TLO 2.5 Renal/Urinary Child

Question 1

Anatomy of urinary system of child

Answer 1

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

Question 2

Urinary diagnostic tests for children

Answer 2

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

Question 3

UTI in children

Answer 3

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

Question 4

Predisposed r/t

Answer 4

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

Question 5

UTI manifestations INFANTS

Answer 5

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

Question 6

UTI manifestation CHILDREN

Answer 6

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

Question 7

What is pyelonephritis?

Answer 7

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

Question 8

UTI therapeutic management

Answer 8

oral antibiotics with non complicated UTI

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

Question 9

UTI interventions HOSPITALIZED CHILD

Answer 9

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

Question 10

UTI interventions NOT HOSPITALIZED CHILD

Answer 10

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

Question 11

Cryptorchidism

what is it?

Answer 11

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

Question 12

Cryptorchidism manifestations

Answer 12

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

Question 13

Cryptorchidism therapeutic management

Answer 13

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

Question 14

Cryptorchidism interventions

Answer 14

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

Question 15

hypospadias

what is it?

Answer 15

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

Question 16

Epispadias

what is it?

Answer 16

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

Question 17

Hypospadias

Manifestations

Answer 17

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

Question 18

Hypospadias

Therapeutic management

Answer 18

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

Question 19

Epispadias

Manifestation and therapeutic management

Answer 19

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

Question 20

Misc. anomalies of GU tract
4 types (male)

Answer 20

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

Question 21

Hydrocele

what is it?

Answer 21

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

Question 22

Phimosis

what is it?

Answer 22

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

Question 23

Testicular torsion

what is it?

Answer 23

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

Question 24

Acute glomerulonephritis (AGN)
what is it?

Answer 24

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

Question 25

AGN manifestations

Answer 25

Hematuria- cola colored urine
Proteinuria
Edema
HTN

Question 26

AGN lab findings

Answer 26

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

Question 27

AGN management

Answer 27

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

Question 28

AGN nursing care

Answer 28

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

Question 29

AGN patient outcomes

Answer 29

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

Question 30

Nephrotic Syndrome

what is it?

Answer 30

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

Question 31

Nephrotic syndrome

Occurs most frequently in?

Answer 31

Toddlers or preschool aged children

Question 32

Nephrotic syndrome

Manifestations

Answer 32

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

Question 33

Nephrotic syndrome

lab findings

Answer 33

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

Question 34

Nephrotic syndrome management

Answer 34

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

Question 35

Nephrotic syndrome nursing care

Answer 35

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

Question 36

Nephrotic syndrome patient outcomes

Answer 36

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