Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pedi Exam #2 > Pediatric - Genitourinary > Flashcards

Pediatric - Genitourinary Flashcards

1
Q

Pediatric Genitourinary System:
How does it differ from adults?

A
  • Kidneys large in relation to abdomen until adolescence
  • Urethra is shorter
  • Female infants urethra opening in close physical proximity to rectum increases risk for infections
  • GFR slower infant and young toddler – less able to concentrate urine and reabsorb amino
  • acids increased risk for dehydration during times when fluid loss or decreased fluid intake
  • Bladder capacity newborn 30mLs – adult capacity by 12mos of age 270mLs
  • Average 1yo voids 400-500mLs /day vs Adolescent 800- 1400 mLs / day
  • Infant or toddler voids 9-10 x/day vs by age 3 same as adult 3-8x/day
  • Reproductive organs immature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pediatric Genitourinary System Assessment:
Health History

A
  • Pregnancy hx of mother: polyhydramnios,oligohydramnios, DM, HTN, ETOH or drug use
  • Birth hx: single umbilical artery, abdominal mass, chromosome
  • abnormality or congenital malformation
  • Fhx: renal disease, chronic UTIs, renal calculi or parental enuresis
  • HPI: when sxs started, assoc symptoms, progression of sxs,
  • voiding patterns, age of TT, incontinent episodes
  • Pmhx: spina bifida, myelomeningocele, past UTIs, surgeries
  • Adolescent female: menarche, sexual behaviors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pediatric Genitourinary Assessment,
cont. (HPI)

A
  • dysuria, frequency, urgency, blood in urine, incontinence, changes in voiding pattern, Urine odor, discharge, edema, masses in groin, scrotum or abdomen, flank or abdominal pain, cramps, N/V, back pain, poor growth, wt gain, fever, trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pediatric Genitourinary Assessment, cont. (Physical Assessment)

A

inspect: growth pattern, pruritis, edema (periorbital/general)
external genitalia rash, constant dribble of urine, displaced
urethral opening, discharge, labial fusion (females), scrotal sac
(male) edema, enlargement, discoloration

palpate: abdomen - masses, tenderness include CVA, scrotum -
bilateral testicles, masses, circumcised?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pediatric Genitourinary Structural Disorders: Bladder Exstrophy

A
  • congenital
  • Bladder open (inside out) and exposed outside of the abdomen/rectus muscles separated
  • Pelvis may be malformed
  • Dx: prenatal US
  • Tx: Surgical repair within days of birth
  • occasionally urinary reservoir vs repair of bladder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pediatric Genitourinary Structural Disorders, cont. - Bladder Exstrophy
(Nursing Assessment)

A
  • Bright red bladder on outside of abdomen
  • Draining urine
  • Skin breakdown
  • Malformed urethra
  • Malformed penis (males)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pediatric Genitourinary Structural Disorders, cont.
(Bladder Exstrophy) - Nursing Management

A
  • Preventing Infection
    • Preop: supine position, bladder kept moist, covered with sterile plastic bag, soiled diapers changed, sponge bathe
    • Post op: urinary catheter/suprapubic catheter
      *
  • Preventing Skin Breakdown
    • Preop: protective barrier creams
  • ostomy nurse consult
  • positioning or bracing if pubic arch separated
  • Maximizing Comfort:
  • Post op: Meds for bladder spasms
  • Risk for bleeding:
  • Post op: urine bloody should clear within a few days
  • If urinary reservoir:
  • Post op: stoma catheterization 4x/day
  • Educate parents
  • mucus-like urine and cloudy
  • HR for Latex allergy
  • latex free catheters
  • latex free gloves and other supplies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pediatric Genitourinary Structural Defects, cont. -
Hypospadias

A

Urethral opening on undersurface (ventral surface) of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pediatric Genitourinary Structural Defects, cont. - Epispadias

A

Urethral opening on dorsal surface of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pediatric Genitourinary Structural Defects, cont.

A
  • Hypospadias: Urethral opening on undersurface (ventral surface) of penis
  • Epispadias: Urethral opening on dorsal surface of penis
  • If left uncorrected, urine stream inaccurate from standing position, Erectile dysfunction and/or interfere with the deposition of sperm (infertile)
  • Surgical correction: 6mos -12mos of age
  • Defer circumcision till after repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pediatric Genitourinary Structural Defects, cont. - (Nursing Assessment Hypospadias/Epispadias)

A

*** Nursing Assessment Hypospadias/Epispadias:

report of unusual urine stream or observance
* Inspect placement of urethral meatus
* Inspect for chordee
* Inspect/palpate for testes
* Nursing Management Post op:
* Urinary drainage via tube or stent while site heals
* Tube taped with penis in upright position prevent stress on incision
* Antispasmodics
* Double diapering – inner contains stool, outer urine (see Nursing procedure 21.2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Obstructive Uropathy - Pediatrics
(Hydronephrosis)

A

Pelvis and Calyces of kidney dilated increased fluid
Causes: congenital
result of obstruction
secondary to vesicoureteral reflux
Complications: renal insufficiency
HTN
renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Obstructive Uropathy – Pediatrics
Nursing Assessment (Hydronephrosis)

A
  • Health hx may include FTT, hematuria, presence of abdominal mass, sxs of UTI
  • Physical exam BP, palpation may reveal enlarged kidneys or distended bladder
  • Treatment: dependent on severity may be watch and wait, may need surgery to correct the cause ie blockage or correct reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Obstructive Uropathy – Pediatrics, cont.
(Vesicoureteral Reflux)

A
  • Urine from the bladder flows back up into the ureters
  • Reflux occurs during bladder contraction with voiding
  • Uni- or bi- lateral
  • Increased pressure placed on kidney can lead to renal scarring and HTN later in life
  • Primary VUR: congenital
    Secondary VUR: other structural or functional problems ie neurogenic bladder, bladder
    dysfunction or bladder outlet obstrutction
    Approx 30-50% children with UTI have VUR
    Goal of Management:
    Preventing pyelonephritis and subsequent renal scarring
    Antibiotic prophylaxis
    Good voiding habits and hygiene practices
    Surgery if Grade 3-5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pediatric Genitourinary Disorders, cont.
(Urinary Tract Infection)

A
  • Most commonly affects the bladder
  • Common organism: E. coli
  • Others: Klebsiella, S. aureus, Proteus, Pseudomonas,
  • Haemophilus
  • Bacteria enters in an ascending manner
  • Contributing Factors: urinary stasis, not completely emptying bladder with voids, decreased fluid intake, sexually active female teen
  • If untreated may lead to pyelonephritis
  • Presentation UTI:
  • Infants: fever, irritability, vomiting, FTT or jaundice
  • Children: fever, vomiting, dysuria, frequency, hesitancy, urgency and/or pain
  • Diagnostics UTI: UA and cx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pediatric Genitourinary Disorders, cont.
(UTI - Therapeutic Management)

A
  • PO or IV antibiotics – C+S final adjust as needed
  • 7-14 day course
  • SA teen may do shorter course
  • increase fluid intake
  • fever management
17
Q

Pediatric Genitourinary Disorders, cont.
(Enuresis)

A
  • continued incontinence of urine past the age of TT
  • nocturnal enuresis generally resolved by 6yo
  • Primary: never achieved full bladder control
  • Secondary: previously demonstrated bladder control over a period of 3-6 consecutive mos.
  • Diurnal: daytime loss of control
  • Nocturnal: nightime loss of control
18
Q

Pediatric Genitourinary Disorders, cont. -
Nursing Management (Enuresis)

A
  • Diurnal: set voiding scheduleincrease daytime fluid intake – increase urge to void
  • Nocturnal: Support, education it is not intentional, limit chocolate and caffeine, limit fluid intake after dinner, void just prior to bed, wake at 11pm, bed pads, make bed with 2 sets of sheets, pullups for overnights away from home, include child in plans for night time control, reward sx for dry nights, include in changing of sheets, do not punish or be punitive, bed alarms, last resort medications
19
Q

Acquired Pediatric Genitourinary Disorders

A
  • Occur as an autoimmune response or result of bacterial infection
  • May also occur as a result of an obstructive d/o or repeated VUR
  • May lead to renal failure
  • Renal Disorders: most frequent cause of HTN in children
20
Q

Acquired Pediatric Genitourinary Disorders -
Nephrotic Syndrome

A
  • Result of increased glomerular basement membrane permeability
  • Congenital – inherited, rare, Finnish descent, poor prognosis
  • Secondary – result of SLE, HSP or DM
  • Idiopathic – most common in children, Minimal Change Nephrotic Syndrome (MCNS)
  • Onset generally by 6yo**
  • Complications: anemia, infection, poor growth, peritonitis, thrombosis and renal failure
21
Q

Minimal Change Nephrotic Syndrome (MCNS)

A
  • Excess loss of proteins (albumin) into the urine – proteinuria
  • Decreased protein (albumin) in bloodstream
  • Hypoalbuminemia results in change in osmotic pressure and fluid shifts from bloodstream into interstitial tissue
  • Decrease in blood volume causes kidneys to conserve sodium and water = further edema
  • Liver produces extra lipoproteins and hyperlipidemia occurs
  • Increased risk for clotting and serious infection
22
Q

Minimal Change Nephrotic Syndrome (MCNS) - Medical Management

A
  • corticosteroids
  • IV albumin with severe edema
  • Diuretics if edema
  • Nephrology

IF good response to steroids better prognosis – if relapse or resistant to steroids may need immunosuppressive therapy ie CSA, cyclophosphamide or Mycophenolate

23
Q

Minimal Change Nephrotic Syndrome (MCNS) - Nursing Assessment

A
  • VS
  • periorbital edema in morning, progress thru day to generalized
  • weakness
  • irritability
  • ascites
  • pallor
  • stretched tight skin
  • Resp – increased WOB
24
Q

Minimal Change Nephrotic Syndrome (MCNS) - Labs

A
  • UA – proteinuria
  • Blood: protein and albumin low, cholesterol and trig high
  • eventually elevated BUN/creat
25
Q

Acquired Pediatric Genitourinary
Disorders, cont. - (Acute Poststreptococcal Glomerulonephritis)

A
  • immune responses cause inflammation and injure the glomeruli
  • usually after an infection pharyngitis or skin – group a B-hemolytic strep
  • most often over 3 yo, peaks 7yo
  • May progress to uremia and kidney failure
  • Treatment: not specific
  • Goal – fluid management and HTN
  • antibiotics if evidence of current strep infection
26
Q

Acute Poststreptococcal Glomerulonephritis - Common Symptoms

A

Hx: fever, lethargy, HA, decreased UO, abdominal pain, vomiting, anorexia, recent strep infection
Exam: elevated BP, mild edema, increased WOB or cough, lungs for crackles, heart for gallop
Labs: Urine proteinuria and hematuria / cola colored urine or dirty green, ESR elevated, BUN/creat may be elevated, elevated ASO titer, elevated DNAase B antigen titer

27
Q

Acute Poststreptococcal Glomerulonephritis - Nursing Management

A
  • AntiHTN meds
  • Na and fluid restrictions
  • Daily wts
  • I+Os
  • urine color
  • Monitor edema
  • Neuro exams – HTN may cause encephalopathy and seizures
  • fatigue – bed rest/ cluster care
  • If edema mild and noHTN, may be home – family monitor urine color and output and BP with
    restricted diet, no strenuous activities until proteinuria and hematuria resolved = Educate
  • Dialysis if renal involvement progresses
28
Q

Hemolytic Uremic Syndrome

A
  • three features:
    hemolytic anemia
    thrombocytopenia
    AND
    acute renal failure
  • HUS features caused primarily by microthrombi and ischemic changes within the organs
  • Thrombotic events in small blood vessels of glomerulus lead to occlusion of glomerular capillary
  • loops and glomerulosclerosis results in renal failure
  • E. Coli most common causative agent
  • S. Pneumoniae and Shigella dysenteriae common
  • Most common in children up to age 5
  • Complications: renal failure, seizures, coma, pancreatitis, intussusception, rectal prolapse,
    cardiomyopathy, CHF, ARDS
28
Q

Hemolytic Uremic Syndrome

A
  • three features:
    hemolytic anemia
    thrombocytopenia
    AND
    acute renal failure
  • HUS features caused primarily by microthrombi and ischemic changes within the organs
  • Thrombotic events in small blood vessels of glomerulus lead to occlusion of glomerular capillary
  • loops and glomerulosclerosis results in renal failure
  • E. Coli most common causative agent
  • S. Pneumoniae and Shigella dysenteriae common
  • Most common in children up to age 5
  • Complications: renal failure, seizures, coma, pancreatitis, intussusception, rectal prolapse,
    cardiomyopathy, CHF, ARDS
29
Q

Hemolytic Uremic Syndrome (Therapeutic Management)

A
  • Fluid balance
  • HTN
  • Electrolytes
  • Acidosis correction
  • PRBC
  • Dialysis prn
  • Eculizumab, monoclonal antibody shown success in terminating the microangiopathic process
  • HR for meningitis administer vaccine for meningococcal prior to administration
30
Q

Hemolytic Uremic Syndrome (Nursing Assessment)

A
  • Hx: watery diarrhea, vomiting, bloody diarrhea, then improves
  • hx of eating ground beef, water parks, petting zoo – then diarrhea
  • Exam: pallor, toxic, edema, oliguria, anuria, elevated BP, abdomen tender, irritability, alt LOC
  • (neuro involvement)
  • Diagnostic: UA blood, protein, pus,casts
  • Serum BUN/Creat, anemia, thrombocytopenia, retic count, bilirubin, LDH, hyponatremia,
  • hyperkalemia, hyperphosphatemia, metabolic acidosis
31
Q

Reproductive Organ Disorders

A

Female:
Labial Adhesions/fusion: partial or complete adherence of labia minora
* UTI may result from stasis of urine behind labia
* Untreated –vaginal orifice may be inaccessible
* Nursing Assessment: HR less than 5yo, hx dysuria or frequency
* assess for fusion
* Nursing Management: estrogen creams as prescribed followed by 1mos of Vaseline after
* adhesions separate

* Vulvovaginitis
* PID
* Menstrual Disorders

32
Q

Reproductive Organ Disorders, cont.

A

Male:
Phimosis: foreskin can not be retracted / normal in newborn, should be retractable as gets older
Irritation, balantitis or UTI may occur
Tx: topical steroid cream 2x/day x 1mos
Paraphimosis: urgent. Foreskin retracts and creates a constricting band around the glans –
incarceration
Tx: Circumcision to release

Nursing Management: gentle retraction of foreskin, apply steroid cream.
Educate: Proper Hygiene Uncircumcised
do not force retraction
frequent diaper changes and wash with mild soap and water
as infant gets older gentle retraction and cleaning
Dry area prior to replacing foreskin

33
Q

Circumcision

A
  • removal of excess foreskin of penis
  • Immediately after birth vs later in life vs never
  • Benefits: decreased risk UTI, STI, AIDS and penile cancer, female partners decreased risk of cervical cancer
  • Complications rare: bleeding, penile adhesions, imperfect removal, meatal stenosis
  • Decisions often based on religious beliefs, cultural or social customs
34
Q

Reproductive Organ Disorders, cont. - Undescended testes

A
  • one or both); absence of testes in scrotal sac (descend into scrotal sac in 7-9 month of
  • gestation)
  • Most resolve spontaneously by 2 mos; intervention needed after 4 mos
  • Complications: poor testicular growth, hernia, torsion, infertility, testicular malignancy, psych – empty scrotal sac, risk of testicular CA if do not treat
  • Tx: Orchiopexy (outpatient) release spermatic cord
  • Pull down testes into scrotum and tack in place
  • Teach: S/sx infection: incision and post-op care
  • Pain management, Need for regular testicular exams
35
Q

Reproductive Disorders (Hydrocele)

A
  • fluid in scrotal sac
  • often benign and self limiting – resolves by one year
  • enlarged scrotum / illuminates
36
Q

Reproductive Disorders (Varicocele)

A
  • venous varicosity along spermatic cord/swelling of scrotal sac
  • Complications: low sperm count/infertility
  • Mass on one or both scrotum/ discoloration – bluish/ bag of worms
37
Q

Testicular Torsion

A
  • testicle abnormally attached to scrotum and twists
  • Emergent: ischemia can occur
  • Most common 12 -18yo
  • Assessment: sudden, severe, scrotal pain, swelling, blue/black
  • Immediate surgery to save testicle

Pedi Exam #2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions