Peds Exam 3b - GU Flashcards
what age group is more prone to dehydration
newborns
S/s of GU disease: newborns
poor feedings
res distress
poor urinary stream
jaundice
seizures
dehy
vomiting
S/s of GU disease: infants
poor feeding
pallor
fever
failure to gain wt
persistent diaper rash
seizure
dehy
vomiting
if we are having urine problems, what else should we check
blood pressure (RASS system happens in kidneys)
do a manual blood pressure
nursing care for GU mgt
-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)
what is the best way to collect urine from a newborn
in & out cath
what does urine specific gravity tell us
hydration status
should nitrates be in your?
yes, they should
nitrites should not and they indicate infection
what indicates infection in the urine
-nitrites
-cloudy
-WBCs
what are 80% of UTI’s caused by
E.coli
send sample to the lab and if positive then send for culture
what medication will not work for a UTI
amoxicillin bc it will not kill E.coli
put children on bactrum
voiding cystoureterography (VCUG)
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
why do we preform a VCUG
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
when will a VCUG be ordered
-if a little girl has 2 to 3 UTIs
-if a little boy has 1 to 2 UTIs
when doing a physical assessment on a GU kid, what is important to look at
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
hypospadias
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)
hypospadias complications
-more at risk for UTIs d/t urine stasis
-body image issues (can’t stand and pee)
epispadias
urethral opening is on the top of the penis
not as common as hypospadias & it is usually paired with another problem
hypospadias therapeutic mgt
-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
when does surgical correction of hypospadias occur
between 6-18 months, lets the child grow but will be fixed before they are potty trained
hypospadias post opt care
-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
what needs to be avoid while catheter and stent are in
-tub baths
if internal stent, only need to avoid for 48 hrs
-sand boxes
-straddle toys
-do not carry on hip
cryptorchidism
a condition in which one or both testicles fail to descend into the scrotum, often associated w/ hypospadias
if one testicle is not descending, what is the child more at risk for
cancers
cryptorchidism: undescended
testes is located somewhere along the normal pathway of descent
cryptorchidism: ectopic
testes is located outside normal pathway
cryptorchidism: retractile
testes can be manipulated into the scrotum
cryptorchidism: absent
testes is absent
cryptorchidism nursing interventions
make sure testicle is present
obstructive uropathy
an obstruction at any level of the upper and lower urinary tract (ex: tumor, stricture, kidney stone, constipation)
obstructive uropathy therapeutic mgt
-surgical correction
-monitor BP
-prepare families
-close observation post opt (pain from stent)
-catheter care
-teaching home care
vesicoureteral reflux
-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
what can repeated UTIs cause
scarring which leads to long term kidney damage
what is one of the leading causes of dialysis later in life
repeated UTIs
what grades of vesicoureteral reflux can be treated w/ antibiotics
grades 1-3
what test do we do when vesicoureteral reflux is suspected
VCUG
when is it best to take antibiotics for vesicoureteral reflux
at night because that is when most of the urinary stasis occurs
vesicoureteral reflux nursing considerations
-teach infection prevention (antibiotic compliance, empty bladder completely, good hygiene)
-have siblings screened
-age appropriate preparation for procedures
vesicoureteral reflux post opt nursing considerations
-no tub baths
-analgesics for pain
-antispasmodics for bladder spasms
-prophylactic abx for 1-2mo post surgery
-urine bag below bladder
hernia
protrusion of a portion of an organ or organs though an abnormal opening
hernia danger arise when
-protrusion is constricted
-circulation is impaired
-interference w/ function of development of other structure
3 types of hernias
1) diaphragmatic (most severe)
2) abdominal wall
3) inguinal canal
diaphragmatic herina
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)
if baby has a left diaphragmatic hernia, what is a nursing consideration
the organs will come up on the left side and push to the right things will not be in correct spot when you listen
diaphragmatic hernia mgt
-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
what is an umbilical hernia filled with
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
what happens to the umbilical hernia when a child gets mad or bears down
the hernia will expand and get bigger
treatment of umbilical hernias
most likely will resolve by itself
inguinal hernia
-can be more severe
-deep in groin
d/t gravity, more likely for things to go through the hole, make sure to be pushing
UTI: urethritis
infection limited to the urethra
UTI: cystitis
infection limited to the bladder
UTI: pyelonephritis
infection involving the kidney
why do girls get UTIs more frequently then boys
-anatomy
-the close proximity between the anal opening and the urethra
-girls do not have prosthetic secretions
UTI S/s: infants
-fever
-wt loss
-FTT
-vomiting
-diarrhea
UTI S/s: children
-dysuria
-frequency, urgency, incontinence
-foul smelling urine
~hematuria
-abdominal pain
-fever
3 goals of therapeutic mgt for UTIs
-cure the infection
-identify predisposing factors
-prevent recurrent infections
UTI nursing strategies
-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
what type of bath increases the risk of a UTI
bubble baths
tub baths are good
enuresis
wetting the bed
enuresis: primary
-familial
-decreased bladder capacity
-developmental lag
-sleep disorder
-nocturnal polyuria theroy
enuresis: secondary
-psychological factors (divorce)
-abuse
-UTI
-diabetes
-sickle cell
-constipation
figure out cause
enuresis treatment
-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
enuresis nursing strategies
-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
hemolytic uremic syndrome (HUS)
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
HUS clinical manifestation
watery diarrhea progresses to hemorrhagic colitis, then to hemolytic anemia and thrombocytopenia
usually always misdx bc it presents like gastroenteritis
what labs will be low in HUS
RBCs & platelets
HUS source of infection
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
HUS S/s
-vomiting
-marked pallor
-oliguria or anuria
-edema
-fatigue
-elevated BP
-abdominal pain & tenderness
-neuro changes
HUS urinalysis results
positive for blood, protein, pus and casts
HUS blood panel results
-BUN & creatinine: elevated
-moderate to severe anemia
-mild to severe thrombocytopenia
-leukocytosis w/ left shift
-hypoNa
-hyperK
-hyperPhos
HUS complications
-chronic renal failure
-seizures & coma
-pancreatitis
-rectal prolapse
-cardiomyopathy
-congestive heart failure
-acute res distress syndrome
she just showed this
HUS therapeutic mgt
-maintain fluid balance
-correct hypertension, acidosis & electrolyte abnorms
-replenish circulating red blood cells
-provide dialysis if needed
abx do not work, symptom treatment
HUS nursing considerations
-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
prevention of HUS
-cook foods to proper temp
-wash hands well
-do not consume well water
-wash all fruits & vegetables
nephrotic syndrome
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
nephrosis clinical manifestations
-massive proteinuria
-sudden, rapid wt gain
-generalized edema
-pleural effusion
-decreased urine output
-diarrhea
-anorexia
-pallor, fatigued
-meuhrcke lines
-decreased BPP
-hypoalbuminemia
-mild hematuria
nephrosis goals of treatment
-reducing protein excretion
-reducing tissue fluid retention (albumin & lasix)
-preventing infection & other complications like anemia, infection, poor growth, peritonitis, thrombosis and renal failure
nephrosis therapeutic mgt
-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
nephrosis nursing considerations
immunocompromised so screen visitors and do not put them in the room with other sick people
nephrosis: additional nursing diagnoses
-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
acute glomerulonephritis (APSG)
a condition in which immune processes injure the glomeruli, ranging from minimal to severe
untreated strep
APSG clinical manifestations
-fever
-lethargy, fatigue, malaise, weakness
-headache, give pain meds
-anorexia, vomiting
-puffy face
-discolored urine (coke color)
-edema
-pallor
-flank or abdominal pain
-HTN
APSG urinalysis
-gross hematuria, milld proteinuria, specific gravity elevated
-culture: negative
in APSG, how do kids show us they’re getting better
increase in urine output
APSG therapeutic mgt
-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
APSG nursing considerations
-daily wts
-I&Os, USG, monitor hematuria
-monitor BP, lytes, & signs of cardiopulmonary congestion
-admin diuretics
-infection prevention
APSG potential for injury
-renal failure
-encephalopathy
-seizures
not peeing out what they should be
for a child with APSG, teach parents
-how to take BP
-follow the prescribed diet
-monitor urine output & color
why do we see acute renal failure in kids
dehydration and nephrotoxic medication
give fluids or stop med then give fluids
acute renal failure prevention
-treat underlying cause
-manage fluid & lytes
-decrease BP
-provide supportive therapy
-drugs: mannitol, albumin, furosemide
acute renal failure nursing considerations
-monitor VS and I&Os
-regulate fluid intake
-nutrition
-monitor for complications
chronic renal failure
treat w/ dialysis (peritoneal bc more gentle & can do at night)
what are we monitoring closes in kids with chronic renal failure
bones because they still need to grow
calcium (low) & phos (high) disturbances -> osteodystrophy
how to treat osteodystrophy
-calcium carbonate
-aluminum hydroxide gel
supportive therapy for chronic renal failure
-diet (high kcal, adequate pro not high, low phos/Na/K+)
-vitamins
-prevention of osteodystrophy
-possible transplant
chronic renal failure nursing considerations
-activity is self limited
-body image disturbances
-watch for metabolic acidosis
-no fleet enemas
