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ABSN > Peds Exam 3b - GU > Flashcards

Peds Exam 3b - GU Flashcards

1
Q

what age group is more prone to dehydration

A

newborns

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2
Q

S/s of GU disease: newborns

A

poor feedings
res distress
poor urinary stream
jaundice
seizures
dehy
vomiting

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3
Q

S/s of GU disease: infants

A

poor feeding
pallor
fever
failure to gain wt
persistent diaper rash
seizure
dehy
vomiting

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4
Q

if we are having urine problems, what else should we check

A

blood pressure (RASS system happens in kidneys)
do a manual blood pressure

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5
Q

nursing care for GU mgt

A

-accurate measurement & recording of wt, ht, I&O, and BP
-prepare child and family for tests (not pleasant tests)
-collection of specimens (harder in kids bc they can’t be trusted)

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6
Q

what is the best way to collect urine from a newborn

A

in & out cath

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7
Q

what does urine specific gravity tell us

A

hydration status

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8
Q

should nitrates be in your?

A

yes, they should
nitrites should not and they indicate infection

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9
Q

what indicates infection in the urine

A

-nitrites
-cloudy
-WBCs

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10
Q

what are 80% of UTI’s caused by

A

E.coli
send sample to the lab and if positive then send for culture

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11
Q

what medication will not work for a UTI

A

amoxicillin bc it will not kill E.coli
put children on bactrum

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12
Q

voiding cystoureterography (VCUG)

A

a catheter is inserted into the bladder and then we inject dye so we can watch the child urinate under xray
will be on exam

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13
Q

why do we preform a VCUG

A

to see if the child is reflexing any urine back from the bladder to the kidneys
if doing can cause repeated UTIs, scarring, hydronephrosis and damage to kidneys

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14
Q

when will a VCUG be ordered

A

-if a little girl has 2 to 3 UTIs
-if a little boy has 1 to 2 UTIs

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15
Q

when doing a physical assessment on a GU kid, what is important to look at

A

the ears, bc they develop at the same as the kidneys in utero so if there is something wrong with your ears then probably something wrong with your kidneys

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16
Q

hypospadias

A

when the urethral opening does not go all the way to the tip of the penis, it is on the ventral surface (under the penis)

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17
Q

hypospadias complications

A

-more at risk for UTIs d/t urine stasis
-body image issues (can’t stand and pee)

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18
Q

epispadias

A

urethral opening is on the top of the penis
not as common as hypospadias & it is usually paired with another problem

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19
Q

hypospadias therapeutic mgt

A

-eval of penis before discharge of newborns bc if present, need to repair
-if present, do not preform circumcision bc will do it during the repair

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20
Q

when does surgical correction of hypospadias occur

A

between 6-18 months, lets the child grow but will be fixed before they are potty trained

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21
Q

hypospadias post opt care

A

-pressure dressing do not change but assess for drainage
-check tip of penis if visible
-catheter / stent in place needs to be closed drainage
-if open drain, double diaper
-teach home care

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22
Q

what needs to be avoid while catheter and stent are in

A

-tub baths
if internal stent, only need to avoid for 48 hrs
-sand boxes
-straddle toys
-do not carry on hip

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23
Q

cryptorchidism

A

a condition in which one or both testicles fail to descend into the scrotum, often associated w/ hypospadias

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24
Q

if one testicle is not descending, what is the child more at risk for

A

cancers

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25
Q

cryptorchidism: undescended

A

testes is located somewhere along the normal pathway of descent

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26
Q

cryptorchidism: ectopic

A

testes is located outside normal pathway

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27
Q

cryptorchidism: retractile

A

testes can be manipulated into the scrotum

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28
Q

cryptorchidism: absent

A

testes is absent

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29
Q

cryptorchidism nursing interventions

A

make sure testicle is present

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30
Q

obstructive uropathy

A

an obstruction at any level of the upper and lower urinary tract (ex: tumor, stricture, kidney stone, constipation)

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31
Q

obstructive uropathy therapeutic mgt

A

-surgical correction
-monitor BP
-prepare families
-close observation post opt (pain from stent)
-catheter care
-teaching home care

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32
Q

vesicoureteral reflux

A

-regurgitation of urine from the bladder into the ureters and kidneys
-graded 1 to 5
-can lead to repeated UTIs, HTN, renal insufficiency or renal failure
-primary reflux is familial and is usually outgrown

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33
Q

what can repeated UTIs cause

A

scarring which leads to long term kidney damage

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34
Q

what is one of the leading causes of dialysis later in life

A

repeated UTIs

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35
Q

what grades of vesicoureteral reflux can be treated w/ antibiotics

A

grades 1-3

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36
Q

what test do we do when vesicoureteral reflux is suspected

A

VCUG

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37
Q

when is it best to take antibiotics for vesicoureteral reflux

A

at night because that is when most of the urinary stasis occurs

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38
Q

vesicoureteral reflux nursing considerations

A

-teach infection prevention (antibiotic compliance, empty bladder completely, good hygiene)
-have siblings screened
-age appropriate preparation for procedures

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39
Q

vesicoureteral reflux post opt nursing considerations

A

-no tub baths
-analgesics for pain
-antispasmodics for bladder spasms
-prophylactic abx for 1-2mo post surgery
-urine bag below bladder

40
Q

hernia

A

protrusion of a portion of an organ or organs though an abnormal opening

41
Q

hernia danger arise when

A

-protrusion is constricted
-circulation is impaired
-interference w/ function of development of other structure

42
Q

3 types of hernias

A

1) diaphragmatic (most severe)
2) abdominal wall
3) inguinal canal

43
Q

diaphragmatic herina

A

a hole in the diaphragm and depending when it occurred during fetal development will depend on how well they do (late the heart and lungs had a chance to grow & develop without other organs coming up and squishing them)

44
Q

if baby has a left diaphragmatic hernia, what is a nursing consideration

A

the organs will come up on the left side and push to the right things will not be in correct spot when you listen

44
Q

diaphragmatic hernia mgt

A

-detected in utero (can be fixed prenatally)
-after birth if not fixed: res distress, cyanosis, scaphoid abdomen, impaired cardiac output
-immediate med attention: intubate, GI decompression, IV fluids, surgery

45
Q

what is an umbilical hernia filled with

A

fluid & air, push on it during diaper changes
should be able to squish this and push it flat, if can’t then emergency bc organs are in there and can be strangled

46
Q

what happens to the umbilical hernia when a child gets mad or bears down

A

the hernia will expand and get bigger

47
Q

treatment of umbilical hernias

A

most likely will resolve by itself

48
Q

inguinal hernia

A

-can be more severe
-deep in groin
d/t gravity, more likely for things to go through the hole, make sure to be pushing

49
Q

UTI: urethritis

A

infection limited to the urethra

50
Q

UTI: cystitis

A

infection limited to the bladder

51
Q

UTI: pyelonephritis

A

infection involving the kidney

52
Q

why do girls get UTIs more frequently then boys

A

-anatomy
-the close proximity between the anal opening and the urethra
-girls do not have prosthetic secretions

53
Q

UTI S/s: infants

A

-fever
-wt loss
-FTT
-vomiting
-diarrhea

54
Q

UTI S/s: children

A

-dysuria
-frequency, urgency, incontinence
-foul smelling urine
~hematuria
-abdominal pain
-fever

55
Q

3 goals of therapeutic mgt for UTIs

A

-cure the infection
-identify predisposing factors
-prevent recurrent infections

56
Q

UTI nursing strategies

A

-appropriate specimen collection
-ensure adequate admin of abx
-push fluids
-avoid tight fitting underwear
-promote comfort
-adequate follow up cultures
- teach preventive measures
-pee after sex
-change pads regularity

57
Q

what type of bath increases the risk of a UTI

A

bubble baths
tub baths are good

58
Q

enuresis

A

wetting the bed

59
Q

enuresis: primary

A

-familial
-decreased bladder capacity
-developmental lag
-sleep disorder
-nocturnal polyuria theroy

60
Q

enuresis: secondary

A

-psychological factors (divorce)
-abuse
-UTI
-diabetes
-sickle cell
-constipation
figure out cause

61
Q

enuresis treatment

A

-most will grow out of it
-kegle exercises
-good abdominal tone
-meds (not daily, only for special occasions)
-moisture alarm
-behavior modification positive reinforcement, do not punish

62
Q

enuresis nursing strategies

A

-limit caffeine & chocolate
-limit fluids after dinner
-use bathroom right before bed
-use bed pads & 2 sets of sheets
-teach use of alarm / wake them up to pee throughout night
-only use pulls on sleep overs bc it wicks moisture away and we want them to feel wet & wake up

63
Q

hemolytic uremic syndrome (HUS)

A

combination of hemolytic anemia and thrombocytopenia that occurs with acute renal failure (usually ingests a toxin like E. coli)
-most common between 5-6 yr

64
Q

HUS clinical manifestation

A

watery diarrhea progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia
usually always misdx bc it presents like gastroenteritis

65
Q

what labs will be low in HUS

A

RBCs & platelets

66
Q

HUS source of infection

A

E. Coli (also s.pneum. or shigella)
-cows (playing with or consuming)
-salad
-don’t wash hands well before preparing food
-unpasteurized dairy or fruit products

67
Q

HUS S/s

A

-vomiting
-marked pallor
-oliguria or anuria
-edema
-fatigue
-elevated BP
-abdominal pain & tenderness
-neuro changes

68
Q

HUS urinalysis results

A

positive for blood, protein, pus and casts

69
Q

HUS blood panel results

A

-BUN & creatinine: elevated
-moderate to severe anemia
-mild to severe thrombocytopenia
-leukocytosis w/ left shift
-hypoNa
-hyperK
-hyperPhos

70
Q

HUS complications

A

-chronic renal failure
-seizures & coma
-pancreatitis
-rectal prolapse
-cardiomyopathy
-congestive heart failure
-acute res distress syndrome
she just showed this

71
Q

HUS therapeutic mgt

A

-maintain fluid balance
-correct hypertension, acidosis & electrolyte abnorms
-replenish circulating red blood cells
-provide dialysis if needed
abx do not work, symptom treatment

72
Q

HUS nursing considerations

A

-contact precautions
-close attention to fluid volume status
-family support (we do not know if they will get better)
-encourage adequate nutrition w/ diet restriction
-monitor for bleeding
-teach prevention

73
Q

prevention of HUS

A

-cook foods to proper temp
-wash hands well
-do not consume well water
-wash all fruits & vegetables

74
Q

nephrotic syndrome

A

you lose a lot of protein in the urine causing low protein in blood stream, cholesterol goes up and you have edema
hypoproteinemia, hyperlipidemia, & edema

75
Q

nephrosis clinical manifestations

A

-massive proteinuria
-sudden, rapid wt gain
-generalized edema
-pleural effusion
-decreased urine output
-diarrhea
-anorexia
-pallor, fatigued
-meuhrcke lines
-decreased BPP
-hypoalbuminemia
-mild hematuria

76
Q

nephrosis goals of treatment

A

-reducing protein excretion
-reducing tissue fluid retention (albumin & lasix)
-preventing infection & other complications like anemia, infection, poor growth, peritonitis, thrombosis and renal failure

77
Q

nephrosis therapeutic mgt

A

-bed rest during edema, unrestricted during remission
-no added salt, high pro diet during edema, reg during remission
-drugs: corticosteroids, immunosuppressant therapy, loop diuretics, salt poor, albumin

78
Q

nephrosis nursing considerations

A

immunocompromised so screen visitors and do not put them in the room with other sick people

79
Q

nephrosis: additional nursing diagnoses

A

-ineffective breathing pattern r/t pressure of ascites
-body image disturbance r/t change in appearance
-activity intolerance r/t fatigue
-altered family processes related to a child w/ serious illness

80
Q

acute glomerulonephritis (APSG)

A

a condition in which immune processes injure the glomeruli, ranging from minimal to severe
untreated strep

81
Q

APSG clinical manifestations

A

-fever
-lethargy, fatigue, malaise, weakness
-headache, give pain meds
-anorexia, vomiting
-puffy face
-discolored urine (coke color)
-edema
-pallor
-flank or abdominal pain
-HTN

82
Q

APSG urinalysis

A

-gross hematuria, milld proteinuria, specific gravity elevated
-culture: negative

83
Q

in APSG, how do kids show us they’re getting better

A

increase in urine output

83
Q

APSG therapeutic mgt

A

-bed rest during acute phase
-no salt added, low protein diet
-control htn manual BP
-antibiotics if strep still present or fever
-isolation from other sick kids

84
Q

APSG nursing considerations

A

-daily wts
-I&Os, USG, monitor hematuria
-monitor BP, lytes, & signs of cardiopulmonary congestion
-admin diuretics
-infection prevention

85
Q

APSG potential for injury

A

-renal failure
-encephalopathy
-seizures
not peeing out what they should be

86
Q

for a child with APSG, teach parents

A

-how to take BP
-follow the prescribed diet
-monitor urine output & color

87
Q

why do we see acute renal failure in kids

A

dehydration and nephrotoxic medication
give fluids or stop med then give fluids

88
Q

acute renal failure prevention

A

-treat underlying cause
-manage fluid & lytes
-decrease BP
-provide supportive therapy
-drugs: mannitol, albumin, furosemide

89
Q

acute renal failure nursing considerations

A

-monitor VS and I&Os
-regulate fluid intake
-nutrition
-monitor for complications

90
Q

chronic renal failure

A

treat w/ dialysis (peritoneal bc more gentle & can do at night)

91
Q

what are we monitoring closes in kids with chronic renal failure

A

bones because they still need to grow
calcium (low) & phos (high) disturbances -> osteodystrophy

92
Q

how to treat osteodystrophy

A

-calcium carbonate
-aluminum hydroxide gel

93
Q

supportive therapy for chronic renal failure

A

-diet (high kcal, adequate pro not high, low phos/Na/K+)
-vitamins
-prevention of osteodystrophy
-possible transplant

94
Q

chronic renal failure nursing considerations

A

-activity is self limited
-body image disturbances
-watch for metabolic acidosis
-no fleet enemas

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