Presence of bacteria in urine caused from outside the urethra getting into bladder and UT - fecal bacteria causes most UTI's - bacteria in blood (seeds in kidney) can cause UTI in infants

TLO 2.5 Renal/Urinary Child Flashcards by jodi Trethewey

Anatomy of urinary system of child

Stress: reduced kidney function in infants
Shorter urethras
Complete bladder control by age 4-5
Most regain normal function following acute renal failure
Output:
Infants: 2mL/kg/hr
Children: .5-1mL/kg/hr
Adolescents: 40-60 mL/hr

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Urinary diagnostic tests for children

Urinalysis, Culture and sensitivity often included
Serum studies: BUN (5-18 child), creatinine (0.3-0.7 child), osmolality
KUB (kidney, ureters, bladder)
Imaging: CT, VCUG (voiding crystal urethrogram), Renal US
Cystoscopy

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UTI in children

Presence of bacteria in urine caused from outside the urethra getting into bladder and UT

fecal bacteria causes most UTI’s
bacteria in blood (seeds in kidney) can cause UTI in infants

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Predisposed r/t

Urinary tract obstructions
Urinary stasis r/t voiding dysfunction
Anatomic differences
Susceptibility to infection
Reflux
Toilet training females
Sexually active adolescent girls

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UTI manifestations INFANTS

vague/nonspecific
fever
irritability
crying when voiding
odorous urine
feeding difficulties

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UTI manifestation CHILDREN

ab pain
frequency/urgency
dysuria
fever
enuresis (involuntary urination, especially by children at night.)

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What is pyelonephritis?

Inflammation of the pelvis (acute infection of kidney):
high fever, chills
back pain
costovertebral angle tenderness
N/V

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UTI therapeutic management

oral antibiotics with non complicated UTI

pyelonephritis:
identifying contributing factors to prevent recurrence
prevent system spread of infection
preserve renal function

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UTI interventions HOSPITALIZED CHILD

educate on reason for procedures
keep infant/child’s routine
encourage parents/child be part of care
monitor hydration: encourage fluids, monitor signs of dehydration, I/O, skin turgor

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UTI interventions NOT HOSPITALIZED CHILD

ensure completion of antibiotic
promote comfort
good hydration
keep following up appointments and diagnostic studies
monitor for return of symptoms

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Cryptorchidism

what is it?

Absence of at least one testicle descent from scrotum:

occurs when one or both testes fails to descent
affects about 1-5% of healthy boys at birth
most infants have spontaneous descent by age 6 months

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Cryptorchidism manifestations

Testes no palpable
Testes not easily guided into the scrotum
Previously descended testis that ascends into extrascrotal position
**Children with undescended testes are at increased risk for malignancy and infertility

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Cryptorchidism therapeutic management

Observation of infant up to 6 months
Assess for testicular presence at each well child exam
Persists >6 mo = orchidopexy (done before 12 mo of age reduces risk of adverse consequences

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Cryptorchidism interventions

Educate parents
provide parents with information/resources
Provide post-op care

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hypospadias

what is it?

Opening of urethral meatus is below the normal placement on the glans of the penis

Different degrees: some slightly ventral to glans or as far back as penoscrotal junction

One of the most common congenital anomaly

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Epispadias

what is it?

Dorsal (on top) placement of urethral opening
Congenital anomaly
Less common, extremely rare

Hypospadias

Manifestations

Occurs from incomplete development in utero
Stenosis of the opening= partial obstruction of urine= altered urine stream
Might interfere with fertility in mature man if left uncorrected
Chordee: downward curvature of penile shaft

Hypospadias

Therapeutic management

Surgical correction, 6-12 mo before toilet training
Should not be circumcised, foreskin can be used to reconstruction
Urinary diversion
Restricted activity for few days, no hip straddling after surgery
Goal: urinary/sexual function normal and improved cosmetic

Epispadias

Manifestation and therapeutic management

Manifestation:
Defect on topside of penis
Often associated with bladder exstrophy (bladder outside the ab wall)
Therapeutic:
Surgical reconstruction

Misc. anomalies of GU tract
4 types (male)

Hydrocele
Phimosis (inability to retract the skin (foreskin or prepuce)
Testicular torsion
Bladder exstrophy (bladder outside of body)

Hydrocele

what is it?

Painless swelling of scrotum
Caused by collection of fluid
Usually resolves by 12 mo of age

Phimosis

what is it?

Inability to retract the foreskin at an age is should retractable
Mild cases: cleaning and gentle manual retraction
Severe cases: surgical enlargement of phimotic ring or circumcision

Testicular torsion

what is it?

Rotation of testicles causing interruption to blood supply
Most be corrected quickly to avoid damage
Sudden onset of severe scrotal pain, erythema, edema

Acute glomerulonephritis (AGN)
what is it?

Inflammatory injury in the glomerulus
Acute post streptococcal glomerulonephritis is the most common type:
-an immune reaction to group A beta-hemolytic streptococcal infection of throat or skin
-damage is caused by antigen-antibody complex that lodges in glomeruli
-streptococcal infection needs to be verified for dx
Most common in preschool or early school age

AGN manifestations

Hematuria- cola colored urine Proteinuria Edema HTN

AGN lab findings

RBC's, casts, small amount of protein in urine Decreased or normal Hgb and Hct Altered electrolytes Elevated BUN/creatinine Elevated ASO titer or Streptozyme, decreased complement

AGN management

``` Supportive Antihypertensive Diuretics Antibiotics for active strep infection Low salt diet Possible fluid restrictions ```

AGN nursing care

``` Prevent fluid excess Provide adequate rest/quiet play Maintain skin integrity Maintain nutritional status Relieve anxiety ```

AGN patient outcomes

Child will remain normal fluid balance The child will exhibit no signs of skin breakdown The child will have adequate nutrition

Nephrotic Syndrome | what is it?

Kidney disorder characterized by proteinuria, hypoalbuminemia, edema Can occur: a primary disease known as minimal change nephrotic syndrome a secondary disorder after glomerular damage a congenital form that is inherited as an autosomal recessive disorder

Nephrotic syndrome | Occurs most frequently in?

Toddlers or preschool aged children

Nephrotic syndrome | Manifestations

``` Severe proteinuria Edema Normotensive Hypovolemia Pallor/fatigue Anorexia Ab pain Increased weight ```

Nephrotic syndrome | lab findings

Protein in urine Possible microscopic hematuria hypoalbuminemia <2.5 g/dL Elevated cholesterol, triglycerides, Hgb, Hct, platelet levels

Nephrotic syndrome management

``` prednisone to initiate remission (remission= less than 1+ urine protein for 3-7 consecutive days) diuretics possible albumin admin prevent infection/skin breakdown no added salt diet ```

Nephrotic syndrome nursing care

``` Live virus vaccines are contraindicated in children receive steroid therapy Monitor for s/s infection Assess fluid status, daily weight, I/O Monitor labs, CBC, UA Observe for s/s of dehydration ```

Nephrotic syndrome patient outcomes

Child will be free from skin breakdown Child will maintain adequate fluid volume Child will not exhibit signs of fluid overload Parents will be able to explain principles of home management