to belly
- acute pain
- edema, mucous, irritation, leaking of blood
- vomiting
- *RED CURRANT JELLY STOOLS (d/t mix of mucus and blood)
9
Q
How is intussusception diagnosed?
A
by ultrasound guided saline enema
10
Q
How is intussusception Treated?
A
- by air enemas (80% cases are able to be reduced by this non-operative route)
- if not, surgery is needed
11
Q
What is pyloric stenosis?
A
- Hypertrophy of pylorus causing constriction of pyloric sphincter w obstruction of gastric outlet
- runs in families
12
Q
When does pyloric stenosis usu develop?
A
-in first 2-5 weeks of life (more common in males)
13
Q
What are the signs and Sx of pyloric stenosis?
A
- *PROJECTILE VOMITING
- child is hungry immediately after feedings
- poor weight gain or weight loss
- can result in signs of dehydration
- palpable olive shaped mass
14
Q
How is pyloric stenosis diagnosed?
A
with sonogram (shows thickening of pylorus)
15
Q
How is pyloric stenosis treated?
A
- treat dehydration
- surgical correction w fundoplacation (required!)
16
Q
Post op considerations with pyloric stenosis surgery?
A
rapid recover feeding 4-5 hours post op
17
Q
What is GERD
A
- Transfer of gastric contents into esophagus
- occurs in everyone but frequency and persistency is what makes is abnormal
18
Q
In what pediatric demographic is GERD very common?
A
infants less than 2 months old (often resolves spontaneously)
19
Q
What are the signs and Sx of GERD?
A
- regurgitation, vomiting, poor feeding, irritable, URI/wheezing
- Sandifer syndrome (arching of the back)
- heartburn
20
Q
What is the treatment for GERD in peds?
A
- thicken formula w ith ceral
- feed small amts more often
- medications: H2 receptor antagonist (Zantac) or PPI (Nexium, Prevacid)
- surgical fundoplication
21
Q
What is celiac disease?
A
- An autoimmune disease caused by sensitivity to the protein gluten
- if gluten is consumed (wheat, barley, rye) an immune response is triggered and damage is caused to lining of sm intestine
- once lining of sm intestines is damaged, nutrients cant be absorbed causing nutrient deficiencies
22
Q
What are the signs and Sx of celiac disease?
A
- diarrhea, abdominal pain, ab distention, weight loss, fatigue
- frothy, foul-smelling stools
- malnutrition
- steatorrhea
- anemia
23
Q
How is celiac disease treated?
A
with a gluten-free diet for LIFE
24
Q
What are some grains/starches that are naturally gluten-free?
A
corn, quinoa, millet, rice, buckwheat, flax, lentils, potato, wild rice, soy, yucca, tapioca
25
Etiology of diarrhea in children?
can be viral (most likely ROTAVIRUS!!) or bacterial
26
What is the most common viral cause of diarrhea in the US?
rotavirus (new vaccine is helping to reduce cases)
27
What is the leading cause of illness in kids aged 5 or less?
acute diarrhea
28
What are the most common bacterial causes of bacterial acute diarrhea?
salmonella, e. coli, shigella, campylobacter
- salmonella (feed borne and person-to-person transmission
- e. coli: food borne
29
Why are children more susceptible to diarrhea and DEHYDRATION?
kids have:
- GREATER body surface area (more at risk for insensible water loss thru skin and lungs)
- FASTER basal metabolic rate (w fever, BMR increases)/higher metabolism
- kidney function is immature
- GREATER fluid requirements than adults
- MORE extracellular fluid volume
30
types of dehydration (3 types)
- isotonic (most common) [water and salt are lost in equal amts)
- hypotonic: electrolyte deficit exceeds water deficit
- hypertonic: water loss exceeds electrolyte deficit
31
As we age, we (INCREASE/DECREASE) intracellular fluid and (INCREASE/DECREASE) extracellular fluid
As we age, we INCREASE intracellular fluid and DECREASE extracellular fluid
32
Why do we tend to decrease our amt of extracellular fluid as we age?
Bc when we get sick, we lose first the extracellular fluid (this is why kids loose a bigger proportional percentage and are at a higher risk of dehydration
33
What are the clinical manifestations of dehydration?
- weight loss (d/t fluid loss)
- rapid pulse
- decr BP
- Decr peripheral circulation
- decr urinary output
- incr specific gravity (seen w dipstick)
- decr skin turgor
- dry mucous membranes
- absence of tears
- sunken fontanel in infants
34
Biggest complication we worry about with diarrhea is...
dehydration
35
nursing management/recommendations for dehydration
- oral rehydration therapy: pedialyte
- small amounts, often
- observe I and O's
- NO ANTIMOTILITY AGENTS
- NO ANTIBIOTICS (if it's d/t a virus)
- early and gradual reintroduction of bland foods (avoid junk food, fried foods and milk. Promote mashed potatoes, baked chicken, chicken noodle soup)
36
How does oral rehydration therapy (ORT) work?
- enhances and promotes reabsorption of H2O and Na
- reduces vomiting, diarrhea, and duration of illness
- usually not given in cases of severe diarrhea
37
ORT contains
75 mEq Na per liter
| -also contains glucose, K, and Cl
38
What is the recommended dose of ORT
50-100ml/kg every 3-4 hours (small volumes, frequently)
39
Signs of progression to SEVERE dehydration
- weight loss of > or = 10%
- very increased HR
- hyperpnea (deep and rapid breaths)
- orthostatic hypotension
- behavior: hyperirritable or lethargic
- thirst: moderate to intense
- mucus membranes: dry to parched
- absent tears, sunken eyes
- sunken fontanel
- very delayed cap refill (>4 seconds)
40
Hospital management of dehydration
- hospitalization for IV rehydration (if ORT isn't sufficient)
- nursing assessment (skin turgor, MMs. fontanels)
- I and Os (1gm wet = 1 ml urine)
- daily weight
- vital signs
- lab values (low bicarb, high H/H)
41
What is acute appendicitis
inflammation of vermiform appendix (leads to eventual obstruction)
42
Signs and Sx of acute appendicitis?
- right lower quad pain
- McBurney's point (invisible line from belly button to RLQ is where pain is felt)
- sometimes periumbilical pain)
- fever
- vomiting
- tachycardia
- pallor
- hypoactive bowel sounds (or absent)
- anorexia
- colicky, cramping, ab pain around umbilicus
- irritable, uncomfortable, apprehensive
43
With acute appendicitis, what does it mean to when there's a sudden relief from pain?
perforation! (much greater risk for infection and death once it perforates)
44
What is the treatment for acute appendicitis?
- surgical removal (laparoscopy vs laparotomy)
- per and post op surgical care (antibiotic therapy, possible NG tue)
- pain mngment (allow child to assume his/her position of comfort
- never give a laxative or an enema if appendicitis is suspected!! (risks perforation)
45
What is a cleft lip/cleft palate?
- facial malformations that occur during early (5-9 weeks) embryonic development)
- lip and/or palate do not fuse together
46
What is the cause of cleft lip/cleft palate?
associated with chromosomal anomalies (pierre robin syndrome),
- Also, heart defects, ear malformations, skeletal deformities, genitourinary abnormality
- also associated with maternal smoking, prenatal infection, advanced maternal age, medications during early pregnancy (anticonvulsants, steroids)
47
When can we usually see/diagnose cleft lips and cleft palates?
in early embryonic development (5-9 weeks)
48
What are the biggest complications concerns with cleft lip/cleft palate?
- FEEDING ISSUES!! (need to use bottles with specialized nipples, children unable to breastfeed)
- **aspiration/aspiration pneumonia (we worry about aspiration most during 1st month of life)
- ear infections
- FTT (bc they aren't eating)
49
Treatment of cleft lip/cleft palate
- surgical closure of lip defect precedes correction of the palate (typically happens ~12-18 months)
- ongoing mngment w plastic surgery, craniofacial specialists, oral surgery, dental and orthodontist, audiology, speech therapy, psychology
50
Post surgical care for cleft lip/cleft palate
- PREVENT INJURY TO SUTURE LINE!!
- place infant supine or side lying (always lie on opposite side of where surgical site was)
- avoid putting ANYTHING in mouth (suction catheters, spoon, straws, pacifiers, plastic syringe, hands)
- may need to restrain hands
- prevent child from crying (can disrupt sutures)
- administer pain meds (prophylactically), cuddle, rock
51
what is the most common facial malformation in children?
cleft lip and/or cleft palate
52
Cleft lip and palate may involve problems in what areas for a child?
nutritional, dental, ear (otitis media) and speech problems
53
Non-reducible (unable to press hernia inward) umbilical hernias may indicate:
incarceration and are considered a medical emergency requiring surgical correction (intestine may be trapped)
54
Common inflammatory disorders of GU tract include: (3)
- UTI
- nephrotic syndrome
- acute glomerulonephritis (AGN)
55
In a nutshell, management of a UTI is directed at:
- eliminating infection
- detecting and correcting functional or anatomic abnormalities
- preventing recurrences
- preserving renal function (prevent renal scarring!)
56
What is nephrotic syndrome
- Characterized by increased glomerular permeability to protein causing massive urinary loss of protein resulting in HYPOPROTEINEMIA and edema (PUFFY FACE ESP EARLY AM)
- it's the most common presentation of glomerular injury in children
57
What is the cause of nephrotic syndrome
idiopathic!
| -can sometimes be congenital and/or can be seen secondary to lupus
58
Managment of nephrotic syndrome? (most common med and diet recommendations)
- corticosteroids (reduces protein loss by decreasing inflammation)
- dietary restrictions: low Na diet, fluid restrictions (in severe cases)
- advise recovered child to avoid other sick children (can reduce risk for recurrent infection)
59
What are the common signs and Sx of acute glomerulonephritis (AGN)?
- decreased urinary output
- edema
- HTN
- *hematuria
- proteinuria
60
What is the most common cause of AGN?
- strep (by far, most common)
| - can also be caused by post infectious pneumococcal or viral
61
How do you treat AGN?
- antibiotics
- diuretics
- antihypertensive meds
- dietary restrictions: Na and fluid
62
How to Dx AGN?
-rapid strep and throat culture
63
what is the most common malignant neoplasm of the kidney in infants and children?
Wilm's tumor
64
Is it okay to palpate the stomach of a child with suspected Wilm's tumor?
Never ever palpate!! Could cause tumor cells to spread to nearby organs
65
What is the most common genitourinary tract disorder?
UTI
66
What's the patho of a UTI?
-infection usu involves LOWER urinary tract (urethra and bladder) but can also affect UPPER urinary tract (ureters, renal pelvis, calyces, and renal parenchyma
67
An upper UTI is also called...
acute pyelonephritis
68
Acute pyelonephritis is dangerous because it can lead to
- renal scarring (non reversible!), HTN and end-stage renal disease.
- enough renal scarring can cause AKI
69
What is the most common bacterial cause of a UTI?
E. coli
70
Etiology of UTIs?
- URINARY STASIS (single most important contributing factor, esp in KIDS)
- structure of lower urinary tract (shorter urethra) (leads to higher incidence in females)
- Reflux (usu resulting from a congenital condition, bladder urine goes up into ureters)
- Anatomic abnormalities
- dysfunction of the voiding mechanism
- bladder compression
71
What are some reasons that make kids more susceptible to UTIs?
- urinary stasis
- concentrated urine
- feces (with e. coli) and urine is sitting in diaper for long periods
72
What are the signs and Sx of a UTI in an INFANT
- poor feeding
- vomiting
- FTT
- frequent urination
- foul-smelling urine
- pallor
- fever (any infant
73
What are the signs and Sx of a UTI in CHILDHOOD
- lower ab pain (suprapubic) and/or back pain
- frequency and urgency on urination, dysuria, hematuria
- poor appetite
- vomiting
- growth failure
- excessive thirst
- enuresis/incontinence
- facial swelling
- pallor
- fatigue
74
Signs and Sx of acute pyelonephritis
fever > 38.3 (101F), chills, back pain, appearing "quite ill"
75
How to diagnose a UTI?
- Urine culture (sterile)
- --sterile catheterization, suprapubic aspiration, clean catch
- urinalysis
- --presence of leukocytes and nitrates (indicative of a UTI)
- blood work
- may need renal US and/or VCUG (Voiding Cystourethrogram) (to check for congenital reflux)
76
Therapeutic management of a UTI
- PO antibiotics (after culture is drawn, try to treat E. coli first, if uneffective, treat with "antibiotic cocktail")
- If less than 2 months, will likely need hospital admission and IV antibiotics (we worry abt urosepsis and bacteremia)
- If vesicoureteral reflux (VUR), may require surgery
- teach kids to DOUBLE VOID
- if bladder spasms present, apply warm, moist heat (if it doesn't raise fever)
77
Common signs and Sx of nephrotic syndrome?
- **proteinuria
- frothy and foamy urine
- HYPOalbuminemia
- HYPERlipidemia
- facial edema (esp in AM)
- weight gain (usu pitting edema)
- ab swelling and diarrhea (d/t edema in intestinal mucosa)
- anorexia
- easily fatigued
- decreased urine volume
78
How do you diagnose nephrotic syndrome?
- urinalysis (3+ protein)
- 24-hr urine protein (if >50mg/kg/day indicates nephrotic syndrome)
- serum albumin (low)
- serum protein (low)
- renal biopsy required
79
How do you treat nephrotic syndrome?
- Goal is to reduce excretion of urinary protein and reduce fluid retention
- dietary restrictions: low Na diet
- fluid restrictions (sometimes diuretics in severe cases)
- CORITCOSTEROIDS (monitor for SE of long term steroid therapy)
- --2mg/kg/day for 6 weeks followed by 1.5mg/kg/day for 4 weeks
80
What are some of the effects/signs of long term steroid therapy?
- rounding of face (moonface)
- weight gain
- increased appetite
- growth retardation
- HTN
- hyperglycemia
- infection
81
How can we educate the parents of a child with nephrotic syndrome?
- 2/3 of children will relapse
- early detection minimizes damage to kidneys
- teach the signs and Sx of nephrotic syndrome
- can use urine dipsticks at home
82
what is the nursing mngment of nephrotic syndrome?
- monitor fluid retention or excretion
- strict I and O's
- urine exam for protein (UA dipstick)
- daily weight and measurement of ab girth
- vital signs (d/t increased risk of infection)
83
How does acute post streptococcal glomerulonephritis (APSGN) usually come about?
-occurs 10-21 days after strep infection in certain strains of strep that cause immune-complexes to deposit in the glomerular basement membrane causing the glomeruli to become edematous occluding the capillary lumen
84
what is the peak age for post strep AGN?
6-7 years (uncommon in kids less than 2 yo)
| -more common in winter and spring (when we see strep the most)
85
Clinical manifestations of AGN
- edema (esp periorbital)
- HTN
- **hematuria (3+, bleeding in upper urinary tract, smoky/tea-colored urine)
- proteinuria
- generalized edema (caused by glomerular filtration)
86
How do you treat AGN?
- this is FULLY TREATABLE and curable! (we treat it like we treat strep)
- dietary modifications: moderate Na, fluid restrictions
- regular measurements (V/S, body weight, i's and o's)
- specific immunity is conferred
- subsequent recurrences are UNCOMMON
- some children have been reported to develop chronic disease (rare)
87
What is a Wilm's tumor?
- also known as nephroblastoma
- malignant renal and intra-abdominal tumor of childhood
- associated with GU anomalies and syndromes
88
what is the peak age for getting Wilm's tumor?
3 years old (more frequent in males)
89
Clinical manifestations of Wilm's tumor
- increased abdominal girth (ab swelling/mass firm and non-tender to one side)
- hematuria
- HTN
- fatigue
- weight loss
90
is there usually pain with a Wilm's tumor?
nope
91
What is the therapeutic management of a Wilm's tumor?
- surgical removal
| - chemotherapy (and possibly radiation)
92
Some nursing considerations for a Wilm's tumor?
- NO AB PALPATION!!!
- pre-op and post-op mngment (monitor BP closely d/t risk of HTN)
- child and family teaching/support (surgery is performed 24-48 hrs after diagnosis. Chemo started immediately after surgery)
93
Where is a Wilm's tumor typically located?
it is a firm mass located on one side left or right of midline in the abdomen
