Lecture 6 Genitourinary

Question 1

primary role of kidneys

Answer 1

maintain composition of body fluids

Question 2

secondary role of kidneys

Answer 2

erythropoietin stimulating factors
renin to reduce blood volume
activate vitamin D
acid-base balance

Question 3

pediatric kidney anatomy

Answer 3

• take up more room in the abdomen
• short urethra
• slower blood flow through kidneys
• less efficient
• small bladder volume

Question 4

when does renal system reach maturity?

Answer 4

2 years

Question 5

pediatric GU history

Answer 5

• prenatal history
• family history
• age of toilet training
• bed wetting (primary or secondary)
• recent infectious diseases
• medications
• unusual elimination patterns including defecation
• sexual or menstrual history if applicable

Question 6

pediatric GU assessment

Answer 6

• consistent weights
• abdominal and extremity girth measurements for edema
• BP and cardiac exam

Question 7

collecting urine for analysis

Answer 7

clean catch
urine bag
catheterization
suprapubic needle aspiration

Question 8

urine labs

Answer 8

urinalysis
urine culture and sensitivities
BUN and creatinine

Question 9

Voiding cystourethrogram

Answer 9

• radiopaque dye infused into bladder with catheter
• watch bladder fill and empty under fluoroscopy
• will se retrograde flow of urine up ureters with bladder contraction if vesicoureteral reflux is presennt

Question 10

normal urinalysis

Answer 10

pH 5-9
specific gravity 1.001 to 1.035
protein <20
urobilinogen <1 mg
clear

Question 11

abnormal urinalysis findings

Answer 11

glucose
ketones
WBCs
RBCs
nitrites
casts

Question 12

hypospadias

Answer 12

urethral meatus on ventral surface of penis

Question 13

epispadias

Answer 13

urethral meatus on dorsal surface of penis

Question 14

how are hypospadias and epispadias treated

Answer 14

no circumcision prior to surgery
surgery at 6-12 months

Question 15

post-op management of hypo/epispadias surgery

Answer 15

no rough housing for 4 weeks
foley catheter care
no tub baths until post-op check and dressing removed

Question 16

bladder exstrophy

Answer 16

wide pubic symphysis
epispadias in males
may be diagnosed on prenatal ultrasound

Question 17

cause of vesicoureteral reflux

Answer 17

can be congenital or secondary to neurogenic bladder or obstruction

Question 18

complications of vesicoureteral reflux

Answer 18

pyelonephritis
dilation of ureters
renal scarring
HTN

Question 19

obstructive uropathy

Answer 19

obstruction in any part of urinary tract

Question 20

complications from obstructive uropathy

Answer 20

hydronephrosis (kidney dilation)
recurrent UTI
renal insufficiency
renal damage

Question 21

post-strep glomerulonephritis

Answer 21

complication following group A strep infection, usually around 10 days after onset

immune response to strep causes inflammation of glomeruli

Question 22

clinical manifestations of PSGN

Answer 22

dark urine
proteinuria
fever
oliguria
abdominal pain
headache
vomiting
edema
hypertension

Question 23

PSGN nursing interventions

Answer 23

usual interventions for fluid excess
limit salt, diuretics, strict I/Os, daily weight, abdominal girth, BP

Question 24

isotonic dehydration

Answer 24

overall loss of volume, both electrolytes and water
most common type of dehydration

Question 25

why are children at risk for dehydration?

Answer 25

- kidneys not good at concentrating urine - higher RR and metabolic rate = more waste to break down and excrete

Question 26

pediatric hydration assessment

Answer 26

- intake and output - weigh diapers - patient weight - fontanelles - mucus membranes - tear production - turgor and cap refill

Question 27

calculating daily fluid needs for children

Answer 27

- 100 ml/kg for first 10 kg - 50 ml/kg for next 10 kg - 20 ml/kg for remaining body weight

Question 28

normal urine output for children

Answer 28

- babies - 2 ml/kg/hr - toddlers - 1.5 ml/kg/hr - children - 1 ml/kg/hr

Question 29

what is nephrotic syndrome?

Answer 29

- impaired glomerular permeability - protein and large particles can filter into the urine - occurs due to many different kidney diseases, describes a combination of clinical findings

Question 30

features of nephrotic syndrome

Answer 30

- hyponatremia, hypoalbuminemia, proteinuria (it's all getting peed out) - hyperlipidemia - renal vein thrombosis - orbital edema - thromboembolism - infection r/t loss of immunoglobulins in urine - coagulability r/t loss of antithrombin in urine

Question 31

signs and symptoms of nephrotic syndrome

Answer 31

weight gain and edema - fluid retention foamy urine from proteins fatigue loss of appetite

Question 32

diagnosing nephrotic syndrome

Answer 32

24 hour urine proteinuria >3g renal biopsy for children >8 years MRI for glomerular scarring

Question 33

nursing interventions for nephrotic syndrome

Answer 33

Strict I/Os urine testing daily weights low salt diet rest medication administration