Preschool: GU alterations Flashcards
What is included in a renal function assessment?
- Urine characteristics (colour, amount, odour)
- Pain or discomfort
- Edema
- Appearance of genitalia/sexual development
What are the red flags in renal function assessment?
- atypical urination pattern (ex. urgency, hesitancy, burning)
- edema, unexpected weight gain
- easily fatigued, lethargic/irritability
- decreased appetite
- abdominal pain
What are the diagnostic assessment tools for renal function? and what would you see?
- Blood Test (renal function – invasive): Elevated WBC
- Urinalysis (routine, culture & sensitivity – non-invasive): WBC in urine, Presence of bacteria and antibiotic sensitivity
- Renal /Bladder Ultrasound (visualization of structures- non-invasive)
- CT Scan (cross section of structures– non-invasive)
- Voiding Cystourethrogram (VCUG) (filling, storage & evacuation function – invasive): usually for frequent UTIs
- Renal Biopsy (percutaneous removal of kidney tissue- invasive)
What is the lower UTI called and where is the inflammation?
cystitis
Bladder/urethra inflammation
what is the upper UTI called and where is the inflammation?
pyelonephritis
Ureters, renal pelvis, renal parenchyma (kidney inflammation)
How many voids should you have a day?
5-6
What is the risk of urine in renal pelvis (hydronephrosis) or pyelonephritis?
Accumulation of urine in renal pelvis (hydronephrosis) or pyelonephritis → renal scarring from inflammation and ischemia → can lead to HTN, renal disease, end stage KD
When is there an increased risk for renal scarring?
- UTI infants under 1 year
- Delay in diagnosis & treatment
- Obstruction
- Recurrent episodes of UTI
What are the S&S of cystitis in neonates? (7)
Poor feeding, vomiting, failure to gain weight, jaundice, abdominal distension, lethargy, fever?
What are the S&S of cystitis in infants? (8)
Fever, diarrhea, vomiting, irritability, lethargy, foul smelling diapers, poor feeding, failure to gain weight
What are the S&S of cystitis in preschoolers? (10)
Fever, hematuria, urgency, dysuria, frequency, cloudy urine, foul smelling urine, dehydration, abdominal pain, enuresis
What are the S&S of cystitis in school age? (11)
Fever, hematuria, urgency, dysuria, frequency, cloudy urine, foul smelling urine, dehydration, abdominal pain, suprapubic or flank pain, enuresis
What are S&S of pyelonephritis? (8)
High fever, chills, abdominal pain, nausea, vomiting, flank pain, costovertebral angle tenderness, moderate to severe dehydration
What is clinical therapy for UTIs?
- administer antibiotics and antipyretics
- encourage fluid intake
- frequent voiding minimizes urinary stasis
- document in and outs (weigh daily)
What are preventative strategies for UTI?
- Proper perineal hygiene
-Encourage child to drink fluids
- Do not hold urine/ void frequently
- Dont wear tight underwear
- Discourage bubble baths and hot tubs: can irritate urethra
- Encourage abstinence of sexual activity
What is vesicoureteral reflux? (VUR)
- Retrograde flow of urine from bladder into ureters (goes back up)
- ranges from reflux of urine into ureter (stage 1) to severe dilation of ureter and renal pelvis with severely blunted calyces at stage 5
- Reflux prevents complete emptying of the bladder = urine returns to bladder = reservoir for bacterial growth
- Bacteria can be moved to kidneys = pyelonephritis
Can you outgrow VUR?
Yes, as they get older, the ureter gets longer and straighter and will shut correctly
How is VUR graded?
Renal ultrasound, voiding cystourethrogram (VCUG) and and/or dimercaptosuccinic acid (DMSA) scan
What are the treatment options of VUR?
use of prophylactic antibiotics is controversial but may be pre-scribed to prevent urinary tract infections
- surgical reimplantation of ureters
- deflux
What is enuresis?
repeated involuntary voiding by a child who has reached an age at which bladder control is expected
What age should you have bladder control?
5-6
What is primary enuresis?
child has never had a dry night; attributed to maturational delay and small functional bladder;not associated with stress or psychiatric cause.
What is secondary enuresis?
child who has been reliably dry for at least 6 months begins bedwetting; associated with stress,infections, and sleep disorders
What are the treatment approaches for enuresis?
- Medication
- Bed wetting alarms
- Bladder exercises
- timed voiding
- Reward system
- fluid restrictions
What is the fluid restrictions for enuresis?
- limit in evening and before bed
- do not take fluids with caffeine
What are bladder exercises for enuresis?
- drink large amount of water and hold urine
- practice stopping voiding midstream
What are timed voiding for enuresis?
void every 2 hours and use double voiding pattern
What are enuresis alarms?
detector attached to child’s pants
alarm sounds do child can get up and finish voiding
What kind of medications may be used for enuresis?
- Tricyclics, anticholinergics – antispasmodic effect
- Desmopressin – anti diruretic
