UNIT 8 GENUITORY CHAPTER 45 CHAPTER 34

Question 1

What is considered Geniutory dysfunction

Answer 1

Any dysfunction involving kidneys, ureter, bladder or urethra

 Disorders may affect waste removal and/or fluid & electrolyte balance

 Urinary tract malformations or malfunctions may be
congenital or acquired

Question 2

Pediatric differences in Urinary Tract

Answer 2

Pediatric differences in Urinary Tract
 Nephrons
 Immature kidney function
 Bladder capacity
 Bladder control

Question 3

What is the most common cause of Urinary Tract Infections?

A. h. phylori
B. C-diff
C. Dehydration
D. E. coli

Answer 3

D. E. coli

Question 4

Which of the following are signs and symptoms of Urinary Tract Infection in pediatric patients?
SELECT ALL THAT APPLY

A. Nasal congestion
B. hyperkalemia
C. Severe rash
D. Foul smelling urine
E. Enuresis
F. Frequency

Answer 4

C. Severe rash
D. Foul smelling urine
E. Enuresis
F. Frequency

*incontinence in a previously
toilet-trained child,
*strong-smelling urine,
*frequency/urgency,
*anorexia,
*vomiting,
*persistent diaper rash,
*crying on urination

• Incontinenceinatoilet-trainedchild
• Frequencyorurgencyofvoiding
• Dysuria
• Grosshematuria

Question 5

How would you diagnose Urinary Tract Infection

Answer 5

Diagnosis: U/A, culture

Question 6

Managent of UTI’s

Answer 6

 Management: Eliminate current infection,
prevent systemic spread of infection, preserve
renal function,

decrease risk factors
(poor hygiene/wiping while potty training, withholding
urine)

Question 7

What is the definition of Enuresis?

Answer 7

bed wetting

Question 8

What are the risk factors for Enuresis?

Answer 8

May be caused by
*structural defects,
*UTI,
*neurological deficits,
*diabetes,
*chronic renal failure

Question 9

How is Enuresis diagnosed

Answer 9

Diagnosis: based on
symptoms

Question 10

S/S of Enuresis

Answer 10

Manifestations: involuntary
passage of urine

Question 11

How would you decrease episodes of Enuresis?

Answer 11

Management:
*limit evening fluids,
*empty bladder prior to
bed

Question 12

What is Nephrotic Syndrome?

Answer 12

INFLAMMATORY PROCESS OF NEPHRONS IN KIDNEY

NO INFECTION

Clinical state that includes
proteinuria, hypoalbuminemia,
hyperlipidemia, and edema

urine +3 +2 dipstick
under 3.5 albumin

hypercholesterimia hdl over 200

Question 13

Pathophysiology of Nephrotic syndrome

Answer 13

Pathophysiology:
disturbances cause basement
membrane of glomeruli to
become permeable to protein

Question 14

What labs or signs symptoms would you suspect to see in patient

Answer 14

Labs:
*proteinuria (massive),
*hypoalbuminemia,
*hypercholesterolemia
*Generalized Edema,
*WEIGHT GAIN
*anorexia,
*irritability,
*lethargy
*Puffiness of face (facial edema):
* Diarrhea
* Anorexia

• Poor intestinal absorption
  *massive proteinuria, hypoalbuminemia, edema, elevated serum lipids, anorexia, and pallor. The child gains weight.

Question 15

Would blood pressure elevated or decreased in Nephrotic Syndrome?

A. Elevated
B. Decreased

Answer 15

B. Decreased

Blood pressure normal or slightly decreased

Question 16

Are patients with Nephrotic Syndrome susceptible to infection?

A. NO
B.Yes

Answer 16

Susceptibility to infection

B.Yes

Question 17

Nursing Management of Nephrotic syndrome

Answer 17

 Focus:
 Reduce excretion of urinary protein
 Reduce edema
 Prevent infection
 Low-sodium diet

 Diuretics
 Corticosteroids x8-12 weeks
 Relapses occur in 2/3 of kids
 Nursing considerations:
 Strict I&O, daily weight
 Urine dipstick for albumin
 Monitor VS, edema

Question 18

What diet should a patient with Nephrotic syndrome be on ?

A. Low calorie, low protein
B. Low sodium, high protein
B. High in Vit-c , low in vitamin d
D. High sodium, low protein

Answer 18

B. Low sodium, high protein

Question 19

CORTICOSTERIOD teaching

Answer 19

 Corticosteroids x8-12 weeks
 Relapses occur in 2/3 of kids
 suppresses immune system ^
 had hygiene stay away from large crowds

Question 20

How would you monitor urine output in an infant ?

Answer 20

amount of wet diapers

Strict I&O, daily weight
 Urine dipstick for albumin
 Monitor VS, edema

Question 21

The nurse reviews the record of a child who is sus- pected to have glomerulonephritis. Which state- ment that relates to this diagnosis would the nurse expect to hear from the child’s parents?
1. “The pediatrician said the kidneys are working well.”
2. “I noticed the urine was the color of cola lately.”
3. “I’m so glad they didn’t find any protein in the urine.”
4. “The nurse who admitted my child said the blood pressure was low.”

Answer 21

2. “I noticed the urine was the color of cola lately.”

Question 22

The nurse performing an admission assessment on a 2-year-old child who has been diagnosed with ne- phrotic syndrome notes that which most common characteristic is associated with this syndrome?
1. Hypertension
2. Generalized edema
3. Increased urinary output
4. Frank, bright red blood in the urine

Answer 22

2. Generalized edema

Question 23

The nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. Which assessment ndings would the nurse expect to observe? Select all that apply.
1. Pallor
2. Edema
3. Anorexia
4. Proteinuria
5. Weight loss
6. Decreased serum lipids

Answer 23

1. Pallor
2. Edema
3. Anorexia
4. Proteinuria

Question 24

A 7-year-old child is seen in a clinic, and the pedia- trician documents a diagnosis of nighttime (noc- turnal) enuresis. The nurse would plan to provide which information to the parents?
1. Nighttime (nocturnal) enuresis does not respond to treatment.
2. Nighttime (nocturnal) enuresis is caused by a psychiatric problem.
3. Nighttime (nocturnal) enuresis requires surgical intervention to improve the problem.
4. Nighttime (nocturnal) enuresis is usually out- grown without therapeutic intervention.

Answer 24

4. Nighttime (nocturnal) enuresis is usually out- grown without therapeutic intervention.

Question 25

S/S OF NEHRPHROTIC SYNDROME

Answer 25

■ Weight gain in the child
■ Periorbital and facial edema most prominent in the morning
■ Leg, ankle, labial, or scrotal edema
■ Decrease in urine output; urine dark and frothy
■ Ascites (uid in abdominal cavity)
■ Blood pressure normal or slightly decreased
■ Lethargy, anorexia, and pallor
■ Massive proteinuria
■ Decreased serum protein (hypoproteinemia) and elevated
serum lipid levels

Question 26

What can cause Acute Glomerulonephritis

Answer 26

Glomerulonephritis refers to a group of kidney dis- orders characterized by inflammatory injury in the glomerulus, most of which are caused by an immunological reaction.

Most cases are postinfectious:
streptococcal infections

No symptoms 1-3 weeks

Question 27

S/S of Acute Glomerulonephritis

Answer 27

*HYPERTENSION
*COLOR COLORED URINE (HEMATURIA)
*OLIGURIA
*PROTEINURIA
*EDEMA

■ Periorbital and facial edema that is more prominent in the morning, spreads to genial area throughout the day
■ Anorexia
■ Decreased urinary output
■ Cloudy, smoky, brown-colored (cola-colored) urine (hematuria)
■ Pallor, irritability, lethargy
■ In an older child: Headaches, abdominal or FLank pain, dysuria
■ Hypertension
Increased anti–streptolysin O titer (used to diagnose disor-
ders caused by streptococcal infections)

Question 28

Does Acute Glomerulonephritis has hypoalbumenia?

A.Yes
B. No

Answer 28

B. No

ONLY NEPHROPHRITIC SYNDROME

Question 29

Is reoccurrence common in Nephrotic Syndrome or Acute Glomerphritis

A. AG
B. NS

Answer 29

B. NS

Yes due to steroid therapy

Question 30

Nursing Managent of AG

Answer 30

Supportive care; if VS stable, treat at home
* Sodium restriction, possible fluid restriction
* Strict I&O, daily weight in the morning before food
* VS q4h (esp BP)
* Recurrence uncommon

Question 31

Low salt or low salt and high protein?

Match the diagnoses with the recommended diet

Nephrotic Syndrome

Acute Glomerphritis

Answer 31

Low salt= Acute Glomerphritis

low salt and high protein= Nephrotic Syndrome