Peds Exam 2 Flashcards
_____ urethras in peds gu system
shorter
renal system includes
kidneys, ureter, bladder, urethra
All nephrons present at birth but _____
immature
Less urine output per day but more ____
voids
Immature structure and function until _____
puberty
One of the most common pediatric infections, Bacteria enter urethra and ascend to bladder.
UTI
involves urethra or bladder
cytitis
kidney infection involving ureters, renal pelvis, or renal parenchyma
pyelonephritis
incomplete bladder emptying
stasis
factors that place children at risk for UTI’s
age, gender, hygiene, stasis (fluid retention)
Sexual intercourse in adolescents promotes “______” of bacteria from perineum and vagina
milking
upper urinary tract infections are located where
kidneys or ureter
what is the primary function of the renal system
maintain fluid balance
what should urine output of a normal child be
1-2ml/kg/hr (30ml/hr for adult)
the characteristics of urine are
color, odor, clarity
how do you measure urine output in a diaper wearing child
weigh the diaper before u put it on ad after it is soiled
what is a sensitive indicator of daily fluid loss and gain
weight/ girth
the amount of fluid retention makes a difference in
BP and HR
the amount of solute in urine is referred to as
specific gravity
the AMOUNT of solute in urine is:
1.016-1.022
2 things that help keep bacteria at bay in the urinary tract
acidity and flow
Incontinence of urine past the age of toilet training
Enuresis
diurnal
daytime
lower urinary tract infections are located where
bladder or urethra
upper urinary tract infections are located where
kidneys or ureter
factors that place children at risk for UTI’s
age, gender, hygiene, stasis
interruption of sleep to void
timed voiding
antidiuretic hormones
desmopressin
Tricyclic antidepressants
imipramine
Anticholinergics
oxybutynin
Fluid accumulation in the scrotal sac.
hydrocele
Transillumination of the scrotum to confirm ______ ______
fluid collection
If hydrocele persists beyond __ to __ months, likely noncommunicating and require surgical repair.
12 and 18
Testicle rotates and twists the spermatic cord, cutting off blood supply to the scrotum.
-Caused by excessive mobility of the testes, impact injury, vigorous activity, cold temp., growth spurt
EMERGENCY
testicular torsion
Bladder extrudes through lower abdominal wall, Displaces umbilicus and separates rectus muscles.
Bladder Exstrophy
Treat bladder spasms with ________.
antispasmodics
for bladder exstrophy: Cover exposed bladder with plastic wrap or sterile plastic bag to keep ____.
moist
Surgical intervention for bladder exstrophy __-__ hours after birth.
48-to-72
Retrograde flow (backflow) of bladder urine into one or both ureters during voiding
- Reflux occurs because the ureters are implanted in the bladder wall at an abnormal angle
Vesicoureteral Reflux (VUR)
Management of VUR
continuous antibiotic prophylaxis (CAP)
what age group is most effected by UTI
2-6
what gender is more effected by UTI
female
name a behavior symptom of a UTI in infant
crying more, especially during urination
fever, not eating, uninterested, diarrhea, urine characteristics are different
physiologic symptoms of UTI in infant
indicate damage to the glomeruli;
nephrotic syndrome
result in the release of too much protein from the body (albumin) into the urine;
nephrotic syndrome
lead to a fluid shift from the intravascular spaces to tissue (interstitial space).
nephrotic syndrome
urinary retention, urinary frequency, urinary urgency
signs and symptoms of UTI in a toddler
How can you help a UTI without meds
no iced tea/soda, cranberry juice (more with e.coli), cleanliness of genital area and keeping well hydrated
what is something that can cause a UTI that is internal
constipation
How can you prevent constipation
high fiber/fluid intake, exercise
wetting the bed
enuresis
when is wetting the bed considered abnormal
when it occurs past the age of bladder control (5+)
what are some requirements to be diagnosed with enuresis
2-3 times a week, 3+ months
enuresis occurs more in females or males?
males
What is considered a sufficient bladder volume to be able to hold all night
300-350 mL
psychological factors that can cause enuresis
divorce, hospitalization, family stress and tendencies (siblings such as twins)
how can enuresis be treated
medications, bladder training, fluid restriction in the evening, waking up in the middle of the night to urinate, or conditioned reflex response device
Inflammation and impairment of the glomeruli not caused by direct infection of the kidneys.
- followed by exposure to bacterial infection
Acute Poststreptococcal Glomerulonephritis
(APSGN)
what is the BEST form of treatment for enuresis that cures it in about 2-3 weeks
conditioned reflex response device (wired underwear)
what are some drugs used to treat enuresis
trofanil, oxybutrinine/ditropan (they use a bed pan), DDADP
abnormal defect where the urine flows backward due to misshaped entrance angle of the ureters to the bladder
vesicoureteral reflux (VUR)
diagnosis by cystourithrogram, long term antibiotics (grades 1-2) and surgical procedures (grades 4-5) for grade 3 you attempt to treat with antibiotics and if it doesn’t work surgery is needed
managing VUR
Symptoms include gross hematuria (cloudy, dark tea-
colored urine), periorbital edema, anorexia, proteinuria,
and hypertension.
Acute Poststreptococcal Glomerulonephritis
(APSGN)
what kind of drain do they often use after surgical intervention for VUR
jackson pratt
Acute renal disease characterized by thrombocytopenia,
hemolytic anemia, and acute kidney injury.
hemolytic uremic syndrome
Main cause of acute kidney injury in early childhood, usually caused by e. coli
hemolytic uremic syndrome
Presents with subtle onset with vomiting, abdominal pain,
anorexia, and ascites.
-toxins enter the bloodstream and destroy red blood cells
-Breakdown of red blood cells clog the kidneys
HUS
refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function.
renal failure
_____ infections are cause of majority
of acute illnesses in children
respiratory
Oronasopharynx, pharynx, larynx, and trachea
upper resp tract
Bronchi, bronchioles, and alveoli
lower resp tract
have protection due to maternal antibodies
infants under 3 months
infection rate increases at what months
3-6
high rate of viral infections; the incidence of these infections decreases by age __.
5
what are some airway obstruction risks in infants
the airway is very small
the airway is short in length so it has increased risk for infection and inflammation
infants have immunologic immaturity
infants can not support their head to open their airway when they can’t breath well
Older than __ years: increase in Mycoplasma pneumonia and beta-strep infections
5
it pushes down on their airway when they lay down and can impede breathing
problem with babies fat necks
Mycoplasmal infections more common in what seasons
fall and winter
Asthmatic bronchitis more frequent in ____ weather
cold
Respiratory syncytial virus (RSV) season considered to be
winter and spring
newborn resp. per min
30-55
1 year resp. per min
25-40
3 year resp. per min
20-30
7 year resp. per min
16-22
10 year resp. per min
16-20
17 year resp. per min
12-20
Tonsils become inflamed/reddened, Report of sore throat/difficulty swallowing
tonsilitis
why are babies not good coughers?
they have immature chest musculature
Caused by numerous viruses, common cold
Nasopharyngitis
nasopharyngitis symptoms
◦ Fever
◦ Nasal inflammation and secretions
◦ Irritability, restlessness*
◦ Decreased appetite and fluid intake
◦ Vomiting and diarrhea
“Strep throat” (bacterial)
-Group A beta-hemolytic streptococci (GABHS)
Streptococcal Pharyngitis
Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress
-Affect larynx, trachea, and bronchi
croup syndromes
Most common croup disorder (viral)
-Low-grade fever, restlessness, hoarseness,
barky cough, dyspnea, inspiratory stridor,
retractions, fear and anxiety over dyspneic state
acute Laryngotracheobronchitis
(LTB)
infant symptoms of cute Laryngotracheobronchitis
(LTB)
nasal flaring, intercostal retractions,
tachypnea, and continuous stridor
Also called spasmodic croup, midnight croup
- Paroxysmal attacks of laryngeal obstruction
- Occurs chiefly at night, sudden; transient
acute spasmodic laryngitis
Serious obstructive, inflammatory process
-Potential for complete respiratory obstruction/failure – medical emergency! (Go to the ER!)
Bacterial Epiglottitis
Prevention of bacterial epiglottis
Hib vaccine
Predictive signs of bacterial epiglottis
Absence of cough, drooling, and agitation
diagnostic signs of bacterial epiglottis
Tripod position*, steeple sign
Also called tracheobronchitis
-Associated with an upper respiratory infection, usually viral, and inflammation of the trachea,
bronchi, and bronchioles
Bronchitis
bronchitis symptoms
Persistent dry, hacking cough as a result of inflammation; chest pain; thick sputum; may vomit
thick mucus
babies are ______ breathers
nose
what should be assessed to evaluate respiratory function in children
oxygenation
work of breathing
airway clearance ability
temperature
What can you use to assess oxygenation
cap refill, pulse ox, skin color, LOC, restlessness, anxiety, ABG
What can you look at to assess work of breathing
nasal flaring, accessory muscle use, are they grunting, head bobbing
How can you assess adequate airway clearance
can they cough (productive/nonproductive)
what do their lungs sound like
how often are they coughing
what causes obstructive emphysema
mucus build up in the alveoli
how long does nasopharyngitis typically last
10 days
what is a common cause of nasopharyngitis
viral: rhinovirus, respiratory syncytial virus, adenovirus
what is the treatment regimen for nasopharyngitis
fluid, rest, decongestants
Acute viral infection, affects infants
-Respiratory Syncytial Virus (RSV) or other viruses
RSV/Bronchiolitis
Caused by seasonal reaction to allergens most often
in the autumn or spring
allergic rhintis
what is the most common age for a Peds patient to get nasopharyngitis
under 5
what helps filter and protect the respiratory system and GI tract?
tonsils
Infection or inflammation in lower airways
bacterial pneumonia
requirements for tonsil removal are
at least 7 beta strep infections in one year or 5 infections in 2 years with really high fever; OR peritonsilar absess OR massive hypertrophy
If the tonsils are removed what does the nurse need to assess for after surgery
bleeding
when is a tonsillectomy patient at most risk for bleeding
right after surgery 7-10 days post-op
how can you tell if a tonsillectomy patient is bleeding
frequent swallowing, blood in vomit
ear pain
otalgia
The “flu” is a viral respiratory illness that is most
prevalent during fall and winter months
influenza A and B
whooping cough
Common cold manifestations: runny nose, congestion, sneezing, mild fever, mild cough
pertussis
what are the 3 types of croup syndromes
laryngotracheo-bronchitis, acute spasmodic croup, epiglottitis
how can laryngotracheo-bronchitis be treated
decadron, nebulized epinephrine ( both reduce airway edema)
very harsh cough that occurs mostly at night and is more likely in mid oct- mid april
acute spasmodic croup
Lung infection with acid-fast bacilli, spread by airborne droplets
tuberculosis
how can you provide short term relief for acute spasmodic croup
steamy shower or cold night air
helps keep alveoli open
grunting
assist with ventilation
retractions, head bobbing
increases diameter of air passages
nasal flaring
