Renal/GU, Fluid & Electrolytes (6-7 ques)

Question 1

dehydration - most concerning

Answer 1

no tears/urine output
decreased/sluggish cap refill
mottled, cool skin
decreased neuro status

Question 2

isotonic dehydration

Answer 2

• most common - equal Na & water loss (Na level = normal)
• causes: vomiting, diarrhea, NPO status, burns

Question 3

hypotonic dehydration

Answer 3

• Na loss > water loss (Na < 135)
• causes: water intoxication; watering down of formula
• SE: seizures, assoc w/cerebral edema
• intervention: neuro checks

Question 4

hypertonic dehydration

Answer 4

water loss > Na loss (Na > 145)

- causes: excessive sweating, ketoacidosis, malnutrition, diabetes insipidus

Question 5

interventions for mild to mod dehydration

Answer 5

• oral rehydration - pedialyte

- age appropriate nutritional support

Question 6

intervention for severe dehydration

Answer 6

• IV fluid w/isotonic fluid (NS or LR)
• 20 ml/kg IV bolus
• if it’s got Dextrose; it’s hypertonic

Question 7

UTI assessment

Answer 7

• 80% caused by E.Coli
• new onset enuresis - rule out UTI
• hematuria, cloudy/foul-smelling urine, increased urine pH

Question 8

UTI treatment

Answer 8

• antibiotic (bactrim, amoxicillin)
• lots of clear fluids
• teach proper wiping (front to back)
• discourage bubble baths

Question 9

hypospadias complications

Answer 9

• recurrent UTIs

- infertility

Question 10

hypospadias intervention

Answer 10

• no circumcision until surgical repair at 1-4 yo (foreskin may be used for surgery)
• keep area clean to prevent infection

Question 11

undescended testes

Answer 11

• if undescended at birth, usually will w/in a few weeks
• kidneys arise from same germ tissue
• if not descended by 5 yo - a risk for sterility

Question 12

undescended testes - intervention

Answer 12

• anticipate kidney function testing
• surgical intervention - 2-5 yo
• post op: maintain thigh suture to prevent re-ascending

Question 13

Nephrotic Syndrome

Answer 13

autoimmune process - occurs 1 week after an immune assault
↑ glomerular permeability to protein (albumin)
“strainer becomes like a spaghetti strainer”
- common in toddlers

Question 14

Nephrotic Syndrome - assessment

Answer 14

• proteinuria (albumin)
• hypoproteinuria
• hypovolemia
• urine –> dark, foamy, frothy, ↑ specific gravity w/↓ output
• edema
• ↓ serum potassium (lost in urine)
• fatigue/lethargy
• anorexia
• abdominal pain

Question 15

Nephrotic Syndrome - intervention

Answer 15

• skin care for edematous skin
• elevate HOB
• reposition frequently
• test first void of day for protein
• small, frequent meals (↑ calorie, ↑ protein w/o added salt)
• daily weight
• corticosteroids – suppresses autoimmune process

Question 16

Acute Glomerulonephritis

Answer 16

“big holes drilled into spaghetti strainer”

• auto immune disorder occurring 1-2 weeks after at a Group A betahemolytic streptococcal infection
• glomerulus loses ability to be selective; allows RBCs and proteins to filter out
• common in kids 4-7

Question 17

Acute Glomerulonephritis - assessment

Answer 17

same symptoms as Nephrotic Syndrome 
\+ cola color urine
\+ blood in urine
\+ ↑ BP
\+ anemia

Question 18

Acute Glomerulonephritis - intervention

Answer 18

• corticosteroids
• antibiotics
• anti-hypertensives