Unit 34 GU/GI & Nutritional Dysfunction Flashcards
What are general GU diagnostic studies?
VCUG/VCG - “Voiding cystourethrogram” x-ray of urinary system to see how urine flows, catheter with corntrast die.
- Ultrasound/bladder scan
- Urinalysis
- Urine C and S (if a sterile sample is needed, cauterization is required)
- BUN (assesses kidney function)
- Creatinine (assesses kidney function)
What are some GU anatomy defects? Vesicoureteral Reflux, Hypospadias, Cryptorchidism.
Vesicoureteral Reflux - reflux of bladder urine up into the ureters. May present with chronic pyelonephritis and require antibiotics
Hypospadias (males) - urethral opening is behind glans penis or anywhere along penile shaft - surgically repaired. DO NOT CIRCUMCISE
Cryptorchidism (males) - one or both of the testicles fails to descend- hcg therapy or surgical repair - common in premies
What is pyelonephritis?
Renal infection eventually causing kidney failure
What do these terms mean, Cystitis, Urethritis , Pyelonephritis, Urosepsis? Where do UTIs start? What do reaccurent UTIs lead to?
- Cystitis (In Bladder)
- Urethritis (In Urethra)
- Pyelonephritis (In kidney’s)
- Urosepsis (worst kind, systemic infection that started renal and spread to blood)
Usually ascend from urethra up
The longer untreated, the move severe
Recurrent UTI’s = scarring, which means permanent renal dysfunction
What are the pediatric manifestations of a UTI? Specifically pyelonephritis? Urosepsis?
**Pediatric PT’s with significant bacteriuria may have no symptoms or vague symptoms like fatigue or anorexia
- Frequency, Dysuria (painful urination)
- Fever
- Odiferous urine
- Blood or blood tinged urine
Pyelonephritis: CVA tenderness, HIGH fever, chills
Urosepsis: Serious changes in MS, tachycardia, possibly hypotension
What are diagnostic studies for UTI’s? How could the urine be collected?
- Dipstick (reagent strip) for bedside urinalysis
- Microscopic urinalysis
- Culture and Sensitivity
> Clean catch
U-bag for collection from child
Catheterization or suprapubic needle aspiration specimen more accurate, or if clean catch cannot be performed
What is the UTI drug therapy for uncomplicated cystitis?
For complicated UTI’s/pyelonephritis? For repeated UTIs?
Uncomplicated UTI’s: short term oral antibiotics
Complicated UTI’s/pyelonephritis: long term IV antibiotics
Repeated UTIs: Prophylactic or suppressive antibiotics such as,
- TMP-SMX (trimethoprim-sulfamethaxole) check for sulfa allergy
- Bactrim (push fluids w/ bactrim)
- Given everyday to prevent reoccurrence, or single dose before invasive events
-Nitrofurantoin (Macrodantin) - urinary antiseptic that stays in urinary tract
What is the nursing care for UTI’s? What do you want to teach?
- Accurate weight measuring (gold standard for IandOs)
- Monitor renal function tests (BUN/Creatinine)
-Monitor urine color, character, amount
Teach:
- bathroom breaks!
- wipe front to back
- white cotton underwear
- LOTS of fluids - water NOT juice
Describe what is the Glomerular Disease, Acute Glomerulonephritis.
- Inflammation of glomeruli that decreases plasma filtration which leads to sodium and water retention, increasesing BP.
- Hypertension
- Decreased filtration = decreased urine
- Often follows strep
- Immune process injury to glomeruli = inflammation
- No specific medical treatment
Complication: renal failure
What can be assessed in Glomerulonephritis?
- Previous infection
- Decreased urine output
- Anorexia/nausea/vomiting
- HYPERTENSION
- HEMATURIA! (to describe, tea,cola, dirty green)
- Increased Anti-streptolysin O (antibody made against streptolysin)
- edema
- Fatigue
- Hx of sore throat
What is the nursing management for Glomerulonephritis? What don’t you want to give?
- BP monitoring and control with (labetalol, nifedipine/diuretics, CCB)
- Sodium/ fluid restrictions during edematous phase
- I and O’s
- Daily weights
- Monitor edema (periorbital and general)
- Watch for encephalopathy/seizures (fluid has nowhere to go)
- NO NSAIDS (inflames kidneys)
- Monitor labs BUN/Creatinine for kidney function
Describe Nephrotic Syndrome.
Glomerulus basement membrane doesn’t filter urine correctly, therefor:
- massive protein loss**PROTEINURIA!! (mostly albumin)
- Fluids follows protein, leaking out of blood vessels into third space (tissues) resulting in edema
- Liver senses protein loss = produces lipids = Hyperlipidemia
- Increased clotting risk due to decreased intravascular volume
What is the therapeutic/nursing management of Nephrotic Syndrome?
-Corticosteroids long term therapy -prednisone; solumedrol IV
-Albumin if needed
-Diuretics furosemide/potassium
-I and O’s/weights
(If not effective, immunosuppressive therapy, cytotoxic rx’s)
> Prevent infection:
- Monitor temp
- Pneumococcal vaccine (this is ok)
- NO LIVES VACCINES
- Prophylactic antibiotics
> Encourage adequate nutrition and growth:
- Possible sodium/fluid restrictions
- Text says give protein
> Educate family:
-Urine dipstick/diet/medication
What do you want to watch out for and do with corticosteroids?
- Watch for infections and they increase BP
- Wean off
What can be assessed in Nephrotic Syndrome?
- EDEMA: periorbital edema and general edema/anasarca/ascites
- Fluid weight gain
- Nausea/vomiting/ from (ascites)- belly edema
- Weakness/fatigue
- May have increases dyspnea
- Irritability
- NO HYPERTENSION
What are significant labs seen in Nephrotic Syndrome?
- PROTEINURIA (Massive)!!!
- Hyperlipidemia
- Creatinine and BUN may be elevated
What are causes of dehydration?
Most often result of abnormal losses like diarrhea and vomiting due to [gastroenteritis] caused by [rotavirus], salmonella, c-diff, e-coli, shigella, etc.
other causes:
- *heat stroke/exhaustion
- stomatitis
- pharyngitis
- tonsillitis
- febrile illness
- CF
- procedural blood loss
What are the pediatric mild to moderate dehydration symptoms?
- Dry, sticky mouth
- Dry skin
- Sleepiness or tiredness
- Thirst
- Decreased urine output
- No wet diapers for 3 hours (infants)
- Headache
- Constipation
- Dizziness or lightheadedness
What are the pediatric severe dehydration symptoms?
- Extreme thirst
- Very dry mouth, skin, and mucous membranes
- Little to no urine (dark colored urine)
- Sunken eyes
- Shriveled dry skin that lacks elasticity (doesn’t bounce back)
- Dysphagia
- Sunken fontanels (in infants)
- Low BP
- Tachycardia
- Tachypnea
- Fever
- Delirium, decrease LOC, or unconsciousness
What will a nurse assess for regarding dehydration?
- Intake and Output
- VS
- Skin color, temp, turgor, cap refill
- Mucous membranes
- Body weight**
- Fontanels (in infants)
- Mental status**
- Urine specific gravity, stool specimen
What is one of the body’s early response to dehydration? Late response?
Tachycardia
Decreased BP
What is the management of mild to moderate dehydration?
Concept: Rehydrate the losses, give maintenance fluids
-Oral rehydration such as pedialyte. (5-10ml Q5 min)
-Can introduce regular diet and milk as tolerated
(no more need for BRAT diet)
What is the management for severe dehydration or those with continued vomiting?
IV Fluids for rehydration:
- Give 50ml/kg over a 4 hr period to treat acute dehydration**
- Isotonic fluids good choice: NS 0.9, Lactated RIngers
- If calories needed D5NS or D5 1/2NS
Regarding severe dehydration or those with continued vomiting, what is the IV fluids for maintenance formula (per 24hrs)?
Add 100ml/kg for first 10 kg of body weight
Add 50ml/kg for second 10 kg of body weight
Add 20 ml/kg for any remaining body weight
Example 32kg child = 1740ml/24hrs
Regarding infants with cleft lip/palate, how would you feed them? What precautions are important with them?
Upright, with special nipple/bottle help
Aspiration precautions
lay on opposite side of where Lip Sx was
What are typical concerns with cleft lip/palate?
Feeding
Ensuring proper growth
Preventing aspiration
When is cleft lip repair usually performed? Palate?
2-3 months old
6-9 months old
What is the nursing care for cleft lip/palate before and after sx?
Before: E - Enlarged nipple S - Stimulate suck by bottom lip S - Swallow R - Rest
After
- Logan bar to prevent tension
- No straws, pacifiers, spoons, or fingers in or around mouth for 7-10 days
- With cleft palate take liquids from a cup
- No tooth brushing for 1-2 weeks
- Elbow restraints possible
Long term:
- Speech therapy
- Orthodontics
Describe Hirschprung Disease.
- Congenital disorder, more common in males and downs syndrome
- Part of large intestine has inadequate nerve supply/motility, narrowed
- Distended abdomen, signs of obsruction
- AKA congenital aganglionic megacalon
They have ribbon like stools`
What is the treatment for Hirschprung Disease?
- Most will require surgery, colon resection where area is removed
- Usually temporary ostomy to let bowel rest and return to normal size
- Nursing concerns: preventative antibiotics, adequate fluid and caloric intake, skin care around site, teaching ostomy care.
Describe the obstructive disorder “Intussusception”, the symptoms, and treatment.
- Segment of bowel/intestine telescopes into a distal segment of bowel
- More common in males and children with CF
- 3 months old to 3 years old (peak 5-9 months)
- Frequent cause of intestinal obstruction
Some symptoms include:
- Jelly stools (little berry like bloody mucus stools)
- Sausage like mass under skin in abdomen
- Abdominal pain
Treatment:
- NGT
- IV Fluids
- Contrast and CO2 instilled into rectum which pushes bowel back into place (if not successful then Sx)
What is Celiac Disease? What can it cause?
- Chronic malabsorption and inflammatory disorder of the small intestine
- Reaction to gluten, (protein in wheat, barley, rye, and oats)
- Usually diagnosed in children but can present in adulthood
Can cause:
- Steatorrhea (excess fat in stool)
- Sever malnutrition and vitamin deficiencies
- Abdominal distention
- Behavioral changes
- Growth retardation
- Anemia
What is the Celiac Disease treatment?
-Low or gluten free diet (substitute with corn and rice)
Nursing priorities:
- Dietician evaluation
- Reinforcement of teaching
- Supplement deficiencies
- Follow growth and labs closely
Name common food allergies, the reactions, and possible prevention.
Common food allergies: *nuts, *milk, eggs, wheat, fish, shellfish, citrus
Reactions range from GI intolerance, skin rashes to anaphylaxis
Prevention?
- Breastfeeding
- Introduce foods 1 at a time between 4-6 months, less allergenic foods first then progress
