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NURS254 Peds > GU & reproductive > Flashcards

GU & reproductive Flashcards

1
Q

At what age are kidneys effective for excreting wastes, acid-base & fluid-electrolyte balance?

A
  • kidneys aren’t efficient for the first 2 yrs
  • most growth occur during first 5 yrs
  • doesn’t fully mature until adolescence
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2
Q

What is the difference in bladder capacity at the age of: birth, 2M old, and adolescent

A
  • neonate: 15-50mLs
  • 2 months: 400mLs
  • adolescent: 700-1,500mLs
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3
Q

nephrons, ureters - peds vs. adults

A
  • nephrons are all present during birth and grows in size
  • ureters are shorter
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4
Q

renal tubules - peds vs. adults

A
  • renal tubules have smaller surface area -> less water reabsorption
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5
Q

glomerular filtration rate - peds vs. adults

A
  • GFR 1/3 to 1/2 of an adult through 1st year of life

GFR increases during childhood

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6
Q

kidney function - peds vs. adults

what is the function of kidneys?

A
  • less efficient at regulating fluid-electrolyte, acid-base balance
  • less ability to concentrate urine

diarrhea, infection, improper feeding can lead to severe acidosis & fluid imbalance

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7
Q

at what age is the child more effective at regulating acid-base, electrolyte-fluid balance

A

increases after 2yrs of age

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8
Q

what is hydronephrosis

A
  • obstruction of the urinary tract -> swelling of kidneys
  • ureteropelvic junction obstruction
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9
Q

what is hypospadias

A
  • congenital, typically diagnosed during infancy
  • urethra opening is on the underside of the penis rather than the tip
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10
Q

treatment for hypospadias or epispadias

A
  • vesicostomy (temporary stoma)
  • sx at before 18 months (stent placed after)
    circumcision delayed to use for reconstruction
    priority: no urinary output -> report HCP
  • meds: antispasmodics (oxybutynin), pain meds, abx

sx discharge usually same day

vesicostomy - opening to urethra attached to catheter to drain urine

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11
Q

nursing care for vesicostomy stoma

A
  • keep stoma clean with soap & water or antiseptic wipe
  • protect it with non stick bandage
  • if slight bleeding -> clean with soap and water, apply neosporin, apply bandage
  • reposition catheter if no urine output
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12
Q

when to call a doctor for vesicostomy stoma

A
  • urine leaking from around the catheter: need to change size
  • stenosis: too tight
  • s/s infection: fever, back pain, bladder pain, bad smelling urine, N/V etc.
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13
Q

what is bladder exstrophy

A
  • bladder, urethra, ureteral orifices out of abdomin
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14
Q

Other findings related to bladder exstrophy

also identify male vs. female abnormalities

A
  • separation of the pubic symphysis (diastasis), inguinal hernia, anus positioned anteriorly, epispadias
  • male: undescended testes, short penis
  • female: bifid clitoris (2 clitoris side by side), short vagina, separated labia (fused)
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15
Q

nursing care for bladder exstrophy

A
  • cover exposed bladder with a plastic transparent dressing
  • prepare newborn for immediate sx
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16
Q

what is neurogenic bladder

A
  • interference in the normal nerve pathways that send signals to the bladder for urination
  • results in overactive OR underreactive bladder

underreactive bladder can lead to kidney injuries

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17
Q

what is nocturnal enuresis

A
  • bedwetting beyond their expected age
  • developmental delay
  • will outgrow
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18
Q

what is undescended testes

A
  • at least one testical fails to move into the scrotal sac as the fetus develops
  • resolved on its own during the first year of life
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19
Q

what is ureteropelvic junction obstruction

type of hydronephrosis

A
  • blockage of urine flow where the ureter meets the kidney: renal pelvis
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20
Q

what does hydronephrosis lead to

s/s?

ureteropelvic junction obstruction is a type of hydronephrosis

A
  • HTN
  • kidneys can’t concentrate urine -> polydipsia/polyuria (partial obstruction) OR oliguria/anuria (complete obstruction)
  • urinary stasis -> bacterial growth
  • kidney damage -> chronic renal failure
  • abdominal/flank pain, palpable mass if kidneys significantly swollen
  • cloudy, dark, or foul smelling urine
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21
Q

treatment for ureteropelvic junction obstruction

A
  • nephrostomy tube into renal pelvis
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22
Q

what is vesicoureteral reflux

A

urine from bladder backs up into the ureter

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23
Q

when are vesicoureteral reflux often diagnosed

A

ultrasound
cytoscopy

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24
Q

complication for vesicoureteral reflux

A
  • recurrent kidney infections
  • hydronephrosis
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25
Q

what is treatment for vesicoureteral reflux

A
  • sx: detatch ureters, drain, reattach
  • ureter tube
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26
Q

what is enuresis

A

involuntary urination/bedwetting at least twice a week for at least 3 months

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27
Q

what are differential diagnoses to think about when a child has enuresis

when is enuresis typically diagnosed

A
  • after age 4 or 5 or if they have regression

differential: UTI, DI etc.

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28
Q

risk factors for enuresis

A
  • family hx
  • twin siblings
  • bladder dysfunction disorders
  • males
  • emotional events
  • behavioral disorders
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29
Q

diagnostics for enuresis

A
  • functional bladder capacity screening: hold urine as long as possible then pee in a container
  • expected bladder capacity (oz) = child’s age + 2 (up to 14yrs old)
  • record of enuresis pattern

1oz = 30mLs

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30
Q

behavioral treatment for enuresis

A
  • reward for dry nights
  • kegel/pelvic exercieses
  • drink a lot then hold until no longer tolerable to stretch bladder
  • awakened at scheduled intervals at night to void
  • urine sensor alarms: wake child up when moisture is detected
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31
Q

medications for enuresis

A
  • desmopressin (antidiuretic hormone): reduce urine volume
  • imipramine (tricyclic antidepressants): inhibits urination
  • oxybutynin (anticholinergics): reduce bladder contractions

desmopressin & imipramine given @PM

32
Q

what should the parent do before bed if the child has enuresis

A
  • limit fluid intake at night
  • encourage voiding before bed
  • avoid training diapers
  • medication administration
33
Q

what are nursing assessments to think about for urinary system assessment?

A
  • urine culture
  • labs: electrolytes, BUN&creatinine, CBC (infection?)
  • abdomen
  • Assess CVS (think about hypovolemic/septic shock)
34
Q

what is normal range for:

what is normal range for:
- urine specific gravity
- GFR
- BUN
- Creatinine

A
  • specific gravity: 1.01 - 1.03
  • GFR: 90 - 120
  • BUN: 7 - 20
  • Creatinine: 0.6 - 1.2
35
Q

what is the normal range for:
- Na
- Cl
- K
- Ca
- Mg
- P

A
  • Na: 135-145
  • Cl: 95-105
  • K: 3.5-5
  • Ca: 9-11
  • Mg: 1.5-2.5
  • P: 2.5-4.5
36
Q

what do you call the UTI if there is infection in the:
- kidney
- bladder
- prostate
- urethra

A
  • kidney: pyelonephritis
  • bladder: cystitis
  • prostate: prostatitis
  • urethra: urethritis
37
Q

what does the following mean:
- pyuria
- dysuria
- oliguria
- anuria
- polyuria

A
  • pyuria: WBC in urine
  • dysuria: painful or burning sensation when urinating
  • oliguria: decreased urine output
  • anuria: absence or near absence of urine
  • polyuria: excessive urine
38
Q

what are risk factors for UTI

A
  • urinary stasis=urinary retention, holding urine for too long
  • reflux in urinary tract system (i.e. kidney stones)
  • uncircumcised penis
  • bubble baths
  • sexual activity
  • catheterizations
39
Q

what are s/s of UTI for children <2yrs of age

A
  • newborn: jaundice, tachypnea, cyanosis, hypothermia or fever
  • poor feeding
  • V/D
  • irritability, lethargy
  • frequent urination
  • fever
40
Q

what are s/s for UTI for children older than 2yrs old

A
  • vomiting
  • enuresis, frequent urination, dysuria
  • blood in urine
  • constipation
  • fever, chills
  • malodorous urine: stinky
  • abdominal/flank pain
41
Q

what is the most accurate methods of obtaining an urine sample in children less than 2yrs old

A
  • sterile catheterization
  • suprapubic aspiration

most of the time a bag is attached to the baby to collect urine sample

42
Q

what is the most common etiology for UTIs

A
  • E. coli: typically from stool migrating to urethra
43
Q

what are urine dipstick results that would indicate UTI

A
  • positive for leukocytes, nitrites, or RBCs
  • appearance: cloudy, hazy, mucus, pus, odorous
44
Q

how to diagnose an UTI

A
  • urinalysis: WBC, cloudy/smelly, nitrites (indicate kidney infection)
  • urine culture for bacteria type >10,000 indicates UTI (don’t give abx until after results for test accuracy)
  • voiding cystourethrogram (VCUG): dye + xray to take pic of bladder & urethra while voiding
  • retrograde pyelogram (RPG): contrast dye in urinary tract to take xray

if recurrent UTIs, repeat urinalysis a week after treatment

45
Q

treatment for UTI

A

abx:
- Septra or Bactrim (Trimethoprim+Sulfamethoxazole): used if <2yrs old
- fluoroquinolones “floxacin”
- phenazopyridine
- nitrofurantoin

most common: bactrim or ciprofloxacin

46
Q

client education for avoiding UTIs

A
  • wipe front to back
  • ensure foreskin retracted prior to hygiene
  • use cotton underwear
  • avoid bubble baths
  • void frequently & empty bladder completely
  • void after intercourse
  • increase fluid intake 2L daily
  • cranberry juice
  • avoid caffeine & alcohol
47
Q

complications from UTI

A
  • renal injury, pyelonephritis
  • urosepsis
48
Q

describe the abdominal pain associated with pyelonephritis

A
  • dull flank pain extending towards umbilicus
49
Q

what is the pathophysiology of nephrotic syndrome

A
  • damaged glomerular membrane that allows protein to pass into urine -> decreased in blood osmotic pressure
  • fluid shifting from vessels into tissues -> edema / hypovolemia
  • hypovolemia triggers secretion of ADH & aldosterone -> hold Na & H2O
  • lipid increase in liver from hypoalbuminema
  • leading to proteinuria(hyperalbuminuria), hyperlipidemia, hypoalbuminemia, and edema
50
Q

what are the causes of nephrotic syndrome

A
  • autoimmune diseases (i.e. Lupus): stress, sickness or sepsis, smoking, sun
51
Q

what is normal lipid panel range - cholesterol, triglyceride, LDL, HDL

A
  • cholesterol <200
  • triglyceride <150
  • LDL <100
  • HDL >60
52
Q

S/S of nephrotic syndrome

A
  • weight gain over days or weeks
  • facial & periorbital edema: decreased throughout the day
  • resp: dyspnea, crackles
  • Muehrcke lines on fingernails (horizontal white lines)
  • ascites
  • HTN
  • V/D, anorexia
  • edema to lower extremities & genitalia
  • dark, frothy colored urine
  • decreased urinary output
53
Q

what result would urinalysis show for nephrotic syndrome

A
  • urinalysis/24hr urine collection
  • proteinuria: up to 15g
  • few RBCs
  • fat
  • increased specific gravity
54
Q

what blood chemistry labs would be done for nephrotic syndrome

A
  • hypoalbuminemia
  • hyperlipidemia
  • hemoconcentration: elevated HgB, Hct, platelets
  • increased erythrocyte sedimentation rate (ESR)
55
Q

diagnostic procedures for nephrotic syndrome

A
  • kidney biopsy: if unresponsive to steroid therapy, biopsy shows damage to epithelial cells lining the basement membrane
  • MRI: scarring of the glomeruli
56
Q

nursing care for nephrotic syndrome

A
  • strict I&Os, DW
  • monitor edema, abdominal girth daily
  • increase protein intake
  • elevate legs for edema
  • **increased risk for infection **
  • cluster care for rest, limit visitors
57
Q

what are the 4 goals of treatment of nephrotic syndrome & their treatment

A
  1. reduce excretion of protein - corticosteroid, plasma expanders: 25% albumin
  2. reduce fluid retention: fluid restriction, lower salt intake, diuretics
  3. prevent infection: abx
  4. minimize complications: risk for hypovolemia
58
Q

what is glomerulonephritis

A
  • inflammation of the vasculature in the glomerulus -> coagulation

s/s another flashcard

meaning, impaired filtration

59
Q

risk factors for glomerulonephritis

A
  • previous streptococcal infection, upper resp infection
  • antibodies and antigens get trapped in the glomerulus
60
Q

s/s of glomerulonephritis

A
  • facial edema worse in AM, spreads to extremities and genitalia with progression of the day
  • periorbital edema
  • encephalopathy: headache, irritable, seizures
  • vomiting, anorexia
  • low grade fever
  • HTN
  • abdominal/flank pain
  • oliguria/anuria
  • cloudy, tea-colored urine
  • hematuria, proteinuria
  • severe: pulmonary congestion & ascites
61
Q

lab tests for glomerulonephritis

A
  • throat culture: strep
  • urinalysis
  • kidney function: BUN, creatinine, filtration rates
    creatinine over 1.3 = bad kidney
    BUN over 20
    urine output <30mL/hr or 1mL/kg/hr
  • blood work: hypoalbuminemia, decreased Hgb, Hct, increased ESR
  • CBC: increased WBC
  • antistreptolysin O(ASO) titer: strep antibodies present

decreased RBC because kidneys create erythropoeitin, which is impaired

62
Q

nursing care for glomerulonephritis

A
  • strict I/Os, DW
  • monitor neuro status
  • diet: restrict K during oliguria, restrict protein for severe azotemia (high nitrates), possible restriction of salt
63
Q

medications for glomerulophritis

A
  • diuretics, antihypertensives: furosemide, lisinopril, losartan
  • lower fluid & water, protein
  • abx for strep
  • sodium polystyrene sulfonate: corrects hyperkalemia

check trough levels for abx to ensure no kidney damage

64
Q

complications for glomerulophritis

A
  • HTN crisis (can lead to stroke)
    key signs:
    headache & ALOC
    N&V
    oliguria
    new, sudden, rapid weight gain
  • acute kidney injury -> dialysis

BP priority assessment for HTN crisis

65
Q

Compare key differences glomerulonephritis vs. Nephrotic syndrome

A
  • glomerulonephritis
    low protein loss, high WBC
    limit protein intake
    decreased RBCs: reduced erythropoietin production
    cause: strep/infections
  • nephrosis
    high protein loss
    increase protein intake
    high RBCs: dehydration
    cause: autoimmune diseases
66
Q

what is hemolytic uremic syndrome (HUS)

A
  • acute kidney injury
  • hemolytic anemia
  • thrombocytopenia
67
Q

pathophysiology of hemolytic uremic syndrome

A
  • shiga toxin produces E. coli -> infection in kidney
  • immune system activated
  • fibrin deposits & platelet aggregation in small arterioles of kidney, gut, and CNS -> narrowing and occlusion & thrombocytopenia
  • RBC passing through the small vessels get shredded
  • spleen removes damaged RBC -> hemolytic anemia

platelet normal: 150,000-450,000
Hgb: 12-18

68
Q

causes of hemolytic uremic syndrome (HUS)

A
  • undercooked meat (beef)
  • exposure to contaminated waters (swimming pool)
  • drinking unpasteurized apple juice
69
Q

s/s of hemolytic uremic syndrome

A
  • anorexia
  • hallucinations
  • edema
  • pallor
  • bruising, purpura, petechiae
  • rectal bleeding
  • decreased urine output
  • fever
  • severe: HTN, anuric
70
Q

lab tests for hemolytic uremic syndrome

A
  • CBC: lower Hgb, Hct
  • urine: positive for blood, protein, casts
  • kidney panel: higher BUN & creatinine
  • fibrin split products in blood and urine from thrombocytopenia
71
Q

nursing management for hemolytic uremic syndrome

A
  • I&Os, DW
  • manage electrolyte & fluid imbalances
  • blood transfusions
  • acute renal failure -> dialysis
  • watch for resp fluid overload
  • assess neuro (may cause seizures)

heparin, abx, corticosteroids, fibrinolytic agents aren’t beneficial

72
Q

what is Wilms tumor

A
  • childhood kidney tumors
  • kidney cells don’t mature and mutate
73
Q

s/s of Wilms tumor

A
  • one sided abdominal mass “bulging”
  • abd pain
  • hematuria, anemia
  • HTN
  • fever, fatigue
  • weight loss, anorexia
  • pulmonary metastasis: lung stuff - dyspnea, cough, SOB, chest pain
74
Q

diagnostics for Wilms tumor

A

DO NOT palpate the abdomen -> pop the tumor causing it to spread
- abd xray, CT or MRI
- CBC (if tumor excretes excessive erythropoietin): polycythemia (lots of RBC)
- urinalysis

75
Q

treatment for Wilms tumor

A

sx: nephrectomy -> chemo

NURS254 Peds (6 decks)

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