GU & reproductive Flashcards
At what age are kidneys effective for excreting wastes, acid-base & fluid-electrolyte balance?
- kidneys aren’t efficient for the first 2 yrs
- most growth occur during first 5 yrs
- doesn’t fully mature until adolescence
What is the difference in bladder capacity at the age of: birth, 2M old, and adolescent
- neonate: 15-50mLs
- 2 months: 400mLs
- adolescent: 700-1,500mLs
nephrons, ureters - peds vs. adults
- nephrons are all present during birth and grows in size
- ureters are shorter
renal tubules - peds vs. adults
- renal tubules have smaller surface area -> less water reabsorption
glomerular filtration rate - peds vs. adults
- GFR 1/3 to 1/2 of an adult through 1st year of life
GFR increases during childhood
kidney function - peds vs. adults
what is the function of kidneys?
- 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
at what age is the child more effective at regulating acid-base, electrolyte-fluid balance
increases after 2yrs of age
what is hydronephrosis
- obstruction of the urinary tract -> swelling of kidneys
- ureteropelvic junction obstruction
what is hypospadias
- congenital, typically diagnosed during infancy
- urethra opening is on the underside of the penis rather than the tip
treatment for hypospadias or epispadias
- 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
nursing care for vesicostomy stoma
- 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
when to call a doctor for vesicostomy stoma
- 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.
what is bladder exstrophy
- bladder, urethra, ureteral orifices out of abdomin
nursing care for bladder exstrophy
- cover exposed bladder with a plastic transparent dressing
- prepare newborn for immediate sx
what is neurogenic bladder
- 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
what is nocturnal enuresis
- bedwetting beyond their expected age
- developmental delay
- will outgrow
what is undescended testes
- 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
what is ureteropelvic junction obstruction
type of hydronephrosis
- blockage of urine flow where the ureter meets the kidney: renal pelvis
what does hydronephrosis lead to
s/s?
ureteropelvic junction obstruction is a type of hydronephrosis
- 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
treatment for ureteropelvic junction obstruction
- nephrostomy tube into renal pelvis
what is vesicoureteral reflux
urine from bladder backs up into the ureter
how are vesicoureteral reflux often diagnosed
ultrasound
cytoscopy
complication for vesicoureteral reflux
- recurrent kidney infections
- hydronephrosis
what is treatment for vesicoureteral reflux
- sx: detatch ureters, drain, reattach
- ureter tube
what is enuresis
involuntary urination/bedwetting at least twice a week for at least 3 months
what are differential diagnoses to think about when a child has enuresis
when is enuresis typically diagnosed
- after age 4 or 5 or if they have regression
differential: UTI, DI etc.
risk factors for enuresis
- family hx
- twin siblings
- bladder dysfunction disorders
- males
- emotional events
- behavioral disorders
diagnostics for enuresis
- 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
behavioral treatment for enuresis
- 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
medications for enuresis
- desmopressin (antidiuretic hormone): reduce urine volume
- imipramine (tricyclic antidepressants): inhibits urination
- oxybutynin (anticholinergics): reduce bladder contractions
desmopressin & imipramine given @PM
what should the parent do before bed if the child has enuresis
- limit fluid intake at night
- encourage voiding before bed
- avoid training diapers
- medication administration
what are nursing assessments to think about for urinary system assessment?
- urine culture
- labs: electrolytes, BUN&creatinine, CBC (infection?)
- abdomen
- Assess CVS (think about hypovolemic/septic shock)
what is normal range for:
what is normal range for:
- urine specific gravity
- GFR
- BUN
- Creatinine
- specific gravity: 1.01 - 1.03
- GFR: 90 - 120
- BUN: 7 - 20
- Creatinine: 0.6 - 1.2
what is the normal range for:
- Na
- Cl
- K
- Ca
- Mg
- P
- Na: 135-145
- Cl: 95-105
- K: 3.5-5
- Ca: 9-11
- Mg: 1.5-2.5
- P: 2.5-4.5
what do you call the UTI if there is infection in the:
- kidney
- bladder
- prostate
- urethra
- kidney: pyelonephritis
- bladder: cystitis
- prostate: prostatitis
- urethra: urethritis
what does the following mean:
- pyuria
- dysuria
- oliguria
- anuria
- polyuria
- 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
what are risk factors for UTI
- 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
what are s/s of UTI for children <2yrs of age
- newborn: jaundice, tachypnea, cyanosis, hypothermia or fever
- poor feeding
- V/D
- irritability, lethargy
- frequent urination
- fever
what are s/s for UTI for children older than 2yrs old
- vomiting
- enuresis, frequent urination, dysuria
- blood in urine
- constipation
- fever, chills
- malodorous urine: stinky
- abdominal/flank pain
what is the most accurate methods of obtaining an urine sample in children less than 2yrs old
- sterile catheterization
- suprapubic aspiration
most of the time a bag is attached to the baby to collect urine sample
what is the most common bacteria for UTIs
- E. coli: typically from stool migrating to urethra
what are urine dipstick results that would indicate UTI
- positive for leukocytes, nitrites, or RBCs
- appearance: cloudy, hazy, mucus, pus, odorous
how to diagnose an UTI
- 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
treatment for UTI
abx:
- Septra or Bactrim (Trimethoprim+Sulfamethoxazole): used if <2yrs old
- fluoroquinolones “floxacin”
- phenazopyridine
- nitrofurantoin
most common: bactrim or ciprofloxacin
client education for avoiding UTIs
- 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
complications from UTI
- renal injury, pyelonephritis
- urosepsis
describe the abdominal pain associated with pyelonephritis
- dull flank pain extending towards umbilicus
what is the pathophysiology of nephrotic syndrome
- 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
what are the causes of nephrotic syndrome
- autoimmune diseases (i.e. Lupus), infection, medications, cancers, DM
what is normal lipid panel range - cholesterol, triglyceride, LDL, HDL
- cholesterol <200
- triglyceride <150
- LDL <100
- HDL >60
S/S of nephrotic syndrome
- 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
what result would urinalysis show for nephrotic syndrome
- urinalysis/24hr urine collection
- proteinuria: up to 15g
- few RBCs
- fat
- increased specific gravity
what blood chemistry labs would be done for nephrotic syndrome
- hypoalbuminemia
- hyperlipidemia
- hemoconcentration: elevated HgB, Hct, platelets
- increased erythrocyte sedimentation rate (ESR)
diagnostic procedures for nephrotic syndrome
- kidney biopsy: if unresponsive to steroid therapy, biopsy shows damage to epithelial cells lining the basement membrane
- MRI: scarring of the glomeruli
nursing care for nephrotic syndrome
- 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
what are the 4 goals of treatment of nephrotic syndrome & their treatment
- reduce excretion of protein - corticosteroid, plasma expanders: 25% albumin
- reduce fluid retention: fluid restriction, lower salt intake, diuretics
- prevent infection: abx
- minimize complications: risk for hypovolemia
what is glomerulonephritis
- inflammation of the vasculature in the glomerulus -> coagulation
s/s another flashcard
meaning, impaired filtration
risk factors for glomerulonephritis
- previous streptococcal infection, upper resp infection
- antibodies and antigens get trapped in the glomerulus
s/s of glomerulonephritis
- 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
lab tests for glomerulonephritis
- 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
nursing care for glomerulonephritis
- strict I/Os, DW
- monitor neuro status
- diet: restrict K during oliguria, restrict protein for severe azotemia (high nitrates), possible restriction of salt
medications for glomerulophritis
- 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
complications for glomerulophritis
- 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
Compare key differences glomerulonephritis vs. Nephrotic syndrome
- 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
what is hemolytic uremic syndrome (HUS)
- acute kidney injury
- hemolytic anemia
- thrombocytopenia
pathophysiology of hemolytic uremic syndrome
- 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
causes of hemolytic uremic syndrome (HUS)
- undercooked meat (beef)
- exposure to contaminated waters (swimming pool)
- drinking unpasteurized apple juice
s/s of hemolytic uremic syndrome
- anorexia
- hallucinations
- edema
- pallor
- bruising, purpura, petechiae
- rectal bleeding
- decreased urine output
- fever
- severe: HTN, anuric
lab tests for hemolytic uremic syndrome
- CBC: lower Hgb, Hct
- urine: positive for blood, protein, casts
- kidney panel: higher BUN & creatinine
- fibrin split products in blood and urine from thrombocytopenia
nursing management for hemolytic uremic syndrome
- 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
what is Wilms tumor
- childhood kidney tumors
- kidney cells don’t mature and mutate
s/s of Wilms tumor
- one sided abdominal mass “bulging”
- abd pain
- hematuria, anemia
- HTN
- fever, fatigue
- weight loss, anorexia
- pulmonary metastasis: lung stuff - dyspnea, cough, SOB, chest pain
diagnostics for Wilms tumor
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
treatment for Wilms tumor
sx: nephrectomy -> chemo
