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peds - GU Flashcards

1
Q

Urinary Tract Infections due to

A

urinary stasis, vesicoureteral reflux, urethral exposure to organisms

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2
Q

Structural Defects are usually

A

hereditary

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3
Q

Insufficient Renal Function

A

Acute, chronic, structural causes

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4
Q

Genitourinary System

A
  • Excretes Wastes
  • Maintains acid-base, fluid, and electrolyte balance * Produce Renin –regulates blood pressure
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5
Q

GU - Pediatric Differences - nephrons?

A
  • All nephrons present at birth
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6
Q

Expected urine output according to age -does it increase or decrease?

A

Urinary output per kilogram of body weight decreases as the child ages because the kidney becomes more efficient at concentrating urine.

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7
Q

Expected urine output according to age - numbers

(2 to 40)

A

Infants 2 ml/kg/hr Children 0.5 - 1 ml/kg/hr Adolescents 40-80 ml/hr

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8
Q

reproductive -
* Pediatric Differences- when is it functional?

A

Functionally immature until puberty
* Genitalia (except clitoris in girls) enlarge gradually through childhood

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9
Q

Diagnostic Procedures

A
  • Computed tomography
  • Cystoscopy
  • Intravenous pyelogram
  • Magnetic resonance
    imaging (MRI)
  • Renal biopsy
  • Renal or bladder
    ultasound
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10
Q

Laboratory Tests

A
  • Blood urea nitrogen
  • Creatinine
  • Creatinine clearance * Basic metabolic panel * Urinalysis
  • Urine culture
  • Urine protein to creatinine ratio
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11
Q

UTIs - more common in…

A
  • 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
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12
Q

UTI pathos - most common bacteria

A

Most common cause * Escherichia coli
* Urinary stasis
* Due to infrequent voiding
* Neurogenic bladder
* Interrupted nerve supply
* Poor hygiene
* Inadequate cleansing after BMs
* Irritated perineum

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13
Q

UTI - clinical manifestations - Infants - what about diaper?

A

vFever
vWeight loss/failure to gain weight vFailure to thrive
vPoor feeding
vIrritability
vVomiting & diarrhea
vFoul smelling urine
vPersistent diaper rash

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14
Q

UTI - clinical manifestations - Older children - same as adults

A

vUrinary frequency
vPain during micturition
vAbdominal pain
vHematuria
vFever chills
vEnuresis (incontinence)
vFlank pain

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15
Q

UTI - assessment - what type of catch?

A
  • 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
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16
Q

Normal Urine pH

A
  • pH 5 to 9
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17
Q

urine shouldn’t have

(no GHK in urine)

A

ØGlucose
ØKetones
ØHgb

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18
Q

Hypospadias - what about circumcision? and does it interfere with voiding?

A
  • 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
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19
Q

Hypospadius - mild

A
  • Congenital anomaly
  • Involving abnormal location of the urethral meatus
  • Incidence - 1 out of 300 male births
  • Mild – slightly off center from tip of penis
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20
Q

Chordee

(cord down the middle)

A
  • Most often accompanies hypospadias * Fibrous line of tissue
  • Downward curvature of penis
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21
Q

hypospadias - Surgical Correction - what age?

A
  • Mild cases not indicated
  • Choice of surgical procedure-depends on defect * 6-12 months
  • Silicone stent
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22
Q

hypospadias - Post-op care - restraints?

A

Sedation
* Arm & leg restraints
* Pain management
* Care of stint or indwelling catheter
* Irrigation if ordered
* I & O

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23
Q

Cryptorchidism - can impair what?

(no sperm in the crypt)

A
  • Failure of one or both testes to descend from the inguinal canal into scrotum
  • Can impair spermatogenesis (the creation of sperm).
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24
Q

Cryptorchidism - common in

A
  • Occurs in 3% of term male infants
  • Higher incidence in preterm infants
  • Normal descent occurs in late gestation
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25
Q

Cryptorchidism - Abdominal

(abdominal ring)

A

Proximal to internal inguinal ring

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26
Q

Cryptorchidism - Canalicular

(cana you go between internal and external)

A

Between the internal and external
inguinal rings

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27
Q

Cryptorchidism - Ectopic

(ectopic abdomen)

A

Outside the normal pathways of descent between the abdominal cavity and the scrotum

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28
Q

Cryptorchidism - patho - exposure to what?

A
  • Failure to descend exposes testes to heat of body (higher temp in abdomen)
  • Leading to low sperm counts at sexual maturity
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29
Q

Cryptorchidism - assessment - just absence of testes

A
  • 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
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30
Q

Cryptorchidism - diagnosis

A
  • Physical exam
  • Help locate non-palpable testis that migrated intra-
    abdominally
  • Ultrasound
  • CT scan
  • MRI
  • Laparoscope (locate testis)
  • Hormonal & chromosomal evaluation
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31
Q

Cryptorchidism - treatment - when can they spontaneously descend?

A
  • Testes do not descend spontaneously * Orchiopexy (surgery to lower testes)
  • Can descend spontaneously by 3 months *
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32
Q

Cryptorchidism - preoperative - is it inpatient or out?

A
  • Usually outpatient
  • Prepare parents & child
    for procedure
  • Surgery on “private parts” can be embarrassing
  • Assure penis will not be affected
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33
Q

Cryptorchidism - post op - ice or heat?

A
  • Scrotal support
  • Ice
  • Monitor Voiding
  • Pain management * Prevent infection
  • Psychological and emotional support
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34
Q

Cryptorchidism - Discharge Instructions - how long to not take a bath?

A
  • Proper incision care
  • Clean diaper area
  • Sponge for 2 days
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35
Q

Inguinal Hernia - who gets it? and is it one side, or both?

A
  • 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
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36
Q

Inguinal Hernia - more common in

A
  • 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
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37
Q

Inguinal Hernia - may be noticed when (2 things)

A
  • May be noticed when child is crying * Straining for a BM
  • Pre-op education
  • Expected post-op status
  • Hernia repair
  • Surgical management
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38
Q

Incarceration - hernia - symptoms

A
  • Medical emergency
  • Acute onset of pain
  • Irritability
39
Q

incarceration - post op - the usual

A
  • Outpatient basis
  • Keep wound clean and dry
  • Pain management
  • Dressing/sealant
  • Change diapers frequently
40
Q

Acquired Renal Health Problems

A

vAcute Postinfectious glomerulonephritis (APIGN) vNephrotic syndrome

41
Q

Glomerulonephritis - can lead to what?

(glom builds up in my system)

A
  • 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
42
Q

Glomerulonephritis - is it acute or chronic?

A
  • Can be acute
  • Chronic
  • Part of a systemic disease like:
    q Lupus
    qDiabetes
  • Or by itself
  • Most common form:
  • Acute Postinfectious Glomerulonephritis
43
Q

Acute Postinfectious glomerulonephritis (APIGN) - what type of bacteria? And are one or both kidneys affected?

A
  • 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
44
Q

Acute Postinfectious glomerulonephritis (APIGN) - patho

A
  • Acute inflammation of the glomeruli
  • Acute post-infectious glomerulonephritis
  • Preceded by a streptococcal infection
  • Respiratory
  • Skin
45
Q

Acute Postinfectious glomerulonephritis (APIGN) - clinical manifestations

(glom has a puffy eye infection)

A

$Many are asymptomatic
$Abrupt onset
$Flank or mid-abdominal pain
$Irritability
$Malaise
$Periorbital Edema (early)

46
Q

Acute hypertension
can cause encephalopathy

A
  • Headache * Nausea
  • Vomiting
  • Irritability
  • Lethargy * Seizures
47
Q

Acute Postinfectious glomerulonephritis (APIGN) - diagnostic labs - protein?

A

ðWBC & Sed rate up
ðBUN up
ðCreatinine up
ðSerum protein - low
ðASO - INDICATES PREVIOUS STREP INFECTION

48
Q

Acute Postinfectious glomerulonephritis (APIGN) -urinalysis

(a cutie glom has blood, protein, and casts)

A
  • Hematuria
  • Proteinuria
  • Red & white cell casts
49
Q

Acute Postinfectious glomerulonephritis (APIGN) -clinical therapy - what might be limited in diet?

A
  • 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
50
Q

Nephrotic Syndrome

(nephrotite is not specific)

A
  • Not a specific disease
  • Clinical state
  • Cause unknown
  • Minimal Change Nephrotic Syndrome (MCNS) – most
    common(85%)
51
Q

Nephrotic Syndrome - clinical manifestations

(other than edema - one thing)

A
  • Gradual onset of massive edema
  • Massive proteinuria
  • Hyperlipidemia
  • Weight gain
52
Q

Nephrotic Syndrome - Diagnostic Tests

(test nephrotiti for al and salt)

A
  • History
  • Symptoms
  • Lab findings
  • Urinalysis
  • Serum albumin * Sodium
  • BUN
  • Electrolytes
53
Q

Nephrotic Syndrome - planning and implementation

A
  • Monitor weight
    *I&O
  • Measure abdominal girth
  • Promote nutrition
  • Fluids – may not be restricted * No salt added
54
Q

Nephrotic Syndrome - Planning and Implementation

A
  • Prevent skin breakdown
  • Prevent infection
  • Medication therapy
55
Q

Wilms Tumor - at what age?

(wil is 2 or 3)

A
  • 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
56
Q

Wilms Tumor- Etiology and Pathophysiology - is it one side or both? which has a worse prognosis?

A
  • 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
57
Q

Wilms Tumor- clinical manifestations - and is it tender?

A

Most common – swelling or mass in abdomen * Firm
* Non-tender
* Confined to one side (midline of abdomen)

58
Q

Wilms Tumor- how to identify

A

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

59
Q

Wilms Tumor- nursing care - don’t do what before surgery?

A

uPost sign
uAVOID PALPATING ABDOMEN PREOPERATIVELY uReduce risk of rupturing capsule and causing tumor
spillage

60
Q

Wilms Tumor- theraputic management - just radiation

A
  • Unless bilateral tumors are present – ØSurgery to remove affected kidney ØExamine opposite kidney
    ØLook for metastasis
  • Radiation/Chemotherapy or both before or after
61
Q

Wilms Tumor- Post op

A

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

62
Q

Wilms Tumor- more post op

A
  • Assess bowel sounds * Abdominal distention * Bowel movements
  • Infection
  • Observe surgical wound * Body temperature
  • Education
  • Protect remaining kidney
    Monitor for UTI & avoid contact sports
63
Q

renal growth - when does it take place?

(kidneys are kids until 5 yrs)

A
  • Most takes place during first 5 years
  • Full size by adolescence
64
Q

Renal efficiency

A

Increases as child matures

65
Q

Bladder capacity and control - number at birth and adulthood

(20 pees at birth)

A

Increases from 20 to 50mL at birth to 700mL in adulthood

66
Q

normal Specific gravity

(space in 1001)

A
  • Specific gravity 1.001 to 1.035
67
Q

normal protein

(no protein after 20)

A
  • Protein <20 mg/dl
68
Q

normal Urobilinogen

(uro is small)

A
  • Urobilinogen up to 1 mg/dls
69
Q

urine shouldn’t have

(CRWN urine)

A

ØWBCs
ØRBCs
ØCasts
ØNitrites

70
Q

hypospadius - severe

(severe meat)

A
  • Severe – meatus on scrotum on perineum
  • May have inguinal hernia, cryptorchidism, & partial absence of foreskin
71
Q

hypospadius - post op care - avoid what?

(hypo can’t hyper kick)

A
  • Avoid kicking, twisting, blockage
  • Home care
  • Activities limited
  • Fluids
  • Antibiotics
  • Signs of infection
72
Q

cryptochidism - risk for what?

(crypto gives me cancer and infertility)

A
  • Risk for infertility
  • Malignancy (risk for cancer is 35-50 times greater)
73
Q

cryptochidism - risk for what?

(cripto is twisted)

A
  • 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
74
Q

cryptochidism - surgery recommended when?

A

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

75
Q

cryptochidism - ointment?

A
  • No medication/ointment over incision
  • Signs of infection
  • Pain management
  • No straddling across hip or toy riding
76
Q

incarceration - symptoms

(distended and vomiting by incarceration)

A
  • Tenderness
  • Anorexia
  • Abdominal distension
  • Vomiting
  • Bloody stools
  • Incarcerated (Irreducible)
  • Symptoms of complete obstruction
77
Q

incarceration can lead to

A

strangulation & necrotic bowel

78
Q

incarceration - sponge bath - how many days?

A
  • Sponge bath for 2-5 days
79
Q

incarceration - post op activities?

(not restricted by incarceration)

A
  • No restriction on activity
  • Older children caution against lifting, pushing, wrestling or fighting, riding bike, sports
80
Q

acute postinfectious glomerulonephritis - when does it appear?

(a cutie from 10 to 21)

A
  • Appears after a latent period of 10 – 21 days days
81
Q

acute postinfectious glomerulonephritis - what ages and gender?\
(a cutie at 2)

A
  • Incidence 2-6 years of age * More common in boys
82
Q

nephrotic syndrome - treatment?

(nephrotiti on steroids)

A
  • 95% respond to steroid therapy
83
Q

nephrotic syndrome - symptoms

(nephrotiti is irritable and in pain)

A
  • Abdominal pain
  • Irritability
  • General malaise * Anorexia occur
  • Pallor
  • Hypertension
84
Q

nephrotic syndrome - IV what?

(nephrotiti loves IV al)

A

1) IV albumin (to pull fluid in) &/or diuretics to flush it out reduce edema

85
Q

nephrotic syndrome - meds (nephrotiti on steroids)

A

2) Corticosteroids – reduce inflammatory process reduces proteinuria

86
Q

wilms tumor - symptoms

(will could hurt, or not)

A
  • Can be asymptomatic
  • Pain
  • Hematuria
87
Q

wilms tumor - HTN - why?

A
  • Hypertension (25%) -
    Due to increased renin production
88
Q

acute postinfection glomerulonephritis - what’s in the pee? and HTN?

A

$Fever
$Hematuria –dark colored urine (tea/cola) $Proteinuria
$Azotemia (build up of nitrogen)
$Edema – feet & ankles
$Hypertension

89
Q

glomerulonephritis - treatment

A

I/O, fluids, monitor

90
Q

glomerulonephritis - how to test?

A

2 rising ASO tests (measures strep)

91
Q

nephrotic syndrome - may restrict

A

fluid due to edema

92
Q

if kidney is removed - monitor for

A

UTI to preserve other kidney

93
Q

periorbital edema

A

EARLY sign - post acute glom, not glomerulonephritis

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