Midterm Flashcards
RENAL: fx.’s of the renal system
the following are processes seen in those >2 of age:
- formation and excretion of urine
- regulates F&E
- regulates acid-base balance
- regulates BP
- stimulates RBC production in the marrow
RENAL: pediatric variation in renal system
infant’s and child.’s total body H2O constitutes a large fraction of their weight
the 1st 2 y of life the kidneys are less efficient at regulating F&E and acid-base balance [inefficient conservation of F&E]
child. <2 y.o. do not ave the mature innervation of stretch receptors in the bladder wall to maintain bladder control [do not recognize sensation of having to urinate]
the urethra is shorter in child. and the kidneys do not have much fat pads [risk for trauma]
the urethral opening is closer to the anus in girls [risk for infection]
RENAL: enuresis
“bed wetting”
considered enuresis if child is developmentally >5 y.o., occurs 2x/week for >3 m., w/ urgency/ frequency
- stress or diabetes insipidus are risk factors for 2o enuresis
tx: drugs [tofranil (anticholinergic), oxybutynin (same)], bladder trining, fluid restriction in evenings, interruption of sleep to void
RENAL: UTI
most common serious bacterial infection in child. that is the result of bacteria ascending to the bladder via the urethra [commonly, e. coli]
risk factors: infant/ young child. [b/c of shorter urethra], female >1 y.o.; urinary tract obstructions, voiding dysfunction, anatomic differences, susceptibility to infection, urinary retention
s/s: infants [fever/hypothermia, irritability, dysuria, change in urine odor/ color, poor weight gain, anorexia, lethargy], child. [abd. pain, frequency/ urgency, dysuria, enuresis, fever
prevention: teach good hygiene, avoid irritants, cotton underwear, adequate fluid intake, empty the bladder regularly
RENAL: normal urinalysis
pH: 5-9 specific gravity: 1.001-1.035 protein <1-2 color: pale yellow-deep gold clarity: clear amount: 1-2 mL/kg/h no glucose, ketones, hgb, nitrites, casts
RENAL: vesicoureteral reflux
occurs when urine flows from the bladder back into the ureters and renal pelvis
risk factors: incompetent valvular mechanism at the uretervesicular junction, UTI
risks: renal damage
s/s: fever, dysuria, frequency/ urgency, nocturia, hematuria, flank/ abd. pain, UTI
tx: prophylactic antibiotics 1-2 m post-op, establish voiding pattern
RENAL: obstructive uropathy
structural and functional abnormalities of the urinary system that interferes w/ urinary flow
risks: hydronephrosis [accumulation of urine in the renal pelvis b/c of obstruction], UTI, renal insufficiency, kidney damage
s/s: abd. mass/ pain, UTI w/ frequency/ urgency/ dysuria, sepsis, hematuria, incontinence
tx: surgical correction
NI: monitor F&E, discharge teaching for management of urinary drains/ diversions
RENAL: types of urinary diversions
ureterostomy
- ureters outside of the abd. wall
vesicostomcy
- surgical opening into the bladder in which the bladder wall is brought to the surface of the abd.
– seen in child. w/ spona bifida, since innervation o the bladder muscles do not work due to malformation of the spinal cord
ileal conduit
- ureters are removed frrom the bladder and attached to the ileum [acts as a bladder]
RENAL: cryptorchidism
undescended testes
failure of normal prenatal descent of testes during 7th-9th month of gestation
s/s: small/ asymmetrical scrotal sac, absent testes
risks: sterility, testicular cancer
tx: surgery
NI: pain management, wound care
RENAL: phimosis
narrowing or stenosis of the perputial opening of foreskin, preventing retraction of the foreskin over the glans
- may be a normal finding in infants and young child.
risks: balanitis [inflammation of foreskin]
RENAL: hypospadias and epispadias
hypospadias: urethral opening on ventral surface of penile shaft; often w/ chordee
epispadias: urethral opening on dorsal surface
tx: surgery [do not perform circumcision on this infants; skin from foreskin is going to be used for reconstruction purposes]
- goals of surgery: normal voiding, cosmetically appropriate, normal urinary/ sexual fx
RENAL: hydrocele
peritoneal abd. fluid in the scrotal sac that entered via a patent channel from the abd. to groin
can be diagnosed using transillumination of the scrotal sac
risk factors: inguinal hernia, NB
tx: surgical repair if fluid is not reabsorbed by 1 y
RENAL: bladder exstrophy
protrusion of posterior bladder wall through incompletely fused anterior bladder and abd. wall that exposes lower urinary tract structures
often seen w/ epispadias and other GU abnormalities
NI: pre-op [maintain sterility and moisture of area, protect surrounding skin]; requires multiple surgeries [repair, continent diversion, reconstruction of genitalia]; post-op [prevent infection, monitor urinary fx., antibiotics, encourage fluid intake, no “straddle toys for 2 w, no swimming/ baths until stent removed]
RENAL: acute post-streptococcal glomerulonephritis
most common childhood renal disease w/ peak ages of 5-7 y immune complexes get trapped in kidneys > inflammatory response >obstruction of glomerular flow > reduced filtrate production
causes: AGN occurs 1-2 w p/ group A-B hemolytic strep. infection [can be caused by other organisms]
risks: HTN, HTN ENCEPHALOPATHY, SEIURES, CARDIAC DECOMPENSATION FROM HYPOVOLEMIA, inflammation > altered glomerular structure and fx. of kidney, infection > antibody-antigen rx., uremia, ACUTE RENAL FAILURE
s/s: hematuria, mild-moderate edema, HTN [b/c of activation of renin-angiotensin system], pale, lethargic irritable, anorexic
dx: ELEVATED ANTIBODY TITERS/ ESR/ specific gravity/ BUN and creatinine
NI: MONITOR BP/ fluid balance/ mental status [HTN > seizures], med.’s [anti-HTN, loop diuretics, anitbiotics]
RENAL: nephrotic syndrome
autoimmune process that occurs 1 w after an immune assault; may be idiopathic or 2o to glomerular damage [lupus, diabetes]
common in male child. ages 2-3 y
risks: increased glomerular basement membrane permeability [esp. to protein] > abnormal losses; permamnent glomerular damage, peritonitis
s/s: HYPOALBUMINEMIA, PROTEINURIA, HYPERLIPIDEMIA, dark foamy frothy urine, slow weight gain [due to edema (anasarca)], anorexia, irritability
tx: corticosteroids [inflammation], IVIG [autoimmune disease]
NI: fluid restriction if appropriate, strict I&O, daily weights, monitor lab values, diet w/ normal protein and hi kcal and no salt
GI: pediatric variation in GI system
mouth
- very vascular, entry for infections
esophagus
- muscle tone of LES not developed until 1 m > regurgitation
stomach
- capacity much smaller than adult, gastric acid reaches adult level by 6 m [can cause irritation since the stomach of a 6 m. o. is still small in comparison to an adult stomach]
intestine
- infant has 250 cm of small intestines, adults 600 cm
- fetal intestines are outside abd. until 11 w gestation
biliary system
- liver large at birth [palpable], pancreatic enzymes not mature until 2 y. o.
GI: cleft lip and palate
congenital anomaly, most common craniofacial malformation where there is an incomplete fusion of embryonic soft tissues and/or palatal arch
risk factors: maternal smoking/ ETOH use/ folic acid deficiency/ young; use of dilantin, depakote, dioxin during preg.
risks: aspiration, choking, infection
tx: surgery [cheiloplasty for lip, staphylorrhaphy for palate], speech therapy
NI: encourage PO feeds [breast feed]
GI: cleft lip and palate surgery
cheiloplasty, cleft lip repair
- repair usually done when infant is 10 w and weighs 10 lbs
- post-op care: suture line care, avoid sucking or prolonged vigorous crying, keep in supine/ side-lying position, arm restraints [prevent placing hands in mouth]
staphylorrhaphy, cleft palate repair
- post-op care: prone position [prevents aspiration of blood/ drainage from suture], pack wound, soft diet
GI: gastroschisis
herniation of the abd. viscera outside the abd. cavity through a defect in the abd. wall to the side of the umbilicus
risks: heat loss, fluid loss, infection, perforation
NI: pre-op [protect protruding abd. organs; place NG/OG to decompress; thermoregulation, F&E deficits [strict I&O, daily weights], infection], post-op [ventilator care, infection, maintain F&E, long-term TPN, pain control, vascular compromise]
GI: omphalocele
intraabdominal contents herniated through umbilical cord w/ failure of the liver and intestines to return to the and. when the abd. wall begins to close
the defect is enclosed by a translucent sac into which the umbilical cord insects
associated w/ other congenital anomalies
NI: pre-op [protect protruding abd. organs; place NG/OG to decompress; thermoregulation, F&E deficits [strict I&O, daily weights], infection], post-op [ventilator care, infection, maintain F&E, long-term TPN, pain control, vascular compromise]
GI: esophageal atresia and tracheoesophageal fistula
failure of embryonic development and separation of trachea and esophagus
EA: abnormal development of esophagus; TEF: abnormal connection b/w trachea and esopahgus
often part of other congenital anomalies:
- VATER syndrome: Vertebral, Anal, Tracheal, Esophageal, Radial and Renal dysplasia
- VACTERL syndrome: Vertebral. Anal, Cardiac, Tracheal, Esophageal, Renal, Limb
s/s: polyhydraminos in utero, frothy saliva w/ drooling, coughing/ choking/ cyanosis, aspiration of feeding ? aspiration pneumonia
NI: pre-op [NPO, suctioning, NGT to evacuate contents], post-op. [NGT/ GT to suction, PN [PO feed p/ 5-7 days post esophagram], monitor resp. complications
GI: abd. hernias
protrusion of muscle wall or organ through abd. opening
types:
- diaphramatic: medical emergency b/c it prevents development and expansion of lungs; sx.’s: nasal flaring, retractions, low pulse ox., tachypnea/cardia
- umbilical: can be pushed back in
- inguinal: can be pushed back in
risks: constriction of opening > impairment of circulation
tx: surgery
GI: meckel’s diverticulum
most common deformity of the GI system where the omphalomesenteric duct [connects the mid-gut to the yolk sac] fails to atrophy during weeks 5-7 gestation
it leaves an out-pouching that contains gastric/pancreatic tissue; secretes HCl acid/ pancreatic enzymes
s/s: irritation, bright red rectal bleeding [no pain]
tx: surgery
GI: GERD
GER [gastroesophageal reflux] is a normal physiologic process during 1st y of age; GERD is when it occurs p/ 1st y
s/s: poor weight gain, irritability, frequent regurgitation, chest pain, hematemesis [irritation of acid to esophagus], cough, abnormal neck posturing [sandifer syndrome]
risks: mucosal tissue damage, failure to thrive, dysphagia, pneumonia
tx: med.’s [H2RA, PPI’s]; nissen fundoplication [apex of stomach get wrapped around LES to create pressure to prevent backflow]
NI: position appropriately, soften feeds
GI: constipation
defined as an alteration in frequency, consistency or ease of passing stools
a NB should have a meconium movement during the 1st 24-36 h of life
causes: NB [atresia, hypothyroidism, cystic fibrosis, imperforate anus], infant [same + diet], child. [diet, psychosocial]
GI: appendicitis
inflammation occurs b/c of obstruction of appendiceal lumen caused by hard fecal mass, parasite, stenosis, tumor
risk factors: high sugar and low fiber diets
risks: rupture of appendix > fecal/ bacterial contamination of the peritoneum
s/s: RLQ pain [mcburney’s point], rebound tenderness, low grade fever
tx: hydration, surgery, antibioctics [if ruptured]
GI: pyloric stenosis
hypertrophy and hyperplasia of the pyloric muscle
s/s: projectile vomiting, dehydration, failure to thrive, visible left-to-right peristalsis [muscles thicken to force food through], mass right to umbilicus
tx: sx. relief, pyloromyotomy [repair of sphincter]
NI: pre-op [NPO, IV, NGT], post-op. [slow PO feed introduction, post-feeding position]
GI: intussusception
it is an intestinal obstruction where the intestine telescopes into itself
s/s: acute flares of abd. pain, vomiting, abd. mass, late sign [jelly stools,, abd. distention]
risks: cuts off circulation to tissue
tx: enemas, surgical reduction
NI: pre-procedure [NPO/ NGT, assess abd./ stools], post-procedure [assess for reduction of intussusception/ passing of contrast medium, fluid management]
