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Nur 4410 Peds Exam #1 > Unit III > Flashcards

Unit III Flashcards

1
Q

Compared to adults, children are at a greater risk for fluid and electrolyte imbalance. Why??

A
  • A greater body surface area
  • A higher percentage of total body water
  • A greater potential for fluid loss via the gastrointestinal tract and skin
  • Increased incidence of fever, URI, and AGE
  • A greater metabolic rate
  • Immature kidneys that are insufficient at excreting waste products
  • Kidneys have a decreased ability to concentrate urine
  • Inability to verbalize thirst
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2
Q

Signs of fluid and electrolyte balance deficit:

A
  • Diaphoresis
  • Vomiting
  • Diarrhea
  • Hemorrhage
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3
Q

Signs of fluid and electrolyte balance overload:

A
  • Kidney disease
  • CHF
  • Over-administration of IV fluids
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4
Q

Fluid and Electrolyte Balance is measured by what?

A

daily weights and I/O

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5
Q

Most common type of dehydration, electrolyte and water deficits are equal, Serum Na = 130-150

A

Isotonic dehydration

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6
Q

Pateints in isotonic dehydration are at risk for:

A

hypovolemic shock

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7
Q

type of dehydration where electrolyte deficit is greater than water deficit, serum Na=<130, symptoms are more sever with small fluid losses

A

hypotonic dehydration

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8
Q

most dangerous type of dehydration, water loss is greater than electrolyte loss, serum Na=>150

A

Hypertonic dehydration

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9
Q

Patients in hypertonic dehydration are at risk for:

A

seizures

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10
Q

maintenance fluid requirement for 0-10 kg

A

100mL/kg of body weight

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11
Q

Maintenance fluid requirement for 11-20 kg

A

1000mL+50mL/kg for each kg > 10

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12
Q

Maintenance fluid requirement for >20 kg

A

1500mL + 20mL/kg for each kg >20

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13
Q

minimum urinary output should be what?

A

1mL/kg/hr

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14
Q

second most common bacterial infection in children

A

gender, age, race, renal tissue, poor hygeine, constipation, nutritional status, structural abnormalities, sexual activity

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15
Q

most common cause of UTI

A

e.coli

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16
Q

S&S of UTI in neonate:

A

failure to thrive, jaundice, fever

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17
Q

S&S of UTI in infant:

A

poor feeder, strong smelling urine, v/d

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18
Q

S&S of UTI in preschooler:

A

anorexia, sleepiness, v/d, abdominal pain, foul smelling urine, enuresis, dysuria, urgency/frequency

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19
Q

S&S of UTI in school age:

A

new enuresis, flank pain, dysuria, urgency/frequency, changes in personality

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20
Q

S&S of UTI in adolescents:

A

fatigue, flank pain

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21
Q

urine backflows from the bladder to the uterus and back to the kidney

A

Vesicoureteral Reflux (VUR)

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22
Q

does vesicoureteral reflux have grades?

A

yes 1-4 (5)

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23
Q

primary (congenital) vesicoureteral reflux

A

may resolve spontaneously

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24
Q

secondary vesicoureteral reflux

A

secondary to UTI

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25
Q

S&S of Vesicoureteral Reflux

A
  • recurrent UTI
  • flank pain
  • abdominal pain
  • enuresis
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26
Q

diagnosis for vesicoureteral reflux

A

VCUG

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27
Q

Vesicoureteral Reflux leaves the patient at risk for:

A

Acute pyelonephritis (renal scarring)

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28
Q

Group A strep 7-14 days prior
Antigen-antibody complexes form and deposit in the glomeruli

A

post-streptococcal glomerulonephritis

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29
Q

S&S of post-streptococcal glomerulonephritis

A
  • gross hematuria, tea/cofee colored urine
  • edema (periorbital)
  • HTN, headache, proteinuria, ascites (more severe)
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30
Q

Diagnosis of Post Streptococcal Glomerulonephritis

A

ASO titer, serum complement (C3), BUN, Creatinine, urinalysis

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31
Q

Nursing care for post-streptococcal glomerulonephritis

A
  • antibiotics
  • I&O
  • diuretics, antihypertensives, corticosteroids
  • dialysis-severe
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32
Q
  • Most common type of acute renal failure in children; Most common in children 6mo-3years
  • Caused by E. Coli (undercooked beef)
  • Bacteria in gut cause capillary wall destruction; endothelium of glomerulus becomes edematous and platelets cause a clot (no renal circulation); increased rennin production  HTN and thrombocytopenia
A

Hemolytic Uremic Syndrome

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33
Q

1st S&S of Hemolyric Uremic Syndrome

A

gastoenteritis and possible URI

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34
Q

2nd S&S of Hemolyric Uremic Syndrome

A

Triad: thrombocytopenia, anemia, ARF

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35
Q

other S&S of Hemolytic Uremic Syndrome:

A

Pallor, lethargy, anorexia, irritability
Decreased UOP, abnormal BMP, HSM, dehydration, bloody diarrhea
Seizures, altered consciousness, dialysis, petechiae, purpura, ecchymosis

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36
Q

Diagnosis of Hemolytic Uremic Syndrome:

A

lab results

  • elevated BUN
  • creatinine
  • potassium
  • phosphorus
  • decreased glucose
  • calcium
37
Q

Nursing care of Hemolytic Uremic Syndrome:

A
  • strict I/O
  • dialy weights
38
Q
A

Hemolytic Uremic Syndrome

39
Q

Vaculitis – component of inflammation in the arteries
Typically follows a URI
Typically ages 4y-10y
Glomerulonephritis component may not develop until 2 months after onset of symptoms

A

Henoch-Schonlein Purpura

40
Q

S&S of Henoch-Schonlein Purpura

A
  • hematuria
  • HTN
  • bloody diarrhea
  • crampy abdominal pain
  • rash
  • RAISED PURPURA
  • joint pain/swelling
  • scrotal swelling
41
Q

Diagnosis of Henoch-Schonlein Purpura

A
  • rash
  • GI complaints
  • hematuria
  • arthritis
42
Q

Nursing care for Henoch-Schonlein Purpura

A

most recover spontaneously

43
Q

damage to glomerular membrane causes permeability that permit passage of protein muscles, can be caused by HIV, SLE, nephrotoxins

A

Chronic Clomerulonephritis

44
Q

S&S of chronic glomerulonephritis

A
  • silent for years
  • presents in adolescence
  • decreased UOP
  • HTN
  • headaches
  • periorbital edema
  • icreased abdominal girth
  • scrotal/labial swelling
45
Q

Diagnosis of Chronic Glomerulonephritis:

A
  • UA
  • BMP
  • pH
46
Q

S&S of renal trauma

A
  • hematuria
  • flank tenderness
  • palpable mass
47
Q

any condition that reduces blood flow to the kidneys
Example-Dehydration, heart failure, burns

A

PreRenal

48
Q

results in destruction to the renal filtering components
Example-Acute tubular necrosis, glomerulonephritis

A

IntraRenal

49
Q

Obstruction of the outflow of urine
Example-Urethral obstruction, ureterocele

A

Post renal

50
Q

Diagnosis of Acute Renal Failure

A

H/P, Labs (UA, BMP, pH), renal US, renal biopsy

51
Q

Difference between chronic and acute renal failure? Chronic has:

A
  • irreversible
  • progressive deterioration
  • 4stages
52
Q

Dialysis solution remains in abdomen for several hours and then drained

A

CAPD - continuous dialysis ambulatory peritoneal dialysis

53
Q

several cycles are performed during sleep

A

CCPD - continuous cycling peritoneal dialysis

54
Q

Hemodialysis is dialysis through the blood
Children must be hemodialyzed three times a week at a dialysis center
AV fistula is preferred site
May also use AV graft or venous catheter
Nursing care
Keep fistula site clean
No BP on that arm
Fluid/dietary restrictions between sessions

A
55
Q

renal transplants are received from donors

A

living or cadaveric

56
Q

can a child receiving renal transplant be immunocompromised?

A

no, they are usually on dialysis until a kidney is available and are usually in end-stage renal disease

57
Q

Abnormal emptying or storage in the bladder
Associated with bladder and bowel withholding and incontinence

A

Dysfunctional Elimination Syndrome/Voiding Dysfunction

58
Q

S&S of dysfunctional elimination syndrome/voiding dysfunction

A

Frequency, urinary incontinence, and urgency

59
Q

Nursing Care for children with Dysfunctional Elimination Syndrome/Voiding Dysfunction

A
  • Ask child about voiding
  • Maintain normal bowel regimen
  • Assess for emotional or social problems
  • Teach girls with an inflamed perineum that they can take baking soda sitz baths and use barrier creams
  • Prophylactic antibiotics
60
Q

Involuntary or unintentional urination at any age when voluntary control should be present

A

Nocturnal Enuresis

61
Q

never gained continence
Many times constipation is a huge cause

A

Primary nocturnal enuresis (PNE)

62
Q

incontinent after being dry 6-12 months

A

Secondary nocturnal enuresis (SNE)

**Social factors huge**

63
Q

Nursing care for patients with nocturnal enuresis

A
  • Bladder hygiene
  • Bedwetting alarms
  • Medications - DDAVP
64
Q

bladder exposed out of the body

A

exstrophy of the bladder

65
Q

Associated with other congenital anomalies

A
  • episadias
  • cleft scrotum
  • rectal prolapse
66
Q

Nursing Care for Exstrophy of the Bladder

A

surgery within first 48 hours of life

67
Q

vulvovaginitis

A

yeast infection

68
Q

vulvovaginitis; due to:

A
  • poor hygeine (preschool age-can’t reach)
  • antibiotic use or irritants
  • STD (adolescent girls)
69
Q

S&S of vulvovaginitis:

A
  • vulvar itching
  • vaginal candidiasis has thick curdy white discharge and is pruritic and foul-smelling
70
Q

Nursing care:

A
  • apply topical antifungal
  • wite front to back
71
Q

fusion of labia minora caused by inflammation, infection, trauma, and estrogen deficit

A

labial adhesions

72
Q

what age group most commonly acquire labial adhesions

A

girls 3m-6y

73
Q

Nursing care for Labial Adhesions:

A

Educate that it may spontaneously resolve; parents can do gentle stretching with diaper changes
May need Premarin cream

74
Q

no menses by age 16years

A

primary amenorrhea

75
Q

has had menses, but spontaneously stopped for 3months or more

A

secondary amenorrhea

76
Q

abnormal dilation in the testicular veins
Most common cause of male infertility - correctable
15-20% of males have a varicocele

A

varicocele

77
Q

S&S of variocele

A

bag of worms

78
Q

Nursing care of Variocele:

A

surgery

79
Q

absent, undescended, or ectopic testicles, most common congenital anomaly, major risk for testicular cancer

A

crytochidism, will need surgery

80
Q

inability to retract foreskin

A

phimosis

81
Q

inability to return foreskin back over glans after retraction

A

paraphimosis

82
Q

Nursing care for phimosis/paraphimosis

A

never force, curcumcision may be necessary

83
Q

urethreal meatus is inferior to usual position, can cause chordee - bending of penis

A

hypospadias

84
Q

urethral meatus is superior to usual position

A

epispadias

85
Q

nursing care for hypospadias/epispadias

A

surgery to correct

86
Q

EMERGENCY!!
Twisted spermatic cord,
Sudden onset of testicular pain
Trauma or physical exertion may promote development but can occur with no etiology
Usually unilateral

A

testicular torsion

87
Q

Nursing care for testicular torsion

A

surgery imperative within 4-8h to prevent orchiectomy

88
Q

External reproductive organs not easily identified as male or female

A

ambiguous genitalia

Nur 4410 Peds Exam #1 (4 decks)

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