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