Renal, Genitourinary, and Reproductive Conditions

Question 1

Function of Kidneys

Renal, GI, Repro Conditions

Answer 1

1. Detoxify blood
2. Eliminate wastes
3. Produce erythropoietin in response to hypoxia to stimulate bone marrow to make more RBCs.
4. Regulate BP by producing renin
   a. Renin stimulates the production of angiotensin I, which stimulates prduction of angiotensin II, which causes peripheral vasoconstrition and secretion of aldosterone.
   b. Aldosterone promotes reabsorption of sodium and water and raises BP; aldosterone also increases renal excretion.
5. Maintain fluid and electrolyte balance
6. Regulate acid/base balance

Question 2

Body water and body weight

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 2

The amount varies with age, sex, and percentage of body fat.
1. The premature infant’s weight is 90% water; the term infant’s weight is 75% to 80% water.
a. The infant has a much greater percentage of total body water in extracellular fluid (42%-45%) than the adult does (20%).
b. The infant therefore cannot conserve water as well as the adult and has less fluid reserve.
2. Because of the increased percentage of water in a child’s extracellular fluid, the child’s water turnover rate is 2 to 3 times higher than the adult’s; 50% of the infant’s extracellular fluid is exchanged every day, compared with only 20% of the adult’s.
3. The child is therefore more susceptible than the adult to dehydration.
4. The proportion of body water to body weight decreases with increasing age as body fat increases and solid body structures grow.
5. The distribution of body water does not reach adult levels until late school age.
6. The adult percentage of body water (63% for men, 52% for women) is attained by age 3; after puberty, females have more fat than males and therefore less water weight.

Question 3

Metabolism

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 3

1. The child’s growth depends on, and results in, an increased metabolic rate.
   a. The child’s metabolic rate is 2 to 3 times higher than that of the adult.
   b. The child therefore also produces more metabolic waste.
2. The child’s pulse, respiratory, and peristaltic rates are higher than the adult’s.
   a. The child has a greater proportion of insensible water loss.
   b. The child therefore needs more water per kilogram of body weight than the adult.

Question 4

Body Surface Area

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 4

1. The newborn has a greater ratio of body surface area to body weight than the adult; this results in greater fluid loss through the skin.
2. Shivering and sweating mechanisms after infancy improve to control body temperature.

Question 5

Electrolytes

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 5

Sodium (135-145 mEq/L)
1. Principal cation of extracellular fluid
2. Influences distribution of body water (water follows sodium) and osmolality
3. Inefficient reabsorption of sodium can result in hyponatremia

Potassium (3.5-5 mEq/L)
1. Principal cation of intracellular fluid
2. Major determinant of cell membrane resting potential, influencing neuromuscular excitability; too much or too little will negatively affect cardiac condution

Calcium (8.5-10.2 mg/dL)
1. Helps maintain normal cell membrane permeability
2. Deficit results in tetany; excess causes hypotonia
3. A component of bone and teeth and the clotting cascade

Phosphorus
1. Crucial for energy production for metabolism and growth
2. Interacts with calcium to promote bone growth

Magnesium
1. Important for muscle and nerve activity

Question 6

Renal Function

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 6

1. The child attains the adult number of nephrons by age 1 year, although these structures continue to m ature throughout early childhood.
2. The infant’s renal function can maintain healthy fluid and electrolyte status; however, it does not compensate as efficiently during stress as the adult’s.
3. The infant has a low glomerular filration rate; however, the rate approaches the adult level by age 2.
4. The infant does not concentrate urine at an adult level.
   a. Average specific gravity for the infant is less than 1.010 (water is 1.000).
   b. Average specific gravity for an adult is 1.010 to 1.030.
5. Although the number of daily voidings decreases with increasing age (because of increased urine concentration and better control), the total amaount of urine produced daily may not vary significantly; the amount of urine is measured by weighing the diaper and subtracting dry weight from wet weight (grams equals milliliters because of the low specific gravity).
   a. Normal urine output is age-dependent: Newborn and infant up to 1 year: normal is 2 ml/kg/hour. Toddler: 1.5 ml/kg/hour. Older child: 1 ml/kg/hour.
   b. The 4-year-old’s bladder holds 250 ml, allowing the child to stay dry through the night.

Question 7

Urinary function studies

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 7

1. Urine is checked for blood, protein, glucose, ketones, and pH via a dipstick; these substances do not usually spill into the urine and are an indication that more assessment is necessary.
2. Specific gravity is checked.
3. Collect urin either by a clean-catch method or catheterization from a diapered patient.
4. An IV pyelogram aids in checking renal pelvic structures by X-ray following injection of contrast material (when describing the procedure to children, refer to the injected dye as “special medicine”).
5. A voiding cystourethrogram aids in viewing the bladder and related structures during voiding, especially to detect strictures and reflux.
   a. Contrast material is instilled in the bladder through a catheter.
   b. The older child may be frightened or embarrassed by having the sensation of having urinated, caused by the contrast material.
6. Blood urea nitrogen (BUN) level, creatinine level, and glomerular filtration rate are also evaluated.
   a. Creatinine clearance is the best measure of kidney function; it is the end product of energy metabolism from muscle so is relatively constant.
   b. BUN is an index of glomerular filtration rate.
   c. Glomerular filtration rate measures the amount of plasma from which a given substance is cleared in 1 minute.

Question 8

Maintenance fluid requirements

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 8

1. Maintenance fluid requirements are the water and electrolytes required to sustain the expenditure of normal physiologic activities.
2. Maintenance fluid requirements are appropriate for use in term infants >2 weeks of age.
3. The Holliday-Segar method of calculating maintenance fluids is as follows:

Daily version for # ml/day
Child’s weight in kg –> multiply by (ml/day) —> = Subtotal
* 1st 10 kg (0-10 kg) X 100 = A
* 2nd 10 kg (11-20 kg) X 50 = B
* Each additional kg (>20 kg) X 20 = C
* TOTAL –> A + B + C = X ml/day

Hourly version for # ml/hr
Child’s weight in kg –> multiply by (ml/hr) —> = Subtotal
* 1st 10 kg (0-10 kg) X 4 = A
* 2nd 10 kg (11-20 kg) X 2 = B
* Each additional kg (>20 kg) X 1 = C
* TOTAL –> A + B + C = X ml/hr

Question 9

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Dehydration: Introduction

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 9

1. Dehydration can occur from significantly decreased fluid intake or from loss of water and electrolytes via vomiting, diarrhea, or diaphoresis; in dehydration, fluid output usually exceeds intake.
2. Expressed as a pergentage of body weight lost as water; dehydration can be severe enough to produce volume depletion, circulatory collapse, and shock.
3. Isotonic dehydration is a deficiency of fluid and electrolytes in approximately equal proportions with a normal serum sodium of 135 to 145 mEq/L.
   a. 15% isotonic dehydration in the infant is considered severe.
   b. 9% loss in the older child is considered severe.
4. In hypotonic dehydration, electrolyte loss is greater than fluid loss with a decreased serum Na < 135 mEq/L, causing extracellular-to-intracellular movement of water that results in cerebral edema and seizures.
   a. Can be caused by watering down infant formula; water intoxiction
5. In hypertonic dehydration, fluid loss is greater than electrolyte loss with a serum Na >145 mEq/L, causign intracellular-to-extracellular movement of water that results in neurologic changes, such as confusion, inability to concentrate, and motor tremors.
   a. Can be caused by excessive sweating, diabetes insipidus, ketoacidosis

Question 10

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Dehydration: Assessment

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 10

1. Assess the quality and quantity of fluid intake and output.
   a. Intake may be greater than output but insufficient to meet the body’s needs.
   b. Water may be lost in stool or vomiting; may also be lost through sweating, secretions, or draingage.
2. Note decreased urine output and concentrated urine.
3. Note a sudden weight loss.
4. Assess for dry skin with poor tissue turgor; assess for a sunken fontanel in the infant.
5. Assess for a decrease in tears and saliva, dry mucous membranes, sunken and soft eyeballs, and thirst.
6. Note pale cool skin with poor perfusion, cool extremities, decreased body temperature, tachycardia, tachypnea, and hypotension.
7. Note lethargy, irritability, and a high-pitched, weak cry.
8. Note feeding behavior to identify when vomiting or diarrhea occurs in relation to meals, if anorexia exists, or if the child feeds vigorously after vomiting.

Question 11

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Dehydration: Interventions

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 11

1. Record hourly all stools, vomitus, and urine.
   a. Note the amount, color, consistency, concentration, time, and relation to meals or stress.
   b. Note the results of specific gravity and other values from urine dipstick tests.
2. Promote fluid intake
3. Provide mouth care
4. Provide skin care; turn the child every 2 hours, if necessary and keep the extremities warm.
5. Measure intake and output carefully.
   a. Weigh diapers and record fluids used to take medications.
   b. Indicate the fluid lost by diaphoresis, suctioning, or other tubes.
6. Weigh the child using the same scale at the same time each day, with the child naked or wearing the same amount of clothing.
7. Provide rest
8. Monitor for and prevent shock
9. If vomiting, use IV replacement of fluids; provide sucking stimulation to the young infant.
10. For mild to moderate dehydration, use oral rehydration therapy, such as Pedialyte/ for severe dehydration, provide IV fluid resuscitation at 20 ml/ kg IV bolus of normal saline or Ringers Lactate.
    a. Administer oral rehydration replacement (with pedialyte) of 2-5 ml every 2-3 minutes or 5-10 ml every 5 minutes
    b. Non-carbonated soda can be used for older children
11. When restarting fluids for the older child, begin with flat non-caffinated soda; do not give solutions with a high sodium content, such as milk or broth; offer bland food.
12. Note that any increase in ambient heat or water loss requires greater fluid intake to meet hydration needs.

Question 12

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Acid-base balance

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 12

1. Acid-bse balance is regulated by the renal, respiratory, and hematologic systems. pH is determined by the kidneys’ regulation of HCO3 (acid buffer/base) and the lung’s regulation of CO2 (acid).
2. Important values to consider when assessing acid-base balance are:
   a. Normal serum pH for the child is 7.35 to 7.45.
   (1) pH < 7.35 is acidosis (net loss of HCO3 or gain of CO2)
   (2) pH > 7.45 is alkalosis (net gain of HCO3 or loss of CO2)
   b. Normal serum HCO3 for the child is 22-26 mEq/L.
   c. Normal PaO2 for the child is 80-100 mmHg.
   d. Normal serum PaCO2 for the child is 35-45 mmHg.
3. Always look at the pH first to determine if it is normal.
   a. If the pH is normal, the child’s body may have compensated for the altered acid-base.
   b. If the pH is abnormal, the acid-base balance is uncompenstated.
4. Next look at the CO2; if abnormal, it usually indicates a respiratory cause.
5. Next look at the HCO3; if abnormal, it usually indicates a metabolic cause.
6. Disturbances in acid-base balance can be pulmonary or metabolic in origin.
   a. Acidosis is the decrease in the normal physiologic pH (pH< 7.35).
   (1) Respiratory acidosis is reflected by an increase in PaCO2 > 45.
   (1a) Respiratory arrest will cause a build-up of CO2 in the blood, since the person is not “blowing it off.”
   (2) Metabolic acidosis is reflected by a decrease in HCO3 < 22.
   (2a) Due to diarrhea (due to loss of HCO3 in stool), increased acid ingestion (as in aspirin poisoning), increased acid production (as in diabetic ketoacidosis), or decreased production of bicarbonate by the kidney (as in kidney failure).
   (2b) Alkalosis is an increase in the normal physiologic pH (pH > 7.45).
   (2b1) Respiratory alkalosis is reflected by a decreased PaCO2 < 35, as seen in hyperventilation.
   (2b2) Metabolic alkalosis is reflected by an increase in HCO3 > 26, as seen in increased production of bicarbonate by the kidneys; also seen in vomiting due to loss of acid-containing stomach contents.

Question 13

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Aspirin poisoning: An example of metabolic acidosis

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 13

1. Aspirin (acetylsalicylic acid) is an analgesic, antipyretic, and anti-inflammatory agent that inhibits platelet aggregation.
2. The normal dose is 1 grain per year of age, up to age 10; toxicity occurs at 200 mg/kg. [Note: 5 grains = 325mg]
3. The body compensates for increased carbonic acid production by increasing the respiratory rate to blow off the excess CO2

Assessment
1. Observe for an increased respiratory rate from metabolic acidosis.
2. Note fever from stimulation of carbohydrate metabolism.
3. Note decreased blood glucose levels.
4. Note altered clotting function; assess for petechiae and blood loss.
5. Check for irritability, restlessness, and tinnitus or altered hearing.

Interventions
1. Maintain a patent airway; support hyperventilation.
2. Perform gastric lavage.
3. Ensure adequate hydration to flush the aspirin through the kidneys.

Question 14

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Intravenous Fluid Administration Pearls

Fluid and Electrolyte Balance

Renal, GI, Repro Conditions

Answer 14

1. Potassium should not be added to the fluids of a dehydrated patient until they have voided.
2. In children who require fluid volume resucitation, use an isotonic fluid (normal saline solution or Lactated Ringer).
3. Any solution with dextrose in it is hypertonic, except for D5W.
4. Dextrose is contraindicated in patients who have diabetic ketoacidosis and who are on a ketogenic diet.

Question 15

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Urinary Tract Infection (UTI)

Renal, GI, Repro Conditions

Answer 15

Introduction
1. A microbial invasion of the urinarty tract, UTI is more common in females because of the placement and size of the urethra.
a. Bladder infection = cystitis
b. Urethra infection = urethritis
c. Kidney infection = pyelonephritis
2. UTI also may be caused by reflux, irritation by bubble baths, poor hygiene, or incomplete bladder emptying.
3. The child has a short urethra.
a. Organisms can be easily transmitted into the bladder.
b. The female urethra is closer to the rectum than the male’s, posing a greater risk of contamination by incorrect wiping after a bowel movement.
4. Vesiculoureteral reflux is when the urine enters the bladder and then refluxes back up the ureters to the kidneys, leading to both inflammation of the ureters and the kidneys.

Assessment
1. Assess the quantity, quality, and frequency of voiding.
2. Note that a clean-catch urine culture will yield large amounts of bacteria.
3. Assess urine for being cloudy and foul-smelling; assess for hematuria and increased urine pH.
4. Ask about a frequent urge to void with pain or burning on urination.
5. Note low-grade fever, lethargy, and poor feeding patterns.
6. Ask about abdominal pain.
7. Assess for enuresis.
8. Assess toileting habits for proper front-to-back wiping and proper hand washing.
9. Assess bathing habits for tub baths or bubble baths.
10. Assess the number of urinary infections per year; UTIs may recur.

Interventions
1. Admin an antibiotic
2. Force fluids to flush the infection from the urinary tract (100 ml/kg/day); clear fluids are best; avoid carbonated or caffinated drinks and chocolate, as they can irritate the bladder mucosa.
3. Teach proper toileting hygiene; encourage the child to use the toilet every 2 hours.
4. Discourage the use of tub baths and bubble baths.

Question 16

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Enuresis

Renal, GI, Repro Conditions

Answer 16

Introduction
1. Repeated involuntary urination after age 5 is called enuresis; it usually occurs while the child is alseep but also may occur during the day.
2. In primary enuresis, the child has never achieved complete bladder control.
3. In secondary enuresis, the child has achieved a period of bladder control.
4. Suggested causes include stress, incomplete muscle maturationof the bladder, altered sleep patterns, and an irritable bladder that cannot handle large amounts of urine.

Assessment
1. Review the child’s history for age of toilet training, onset of enuresis, and frequency of occurrences.
2. Ask about a history of previous UTIs, burning on urination, and a sense of urgency.
3. Expect urinalysis, urine culture and sensitivity, and blood studies, including BUN and creatinine to evaluate for UTI and for kidney function.

Interventions
1. Be aware that treatment varies with the cause.
2. Remind the child to use the toilet approximately every 2 hours.
3. Administer desmopressin (DDAVP) nasal spray to decrease nighttime urine output, if ordered.
4. Provide emotional support to the child and parents.
a. Do not embarrass or punish the child.

Question 17

Nephrotic Syndrome/Nephrosis

Renal, GI, Repro Conditions

Answer 17

Introduction
1. Nephrotic syndrome is an autoimmune process that occurs 1 week after an immune assult; may be idiopathic.
2. **It increases glomerular permeability

Question 18

Acute Glomerulonephritis (AGN)

Renal, GI, Repro Conditions

Answer 18

Introduction
1. AGN is an autoimmune immune-complex disorder occuring 1 to 2 weeks after a group A beta hemolytie streptococcal infeciton.
a. Antibodies are made against the toxin of the streoptococci but attack the glomerulus because of similarities in their antigenic markers.
b. The condition results in antigen-antibody complexes that initiate the complement cascade and cause renal damage in the glomeruli.
c. Streptococcus is not present in the kidney at any time.
d. AGN can also be caused by other organisms, such as pneumococci and viruses.
2. The disorder is common in children ages 4 to 7 years.

Assessment
1. Assess for signs and symptoms of altered renal function from edema and kidney damage.
2. Test urine for hematuria; the urine is cola colored (smoky).
3. Note decreased urine output.
4. Note results of blood tests.
a. An increased sedimentaiton rate indicates inflammation.
b. An increased antistreptolysin O (ASO) titer indicates a recent streptococcus infection.
5. Assess for and monitor increased BP.
6. Note the appearance of periorbital or dependent edema.
7. Note irritability, lethargy, and an anemic appearance.

Interventions
1. Implement the same measures as for nephrosis; also include antibiotics and antihypertensive medicaitons.
2. Monitor intake, output, and daily weight.
3. Institute moderate sodium restricitons for the child with hypertension or edema.

Question 19

Hemolytic Uremic Syndrome

Renal, GI, Repro Conditions

Answer 19

Introduction
1. Associated with a recent bacterial or viral infection, especially related to petting zoos as well as ingestion of E. Coli
2. Most common cause of renal failure in those < 3 years of age.
3. Includes a triad of symptoms: acute renal failure, hemolytic anemia, and thrombocytopenia.
4. Prognosis is good, but there may be residual renal impairment.

Assessment
1. Prodromal symptoms may be respiratory or gastrointestinal (vomiting and diarrhea that may be bloody).
2. 5 to 10 days later, pallor, bruising, hematuria, oliguria, bloody diarrhea, hypertension, edema and irritability may develop.
a. Measure intake and output.
b. Assess for flank pain.
c. Assess skin at leaste twice dialy for new bruising or purpura.
d. Check urine and stool for blood and protein.
e. Assess for and manage hypertension.
f. Weigh daily.
3. Assess for cardiac compensation.

Interventions
1. Prepare for dialysis, if ordered.
2. Replace fluid/electrolytes/nutritional needs
3. Handle gently to avoid further bruising.

Question 20

Acute Kidney Injury/Renal Failure

Renal, GI, Repro Conditions

Answer 20

Introduction
1. Multiple causes can result in failure of kidneys to regulate volume and composition of urine.
a. Prerenal causes: dehydration, hypovolemia
b. Intrarenal causes: kidney infections, obstructions with damage, or nephrotoxic agents
c. Postrenal: obstruction
2. Glomerular filtration rate decreases, BUN and creatinine increase, output decreases, and sodium levels drop because of dilution of extracellular fluid.

Assessment
1. Strict intake and output.
2. Assess neurologic symptoms associated with the buildup of toxins and decrease of sodium (irritability, seizures).
3. Assess for signs of edema and CHF caused by the buildup of fluids.
4. Assess for metabolic acidosis and compensatory hyperventilation.
5. Be aware of kidney’s role in stimulating erythropoiesis; assess for signs of anemia.

Intervention
1. Limit fluid intake depending on output; monitor IV fluids to prevent fluid overload.
2. Correct electrolyte levels of sodium and potassium.
3. Assist child to eat foods that do not have a high water content, i.e., watermelon; monitor protein and salt intake.
4. Prepare child for dialysis, if needed.
5. Promote good skin care; toxins are excreted through the skin, causing pruritus; keep nails trimmed and use a moisturizing cream.

Question 21

Hypospadias and Epispadias

Renal, GI, Repro Conditions

Answer 21

Introduction
1. Hypospadias is a congenital anomaly of the penis; the urethral opening may be anywhere along the ventral side of the penis.
2. Epispadias is an uncommon condition associated with exstrophy of the bladder; the urethral opening may be anywhere along the dorsal side of the penis.
3. Both conditions shorten the distance to the bladder, offering easier access to bacteria.

Assessment
1. Observe the angle of urination.
2. Assess the exit site.
3. Note history of frequent UTIs.

Interventions
1. Keep the area clean to exclude bacteria.
2. Be aware that surgery involving implants or reconstruction may be needed to reduce the chance of UTIs and infertility.
3. Do not circumcise the infant with suspected hypospadias at birth; the foreskin may be needed later during surgical repair. Teach the family how to keep an uncircumcised penis clean to prevent infection.

Question 22

Hypospadias

Answer 22

Hypospadias is a congenital anomaly of the penis; the urethral opening may be anywhere along the ventral side (facing down/under side) of the penis.

Question 23

Epispadias

Answer 23

Epispadias is an uncommon condition associated with exstrophy of the bladder; the urethral opening may be anywhere along the dorsal side (facing up/top side) of the penis.

Question 24

Undescended Testes

Renal, GI, Repro Conditions

Answer 24

Introduction
1. The testes descend from the abdomen into the scrotum during the last 2 months of gestation.
2. If the testes are not descended at birth, they may descend on their own in a few weeks.
3. If the testes remain in the abdominal cavity after age 5, the seminiferous tubules may degenerate because of the increased body temperature in the abdomen, resulting in sterility.

Assessment
1. Palpate the scrotum (undescended testes are usually unilateral).
2. Visually inspect the scrotum; one side may appear underdeveloped.

Interventions
1. Expect diagnostic tests to check kidney function; the kidneys and the testes arise from the same germ tissue.
2. Be aware that surgery is usually performed between ages 2 and 5, with one suture passing through the testes and scrotum that attaches to the thigh.
a. Prevent pulling o nthe thigh suture postoperatively.
b. The testes could re-ascend into the abdomen through the inguinal canal if the suture disconnects.

Question 25

Testicular Torsion

Renal, GI, Repro Conditions

Answer 25

Introduction
1. Testicle rotates interfering with blood supply to the spermatic cord.
2. Typically occurs in adolescents but can occur at any age.

Assessment
1. Sudden severe pain and swelling in the scrotum; can also be abdominal pain, frequent urination, nausea/vomiting.

Intervention
1. Considered to be a surgical emergency in order to save blood supply to the testes. Seek emergency care.

Question 26

Dysmenorrhea/Menstrual Cramps

Renal, GI, Repro Conditions

Answer 26

Introduction
1. Caused by prostaglandin release from the lining of the uterus during menstruation
a. Primary dysmenorrhea is common in 1-3 years after menarche begins; it does not accompany any pelvic pathology
b. Secondary dysmenorrhea is usually due to a pathological condition

Assessment
1. Lower abdominal cramping which may radiate to the thighs and lower back; may be associated with nausea/vomiting, diarrhea, headache, and fatigue; may occur a few hours before menses starts or during the first few days of the menstrual cycle when the flow is the heaviest
2. Rule out other potential causes of abdominal pain and/or GYN pain, such as pelvic inflammatory disease, ectopic pregnancy, and miscarriage.

Interventions
1. NSAIDS inhibit prostaglandins and are not effective in pain relief (but side effects of long term use of NSAIDS include nauseea, dyspepsia, peptic ulcer and diarrhea)
2. Have patient lie down in a position of comfort; applying heating pad on low heat to abdomen for 20 minutes, if ordered

Question 27

Pelvic Inflammatory Disease (PID)

Renal, GI, Repro Conditions

Answer 27

Introduction
1. Caused by ascending spread of microorganisms (often sexually transmitted infections (STIs), sespecially chlamydia [most common STI in teens] and gonorrhea) from the vagina into the uterus and fallopian tubes; can result in abscesses, increased risk of ectopic pregnancy, chronic pelvic pain and sterility
a. Risk for PID increases with increased number of sex partners with douching; PID can occur weeks or months after an infection with an STI

Assessment
1. Symptoms may be from none to severe lower abdominal discomfort
2. Symptoms may include fever, vaginal discharge with a foul odor, painful urination and painful intercourse
3. Rule out appendicitis
4. Ask about sexual activity

Interventions
1. Evaluate for improvement within days of antibiotics being prescribed; counsel regarding importance of completing the antibiotic course of treatment
2. Encourage patient to inform sexual partner to seek treatment as well
3. Counsel patient about the cause and consequences of PID and assist in behavior chnges.
a. Help the teen to find ways of experiencing love and affection that do not involve sexual activity.
b. Encourage barrier protection with sexual activity
c. Limit the number of sexual partners

Question 28

The urine specimen of a child with acute glomerulonephritis would likely be:

a. Normal in color but very scant amount
b. Normal in color but cloudy due to loss of albumin
c. Normal in color and amount
d. Rusty brown color due to hematuria

Answer 28

d

The urine specimen in a child with acute glomerulonephritis would most likely be rusty brown color due to blood that spills through the porous glomerulus.

Question 29

The parents of a 6-year-old tell the nurse that they are very concerned that he has started wetting the bed. They ask the nurse what they should do. Which of the following is the nurse’s best response?

a. “Tell him that he can no longer drink milk with his beddtime snack until he stops having accidents.”
b. “Take turns getting him up every few hours during th enight to help him empty his bladder.”
c. “Place a calendar on the fridge showing which nights he was wet and dry.”
d. “When he does wake up wet, have him change his own pajamas and help change the sheets.”

Answer 29

d
(*Think Erikson’s!)

Having the child assist with changing the sheets and pajamas may help foster his sense of industry. A lack of a beverage may be perceived as a punishment. The word accident should not be used as it implies that the child can prevent it when he may have no control over the enuresis. Although it may be helpful to have the child void once during the night, waking the child every few hours will interrupt the child’s needed rest. A calendar placed on the fridge can easily be seen by others and cause embarassment.

Question 30

The nurse is caring for Manuel, a 5-year-old with glomerulonephritis. When reviewing Manuel’s lab results, the nurse would expect to find which of the following?

a. Decreased sedimentation rate (ESR)
b. Decreased antistreptolysin O (ASO) titer
c. Anemia
d. Low protein in urine

Answer 30

c

Anemia occurs due to blood lost in the urine. In glomerulonephritis, there is an increased sedimentation rate (ESR) indicating the inflammatory response. The antistreptolysin O (ASO) titer is increased indicating that there was a recent streptococcus infection. There is high, not low, protein in urine.

Question 31

The nurse is caring for 3-year-old Braden, who has been diagnosed with nephrotic syndrome. When reviewing his lab results, the nurse would expect to find which of the following?

a. Frank hematuria
b. Hyperalbuminemia
c. Proteinuria
d. Urine with a low specific gravity

Answer 31

c

Proteinuria occurs as large amounts of protein are lost in the urine. Hypoalbuminemia is present as the body loses large amounts of albumin in the urine. Although microscopic hematuria may occur, frank hematuria does not occur in nephrotic syndrome. The urine has a high specific gravity as there is a decrease in urine production.

Question 32

You are caring for 3-year-old Gabriella, who has just been diagnosed with nephrotic syndrome. She is pale, edematous, and has a poor appetite. Which of the following laboratory findings would you expect?

a. Glycosuria
b. Gross hematuria
c. Proteinuria
d. Hyperalbuminemia

Answer 32

c

Children with nephrotic syndrome demonstrate proteinuria because they experience increased glomerular permeability to protein. Other lab findings include microscopic hematuria (not frank hematuria) and hypoalbuminemia.

Question 33

Acute glomerulonephritis can be prevented by:

a. Keeping the kidneys flushed by increased amounts of fluids.
b. Taking a full course of antibiotics following strep throat.
c. Getting immunizations against influenza.
d. Keeping urine acidic.

Answer 33

b

Acute glomerulonephritis is an autoimmune immune-complex disorder occurring one or two weeks after a group A beta-hemolytic streptococcal (or less commonly a pneumococcal or viral) infection. Antibodies are made against the toxin of the streptococci but attack the glomerulus of the kidney because of similarities in their antigenic markers. Prevention of this condition is promoted by instructing parents about the importance of administering the full dose of antibiotics during a strep throat infection.

Question 34

Which of the following is true concerning undesceded testes?

a. Surgery is postponed until after the age of 5 to allow sufficient time for spontaneous descent.
b. Kidney funciton testing should also be done.
c. It typically occurs bilaterally.
d. Postoperatively, the child is kept in a straddle position.

Answer 34

b

Kidney function testing is performed int he child with undescended testes as teh testes and kidneys arise from the same germ tissue. Undescended testes are typically unilateral. If the testes do not descend spontaneously, surgery is performed between the ages of 2 and 5 to prevent infertility. The straddle position is avoided.