peds - GU Flashcards
Urinary Tract Infections due to
urinary stasis, vesicoureteral reflux, urethral exposure to organisms
Structural Defects are usually
hereditary
Insufficient Renal Function
Acute, chronic, structural causes
Genitourinary System
- Excretes Wastes
- Maintains acid-base, fluid, and electrolyte balance * Produce Renin –regulates blood pressure
GU - Pediatric Differences - nephrons?
- All nephrons present at birth
Expected urine output according to age -does it increase or decrease?
Urinary output per kilogram of body weight decreases as the child ages because the kidney becomes more efficient at concentrating urine.
Expected urine output according to age - numbers
(2 to 40)
Infants 2 ml/kg/hr Children 0.5 - 1 ml/kg/hr Adolescents 40-80 ml/hr
reproductive -
* Pediatric Differences- when is it functional?
Functionally immature until puberty
* Genitalia (except clitoris in girls) enlarge gradually through childhood
Diagnostic Procedures
- Computed tomography
- Cystoscopy
- Intravenous pyelogram
- Magnetic resonance
imaging (MRI) - Renal biopsy
- Renal or bladder
ultasound
Laboratory Tests
- Blood urea nitrogen
- Creatinine
- Creatinine clearance * Basic metabolic panel * Urinalysis
- Urine culture
- Urine protein to creatinine ratio
UTIs - more common in…
- More common in males 1st 6 months
- Uncircumcised – 10-12 times – to develop UTI
- After 6 months girls
- More common in girls
- Due to shorter urethra
- Urethra closer to anus & vagina * Increasing risk of contamination
UTI pathos - most common bacteria
Most common cause * Escherichia coli
* Urinary stasis
* Due to infrequent voiding
* Neurogenic bladder
* Interrupted nerve supply
* Poor hygiene
* Inadequate cleansing after BMs
* Irritated perineum
UTI - clinical manifestations - Infants - what about diaper?
vFever
vWeight loss/failure to gain weight vFailure to thrive
vPoor feeding
vIrritability
vVomiting & diarrhea
vFoul smelling urine
vPersistent diaper rash
UTI - clinical manifestations - Older children - same as adults
vUrinary frequency
vPain during micturition
vAbdominal pain
vHematuria
vFever chills
vEnuresis (incontinence)
vFlank pain
UTI - assessment - what type of catch?
- Urinalysis (UA)
- Urine culture
- Microscopic –large numbers of WBCs
- Large numbers of bacteria
1) Obtain catheter specimens in infants and young
children
2) Clean-catch specimen
Normal Urine pH
- pH 5 to 9
urine shouldn’t have
(no GHK in urine)
ØGlucose
ØKetones
ØHgb
Hypospadias - what about circumcision? and does it interfere with voiding?
- Does not interfere with voiding
- Could interfere with reproduction
- If not repaired by adulthood
- Routine circumcision may be avoided * As foreskin may be needed for the repair
Hypospadius - mild
- Congenital anomaly
- Involving abnormal location of the urethral meatus
- Incidence - 1 out of 300 male births
- Mild – slightly off center from tip of penis
Chordee
(cord down the middle)
- Most often accompanies hypospadias * Fibrous line of tissue
- Downward curvature of penis
hypospadias - Surgical Correction - what age?
- Mild cases not indicated
- Choice of surgical procedure-depends on defect * 6-12 months
- Silicone stent
hypospadias - Post-op care - restraints?
Sedation
* Arm & leg restraints
* Pain management
* Care of stint or indwelling catheter
* Irrigation if ordered
* I & O
Cryptorchidism - can impair what?
(no sperm in the crypt)
- Failure of one or both testes to descend from the inguinal canal into scrotum
- Can impair spermatogenesis (the creation of sperm).
Cryptorchidism - common in
- Occurs in 3% of term male infants
- Higher incidence in preterm infants
- Normal descent occurs in late gestation
Cryptorchidism - Abdominal
(abdominal ring)
Proximal to internal inguinal ring
Cryptorchidism - Canalicular
(cana you go between internal and external)
Between the internal and external
inguinal rings
Cryptorchidism - Ectopic
(ectopic abdomen)
Outside the normal pathways of descent between the abdominal cavity and the scrotum
Cryptorchidism - patho - exposure to what?
- Failure to descend exposes testes to heat of body (higher temp in abdomen)
- Leading to low sperm counts at sexual maturity
Cryptorchidism - assessment - just absence of testes
- Absence of one or both testes in scrotal sac may be noted at birth
- Noted by parent/provider
- If not felt on exam
- Monitor as testes may descend later
Cryptorchidism - diagnosis
- Physical exam
- Help locate non-palpable testis that migrated intra-
abdominally - Ultrasound
- CT scan
- MRI
- Laparoscope (locate testis)
- Hormonal & chromosomal evaluation
Cryptorchidism - treatment - when can they spontaneously descend?
- Testes do not descend spontaneously * Orchiopexy (surgery to lower testes)
- Can descend spontaneously by 3 months *
Cryptorchidism - preoperative - is it inpatient or out?
- Usually outpatient
- Prepare parents & child
for procedure - Surgery on “private parts” can be embarrassing
- Assure penis will not be affected
Cryptorchidism - post op - ice or heat?
- Scrotal support
- Ice
- Monitor Voiding
- Pain management * Prevent infection
- Psychological and emotional support
Cryptorchidism - Discharge Instructions - how long to not take a bath?
- Proper incision care
- Clean diaper area
- Sponge for 2 days
Inguinal Hernia - who gets it? and is it one side, or both?
- Inguinal hernia is a painless inguinal or scrotal swelling of variable size
- protrusion of abdominal tissue, such as bowel, extends into inguinal canal
- Hernia may exist elsewhere on the abdominal wall
- Mostly in males
- Bilateral
Inguinal Hernia - more common in
- More likely in males
- Due to inherent weakness along inguinal canal * Due to the way males develop in womb
- Testicles form within abdomen
- Than move down
Inguinal Hernia - may be noticed when (2 things)
- May be noticed when child is crying * Straining for a BM
- Pre-op education
- Expected post-op status
- Hernia repair
- Surgical management
Incarceration - hernia - symptoms
- Medical emergency
- Acute onset of pain
- Irritability
incarceration - post op - the usual
- Outpatient basis
- Keep wound clean and dry
- Pain management
- Dressing/sealant
- Change diapers frequently
Acquired Renal Health Problems
vAcute Postinfectious glomerulonephritis (APIGN) vNephrotic syndrome
Glomerulonephritis - can lead to what?
(glom builds up in my system)
- Condition that interferes with kidney function
- Can lead to potentially
1) Dangerous buildup of waste products in blood stream
2) Hampers kidney’s ability to remove
q Waste
q Excessfluids
Glomerulonephritis - is it acute or chronic?
- Can be acute
- Chronic
- Part of a systemic disease like:
q Lupus
qDiabetes - Or by itself
- Most common form:
- Acute Postinfectious Glomerulonephritis
Acute Postinfectious glomerulonephritis (APIGN) - what type of bacteria? And are one or both kidneys affected?
- Allergic reaction (antigen-antibody) to group A beta- hemolytic streptococcal infection
- Antibodies produced to fight invading organisms also react against glomerular tissue
- Both kidneys usually affected
- Mild cases usually recover in a couple of days
Acute Postinfectious glomerulonephritis (APIGN) - patho
- Acute inflammation of the glomeruli
- Acute post-infectious glomerulonephritis
- Preceded by a streptococcal infection
- Respiratory
- Skin
Acute Postinfectious glomerulonephritis (APIGN) - clinical manifestations
(glom has a puffy eye infection)
$Many are asymptomatic
$Abrupt onset
$Flank or mid-abdominal pain
$Irritability
$Malaise
$Periorbital Edema (early)
Acute hypertension
can cause encephalopathy
- Headache * Nausea
- Vomiting
- Irritability
- Lethargy * Seizures
Acute Postinfectious glomerulonephritis (APIGN) - diagnostic labs - protein?
ðWBC & Sed rate up
ðBUN up
ðCreatinine up
ðSerum protein - low
ðASO - INDICATES PREVIOUS STREP INFECTION
Acute Postinfectious glomerulonephritis (APIGN) -urinalysis
(a cutie glom has blood, protein, and casts)
- Hematuria
- Proteinuria
- Red & white cell casts
Acute Postinfectious glomerulonephritis (APIGN) -clinical therapy - what might be limited in diet?
- Supportive
- I&O
- Fluid & Electrolyte imbalance
- Weigh daily – monitor fluid imbalance
- Maintain fluid restriction if ordered
- Sodium, potassium, & protein may be limited * Monitor dietary intake
- Activity level
Nephrotic Syndrome
(nephrotite is not specific)
- Not a specific disease
- Clinical state
- Cause unknown
- Minimal Change Nephrotic Syndrome (MCNS) – most
common(85%)
Nephrotic Syndrome - clinical manifestations
(other than edema - one thing)
- Gradual onset of massive edema
- Massive proteinuria
- Hyperlipidemia
- Weight gain
Nephrotic Syndrome - Diagnostic Tests
(test nephrotiti for al and salt)
- History
- Symptoms
- Lab findings
- Urinalysis
- Serum albumin * Sodium
- BUN
- Electrolytes
Nephrotic Syndrome - planning and implementation
- Monitor weight
*I&O - Measure abdominal girth
- Promote nutrition
- Fluids – may not be restricted * No salt added
Nephrotic Syndrome - Planning and Implementation
- Prevent skin breakdown
- Prevent infection
- Medication therapy
Wilms Tumor - at what age?
(wil is 2 or 3)
- Description
Intrarenal tumor that is also called a nephroblastoma
Common abdominal tumor during childhood 6% of all childhood tumors
Occurs between2 & 3 years of age
Wilms Tumor- Etiology and Pathophysiology - is it one side or both? which has a worse prognosis?
- Small proportion show a genetic basis * Family members at increased risk
- Unilateral or bilateral
- Bilateral have a poor prognosis
Often encapsulated - Metastasizes to lungs & liver
- Prognosis based on stages of disease
- 75% of children have 5 year survival rate
Wilms Tumor- clinical manifestations - and is it tender?
Most common – swelling or mass in abdomen * Firm
* Non-tender
* Confined to one side (midline of abdomen)
Wilms Tumor- how to identify
vUltrasound
vIV pyelogram (x-ray of bladder) reveals a growth
vCT scan of lungs, liver, spleen, and brain (identify
metastasis)
vCBC, BUN, Creatinine levels, liver function tests
Wilms Tumor- nursing care - don’t do what before surgery?
uPost sign
uAVOID PALPATING ABDOMEN PREOPERATIVELY uReduce risk of rupturing capsule and causing tumor
spillage
Wilms Tumor- theraputic management - just radiation
- Unless bilateral tumors are present – ØSurgery to remove affected kidney ØExamine opposite kidney
ØLook for metastasis - Radiation/Chemotherapy or both before or after
Wilms Tumor- Post op
uFocus on Pain management
uClose monitoring of fluid levels uIncisional pain
uPain from postop shift of internal organs uTo compensate for loss of kidney
uI & O
uDaily weight
uDaily urine specific gravity uComplete pain assessment with VS
Wilms Tumor- more post op
- Assess bowel sounds * Abdominal distention * Bowel movements
- Infection
- Observe surgical wound * Body temperature
- Education
- Protect remaining kidney
Monitor for UTI & avoid contact sports
renal growth - when does it take place?
(kidneys are kids until 5 yrs)
- Most takes place during first 5 years
- Full size by adolescence
Renal efficiency
Increases as child matures
Bladder capacity and control - number at birth and adulthood
(20 pees at birth)
Increases from 20 to 50mL at birth to 700mL in adulthood
normal Specific gravity
(space in 1001)
- Specific gravity 1.001 to 1.035
normal protein
(no protein after 20)
- Protein <20 mg/dl
normal Urobilinogen
(uro is small)
- Urobilinogen up to 1 mg/dls
urine shouldn’t have
(CRWN urine)
ØWBCs
ØRBCs
ØCasts
ØNitrites
hypospadius - severe
(severe meat)
- Severe – meatus on scrotum on perineum
- May have inguinal hernia, cryptorchidism, & partial absence of foreskin
hypospadius - post op care - avoid what?
(hypo can’t hyper kick)
- Avoid kicking, twisting, blockage
- Home care
- Activities limited
- Fluids
- Antibiotics
- Signs of infection
cryptochidism - risk for what?
(crypto gives me cancer and infertility)
- Risk for infertility
- Malignancy (risk for cancer is 35-50 times greater)
cryptochidism - risk for what?
(cripto is twisted)
- Greater risk for torsion (twisting of testis on its blood
supply) and trauma - Higher incidence of cancer
- Associated with inguinal hernia
- Testes continue to secrete hormones
cryptochidism - surgery recommended when?
Surgery –
* Recommend at 6 months full term infant
* 12 months – premature infants
* Avoid damage
* Preserve fertility
* Avoid psychological effects
* Fear of castration
* Body image issues in older children
cryptochidism - ointment?
- No medication/ointment over incision
- Signs of infection
- Pain management
- No straddling across hip or toy riding
incarceration - symptoms
(distended and vomiting by incarceration)
- Tenderness
- Anorexia
- Abdominal distension
- Vomiting
- Bloody stools
- Incarcerated (Irreducible)
- Symptoms of complete obstruction
incarceration can lead to
strangulation & necrotic bowel
incarceration - sponge bath - how many days?
- Sponge bath for 2-5 days
incarceration - post op activities?
(not restricted by incarceration)
- No restriction on activity
- Older children caution against lifting, pushing, wrestling or fighting, riding bike, sports
acute postinfectious glomerulonephritis - when does it appear?
(a cutie from 10 to 21)
- Appears after a latent period of 10 – 21 days days
acute postinfectious glomerulonephritis - what ages and gender?\
(a cutie at 2)
- Incidence 2-6 years of age * More common in boys
nephrotic syndrome - treatment?
(nephrotiti on steroids)
- 95% respond to steroid therapy
nephrotic syndrome - symptoms
(nephrotiti is irritable and in pain)
- Abdominal pain
- Irritability
- General malaise * Anorexia occur
- Pallor
- Hypertension
nephrotic syndrome - IV what?
(nephrotiti loves IV al)
1) IV albumin (to pull fluid in) &/or diuretics to flush it out reduce edema
nephrotic syndrome - meds (nephrotiti on steroids)
2) Corticosteroids – reduce inflammatory process reduces proteinuria
wilms tumor - symptoms
(will could hurt, or not)
- Can be asymptomatic
- Pain
- Hematuria
wilms tumor - HTN - why?
- Hypertension (25%) -
Due to increased renin production
acute postinfection glomerulonephritis - what’s in the pee? and HTN?
$Fever
$Hematuria –dark colored urine (tea/cola) $Proteinuria
$Azotemia (build up of nitrogen)
$Edema – feet & ankles
$Hypertension
glomerulonephritis - treatment
I/O, fluids, monitor
glomerulonephritis - how to test?
2 rising ASO tests (measures strep)
nephrotic syndrome - may restrict
fluid due to edema
if kidney is removed - monitor for
UTI to preserve other kidney
periorbital edema
EARLY sign - post acute glom, not glomerulonephritis
