Pediatric- Reproductive and Renal Issues Flashcards
What is a enuresis
Uncontrolled or unintentional urination, that occurs after a child, is beyond in an age at which bladder control is achieved
How often do you have to have an appropriate urination for it to be qualified as enuresis
During the day or night at least twice a week for at least three months
What is primary enuresis?
My child has never been free of bedwetting for any extended period of time
What is secondary enuresis?
A child who started bedwetting after development of urinary control
What are risk factors of enuresis?
Males
emotional events ( new siblings, divorce)
How do you diagnose enuresis
Functional bladder capacity screening
What is a functional bladder capacity screening?
Child as instructed to hold off urinating for as long as possible, and then instructed to urinate into a container
The urine output is that measured
The expected bladder capacity in ounces is a child’s age +2
Education for a family with a child who has enuresis
Urinate prior to bedtime
Fluids during the day and restrict fluids, at least two hours prior to bedtime
Avoid caffeinated or carbonated drinks
Use positive reinforcement
Keep calendar of wet and dry days
Have child to change bed linens, and clothing
Wake the child up at scheduled intervals during the night
What is conditioning therapy and enuresis?
Placing an alarm sensor on the bed, that rings alarms when the child voids to awaken child to get up to use the bathroom
What is retention control measures in enuresis?
Have the child consuming large amounts of fluid to stretch the bladder, if not contraindicated
What desmopressin acetate
Reduces the volume of urine
Restrict child’s fluid intake after dinner
Administer medication, a bedtime
What is imipramine hydrochloride
Inhibits urination
Monitor for increase in suicidal thoughts
Length of treatment 6 to 8 weeks
Take with food
Administer med one hour before bed
Avoid sun exposure
What is oxybutynin chloride
Reduce his bladder contractions
Complications, emotional problems
What is bacteriuria
Bacteria in the urine
What is a reoccurrence UTI?
Multiple occurrences of asymptomatic or symptomatic bacteriuria
What does persistent UTI?
Bacteriuria that does not resolved with antibiotic therapy
What is a febrile UTI?
Systematic bacteriuria with fever
What is cystitis?
Inflammation of the bladder
What is urethritis?
Inflammation of the urethra
What is pyelonephritis
Inflammation of the upper urinary track in the kidneys
Risk factors for your UTI
Female
Tight underwear
Bubble baths
Sexual activity
UTI findings in an infant
Increase in irritability
Poor feeding
Increased thirst
Screaming with urination
Foul smelling urine
Diaper rash
UTI findings in a child
Abdominal or back pain
Pain with urination
Poor appetite
Slow growth
Swelling of face
Blood in urine
What is the most accurate method for obtaining urine in child less than two?
Sterile, catheterization
Client education for uti
Females wipe front to back
Uncircumcised men ensure foreskin is retracted
Underwear, dry cotton, underwear
Avoid bubble baths
Void frequently
Empty bladder completely
Void immediately after intercourse
A nurse is teaching a parent of a child who has a urinary tract infection, which of the following should the nurse include in the teaching(select)
Where nylon underpants
Avoid bubble baths
Empty bladder completely with each void
Watch for manifestations of infection
Wait perineal area back to front
Avoid bubble baths
Empty bladder completely with each void
Watch for manifestations of infection
A nurse is planning care for a child who has a urinary tract infection which of the following intervention should the nurse include
Administer antidiuretic
Restrict fluids
Evaluate the child self-esteem
Encourage frequent voiding
Encourage frequent voiding
A nurse is caring for a child who has enuresis, which of the following is a complication of enuresis
 Urinary tract infection
Emotional problems
Urosepsis
Progressive kidney disease
Emotional problems
A nurse is assessing an infant who has suspected urinary tract infection, which of the following are expected findings(select)
Increase in hunger
Irritability
Decreasing urination
Vomiting
Fever
Irritability
Vomiting
Fever
A nurse is assessing a child who has a urinary tract infection, which of the following manifestation of a urinary tract infection(select)
Night sweats
Swelling of the face
Pallor
Pale colored urine
Fatigue
Swelling of the face
Pallor
Fatigue
When do children become aware and very interested in the genital area
Between three and six years of age
When is the ideal repair of structural defects of the genital area?
Done between 6 to 12 months of age, but before three years of age to minimize the impact on body image, and promote healthy development
What is obstructive uropathy?
Obstruction in the urinary system
How to fix obstructive uropathy
Surgical procedure that diverts the flow of urine to bypass the abstraction, including surgical, repair and insertion of urethral stent
What is chordee
Central curvature of the penis
How to fix chordee
Surgical release of the fibrous band
What is bladder exstrophy?
A version of the posterior bladder through the anterior bladder wall in lower abdominal wall
Expose bladder, urethral, and ureter orifices through the suprapubic area
Epispadias present
What should the nurse do if there is bladder exstrophy?
Cover the explodes, better with sterile, nonadherent dressing,
prepare the child for immediate
What is hypospadias
Urethral opening located just below the glans penis behind the glans penis or on the ventral surface of the penile shaft
Meatus opening below the glans penis
Nearest opening along the ventral surface of the penis, scrotum or peroneal
What is epispadias in males
Widen pubic symphysis
Urethra opened on dorsal surface of the penis
Possible exstrophy
What is episoadias of the female
Wide urethra
Possible exstrophy of the bladder
How do fix epispadias
Surgery performed during the first year of life
What is phimosis
Nearing of the preputial opening of the foreskin
Inability to retract foreskin of penis
Usually disappears as a child grows
Nursing action for phimosis
Proper hygiene for external foreskin cleansing
Foreskin should not be forcibly retracted
What is Cryptorchidism
Undescended testes
Inability to palpate testes within the scrotum
When is surgery preformed during cryptorchidism
Six and 24 months of age
What is hydrocele
Fluid in the scrotum
Enlarge scrotal sac
Can resolve spontaneously
If hydrocele is not resolved by one year of age what do you do?
Surgical repair
What is variocele
Elongation dilation in tortuosity of the veins of the spermatic cord superior to the testicles
How do you fix variocele
Variocelectomy
What is testicular torsion?
Testes hangs free from its vascular structure
Pain is either a cute or insidious an answer in radiates to the groin area
How do you fix testicular torsion?
Immediate surgery
What is ambiguous genitalia?
Erroneous or abnormal sexual differentiation karyotyping is performed to determine the infant chromosomal pattern
Genetic counseling can help
What do you teach a client who hast to get surgery on their genitalia?
Surgery is not a punishment, and it will not mutilate the body
Do not provide to baths for at least one week
Limit activity
A nurse is caring for an infant who is Hydrocele which of the following actions should the nurse take?
Prepare the child for surgery
Explain to the parents that the issue with self resolve
Retract the foreskin and cleanse several times daily
Refer the family for genetic counseling
Explain to the parents that the issue will self resolve
A nurse is caring for a male infant who has an epispadias which of the following findings should the nurse expect?(select)
Bladder exstrophy
Inability to retract foreskin
Widen pubic symphysis
Urethral opening on the dorsal side of the penis
Pain
Bladder exstrophy
Widened pubic symphysis
Urethral opening on the dorsal side of the penis
A nurse is caring for an infant who has ambiguous genitalia, which of the following action should the nurse take (select)
 Prepare the child for surgery
Test child’s infants function
Cover the genitals with sterile dressing
Refer to the family for genetic counseling explain the need for a chromosomal analysis 
Prepare the child for surgery
Refer to the family for genetic counseling
Explain the need for chromosomal analysis
A nurse is caring for an infant who has obstructive uropathy which of the following findings should the nurse expect(select)
Decrease urine flow
Urinary track infection
Intrauterine polyhydramnios
Concentrated urine
Hydronephrosis
Urinary tract infection
Hydroephrosis
What is acute glomerulonephritis
Benign inflammation of the glomeruli which causes intravascular coagulation that lasts about one to two weeks
Acute poststreptococcal glomerulonephritis is an antibody antigen disease that occurs as a result of
Certain strains of the group a beta hemolytic streptococcal infection
Risk factors for acute glomerulonephritis
Acute poststreptococcal glomerulonephritis
Recent upper respiratory infection, or streptococcal infection
Findings with acute glomerulonephritis
Cloudy T colored urine
Decreased urine output
Hematuria
Proteinuria
Irritability
Ill appearance
Facial edema, worsen morning
Encephalopathy
General swelling
Nursing care in acute  glomerulonephritis
Play the child on the same scale with the same amount of clothing
Implement seizure precaution
Possible restriction of sodium
Restrict foods, high in potassium
What is nephrotic syndrome?
Alterations in the g glomerular membrane allow proteins, especially albumin to pass into the year and resulting in decrease blood osmotic pressure which leads to protein, urea, hyper lipidemia an edema
What is secondary nephrotic syndrome?
Occurs after or is associated with Kamarie alert damage due to a known cause
What is congenital nephrotic syndrome?
An inherited disorder
Expected findings in nephrotic syndrome
 Waking over a period of days
Facial edema
Ascites
Edema and lower extremities
Muerhrcke lines on fingernails(white lines, parallel to the lunula)
Genital swelling
Decreased frothy urine
What is hypoalbuminemia
Reduce blood proteins and albumin
What is hyper lipidemia?
Elevated blood, lipid levels
What is hemoconcentration?
Reduce sodium levels
What is indicated only if nephrotic syndrome is unresponsive to steroid therapy?
Kidney biopsy
Nursing care for a patient with nephrotic syndrome
Strict I & O
Weigh diapers
Check urine protein
Monitor daily weight
Monitor, edema and abdominal girth
Elevate legs and feet to relieve edema
Salt can be restricted
What medication do you use for nephrotic syndrome?
Corticosteroid: prednisone
Diarrhetic : furosemide
Plasma, expanders
Immunosuppressant : cyclophosphamide
What is hemolytic uremic syndrome?
An acute renal disease characterized by acute renal failure, hemolytic, anemia, and thrombocytopneia
What is one of the main causes of acute renal failure in early childhood?
Hemolytic uremic syndrome
What happens during hemolytic uremic syndrome?
Breakdown of red blood cells clog the kidneys toxins enter the bloodstream and destroy red blood cells
Risk factors for hemolytic uremic syndrome
Diarrhea positive HUs
Diarrhea negative or atypical HUS
Findings and hemolytic uremic syndrome
Occurs after prodromal period of diarrhea and vomiting occasionally occurs after varicella measles or UTI
Loss of appetite
Hallucination
Bruising, purpura, or rectal bleeding
Anuric and hypertensive
What should the nurse do with a patient has hemolytic uremic syndrome?
Administer fluid replacement
Correct acidosis and electrolyte imbalances
Monitor CNS for seizure activity
Provide seizure precautio
Blood transfusions with fresh washed packed cells for severe anemia
What should you teach a patient who has hemolytic uremic syndrome?
Avoid undercooked meat, especially ground beef
Avoid unpasteurized, apple juice and unwashed raw vegetables
Avoid alfalfa sprouts
Avoid public pools
What is acute renal failure?
Inability of the kidneys to excrete waste material, concentrate, urine and conserve electrolytes
What are prerenal risk factors for acute renal failure?
Dehydration, secondary to diarrheal disease, or persistent vomiting
Surgical shock
Accidental poisoning
What are intrinsic renal risk factors for acute renal disease?
Damage to the glomeruli
Obstruction of the urinary system
Expected findings and acute renal failure
Ogularia
Abrupt diuresis
Edema
Circulatory collapse
Cardiac arrhythmia
Seizures
Medication’s for acute renal failure
Mannitol furosemide calcium gluconate
Sodium bicarbonate glucose and insulin
Sodium polystrene solfonate
Mannitol and furosemide does what
Provoke a flow of urine in a child who has oligularia and lower tracked obstruction
What is calcium gluconate do?
Reduce blood potassium levels
What is sodium bicarbonate do?
Elevate blood pH and causes a transient fluid shift to the reduce blood potassium levels
What does glucose and insulin Ivy do?
Causes glucose in potassium to move into cells
What is sodium polystryrene  sulfonate do?
Rectally or orally find potassium in excreted from the body
What is chronic renal failure?
Begins when the disease kidneys can no longer maintain the normal chemical structure of body fluids under normal conditions, and there’s an extensive irreversible damage to the nephrons
Expected findings in chronic renal failure
Loss of energy
Occasional elevator, BP
Delayed growth
Decrease interest in activities
Decrease or increase urinary output
Uremic odor to breath
Muscle cramps
Puffiness to face
What should the nurse do with a patient with chronic renal failure?
Provide rest
Initiate fluid restriction, if Adam a present
Daily weight
Neuro check
Sodium restriction
Phosphorus reduction
Nutrition for a patient with chronic renal failure
Provide adequate calories and protein for growth
Restrict dietary phosphorus
Potassium is restricted
Limit protein
Take dietary sources of Folic acid and iron
A nurse is assessing a child who is nephrotic syndrome, which of the following findings should the nurse expect(select)
Urine dipstick +2 protein
Edema in the ankles
Hyper lipidemia
Polyurea
Anorexia
Urine dipstick plus 2 protein
Edema in the ankles
Hyper lipidemia
Anorexia
A nurse is caring for a school age child who has acute glomerulonephritis which of the following findings should the nurse report to the provider?
BUN 8 my/dL
Blood creatinine 1.3 mg per deleter
Blood pressure 100/74
Urine output 550 mL in 24 hours 
Blood creatinine, 1.3 mg/dL
A nurse is caring for a preschooler who has nephrotic syndrome, which of the following findings should the nurse report to the provider
Blood proteins 5.0
Hgb, 14.5
HCT 40%
Platelet 200,000 
Blood protein, 5.0.
The nurse is assessing a child who has chronic renal failure which of the following findings should the nurse expect
Flushed face
Hyperactivity
Weight gain
Delayed growth
Delayed growth
A nurse is caring for a child who has a cute poststreptococcal glomerulonephritis which of the following manifestations, should the nurse expect(select)
Pale urine
Pre-orbital edema
Ill appearance
Decrease creatinine
Hypertension
Pre-orbital edema
Ill appearance
Hypertension
