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ADN005 Pediatrics > Week 3 Chapter 43 > Flashcards

Week 3 Chapter 43 Flashcards

1
Q

Blood flow through the kidneys

A

GFR

Expected urine output in 0.5ml/kg/hr

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2
Q

Kidney is ____________ relation to the stomach

A

Large

Prone to injury

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3
Q

Urethra is shorter which means?

A

Increased UTI- Bacteria entry into the bladder

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4
Q

GFR is______________ in infants which means?

A

Slower; Dehydration risk

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5
Q

What is the bladder capacity in newborn?

A

30mL

Adult size by 1 year- 270mL

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6
Q

Immature at birth but mature in adolescence

A

Reproductive Organs

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7
Q

Past Medical history for GU Disorders

A

Maternal Polyhydramnios, oligohydramnios, diabetes, HTN, or alcohol or cocaine ingestion

Neonatal History: Presence of a single umbilical artery, abdominal mass, chromosome abnormality, or congenital malformation

Family History: Renal Disease or uropathology, chronic UTIs, renal calculi, or history of parenteral enuresis

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8
Q

S/S of GU Disorders

A

Burning on urination
Changes in voiding pattern
Blood in the urine
Foul smelling or dark colored urine
Vaginal or urethral discharge
Genital pain, irritation, or discomfort
Edema

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9
Q

S/S of GU Disorders

A

Masses in the groin, scrotum, or abdomen
Flank or abdominal pain; cramps
Distention in lower abdomen
Nausea and Vomiting
Poor growth; weight gain
Fever
Infectious exposure
Trauma

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10
Q

Common Lab and Diagnostic Testings

A

CBC, electrolytes, creatinine, total protein, albumin

Urinalysis( clean catch, suprapubic, or catheterized culture and sensitivity)

Creatinine Clearance
Time Urine Collections for creatinine, total protein

Cystoscopy, urodynamic studies
VCUG
Renal Ultrasound
Renal Biopsy

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11
Q

Common Medications for GU Disorders

A

Antibiotics
Anticholinergics
Desmopressin
Diuretics
Corticosteroids
ACE Inhibitors and other Anti HTNs
Imipramine
Immunosuppressants
Albumin IV

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12
Q

Common Medical Treatments for GU Disorders

A

Urinary Diversion
Foley Catheter
Ureteral Stent
Nephrostomy Tube
Suprapubic Tube
Vesicostomy
Appendicovesicotomy
Bladder Augmentation
Dialysis

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13
Q

important to clean urine bag and pat dry

A

True

If collecting urine culture, be sure to use betadine or cleaning application per policy and apply bag, check bag frequently for urine.

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14
Q

Sterile Urinary Catheterization

A

Same as adults but size varies

Discuss procedure with parents

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15
Q

6F for ..

A

Birth to 2 years

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16
Q

6-8 Foley for

A

2 to 5 Years

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17
Q

8-10 Foley for..

A

5 to 10 years

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18
Q

10-12 Foley for…

A

10- 16 years

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19
Q

Urine specimens may be collected using a variety of different methods in infants and children

A

True

Urine Bag
Sterile Urinary Catheterization
Suprapubic Aspiration

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20
Q

When performing or examining catheterization allow children to sit with their parent to decrease anxiety

A

True

Use familiar terms such as pee pee or tinkle or potty to explain the child what is needed and to gain cooperation

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21
Q

Structural Disorders

A

Hypospadias/ epispadias
Obstructive Uropathy
Hydronephrosis
Vesicoureteral Reflux

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22
Q

Urethral Defect in which the opening is on the ventral surface of the penis rather than the end of the penis .

A

Hypospadias

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23
Q

Urethral defect in which the opening is on the dorsal surface of the penis.

A

Epispadias

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24
Q

What happens if hypospadias or epispadias is left untreated?

A

Boy may not be able to urinary stream from standing position

May also result in erectile dysfunction or interfere with depositing sperm during intercourse

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25
Q

Repairs for hypo and epispadias occurs at

A

12 -18 months

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26
Q

Urinary output is very closely monitored due to a temporary stent or catheter placement.

A

True

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27
Q

No urinary output=

A

PRIORITY

Indicates urethra is blocked and must be reported to HCP; circumcision is delayed

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28
Q

Any obstruction along the ureter between the kidney, pelvis, and bladder

A

Obstructive Uropathy

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29
Q

Common Sites for Obstructive Uropathy

A

UPJ- Pelvis to Ureter
UVJ- lower ureter to bladder
Ureterocele- Ureter swells into bladder
Posterior Urethral Valves- Flaps of tissue in proximal urethra, males only

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30
Q

Complications of Obstructive Uropathy

A

Recurrent UTI, renal insufficiency, damage to kidney resulting in kidney failure

Requires surgical intervention

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31
Q

_______________ is withheld from IVF until adequate UOP is established to avoid hyperkalemia should the kidneys fail to function properly

A

Potassium

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32
Q

Renal Pelvis and calyces are dilated

May occur as congenital defect, because of obstructive uropathy or VUR

A

Hydronephrosis

Complications include renal insufficiency, HTN, and renal failure

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33
Q

Urine from bladder flows back up to the ureters caused by faulty valve within the bladder

A

Vesicoureteral Reflux

Occurs during bladder contraction with voiding

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34
Q

If reflex occurs when the urine is infected, the kidney exposed to bacteria which may result in in?

A

Pyelonephritis

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35
Q

Kidney may appear large on abdominal x ray due to urine back up

A

True

36
Q

Vesicoureteral Reflux can lead to

A

renal scarring, HTN, renal insufficiency or failure

Manage with antibiotic prophylaxis, hygiene

37
Q

Grade III, IV, V warrant what for Vesi Reflux?

A

Surgical Intervention

38
Q

Acquired and Functional Disorders

A

UTI
Enuresis
Nephrotic Syndrome
Acute Glomerulonephritis
Hemolytic Uremic Syndrome
Renal Failure ( Acute and Chronic)

39
Q

Infection of the urinary tract and most commonly affecting the bladder

Short Urethra

A

UTI

Urethra close to vagina and anus

Sexually Active female at higher risk

40
Q

UTI in Infants presents

A

Fever, irritability, vomiting, failure to thrive, or jaundice

41
Q

UTI in Children presents as

A

Fever, vomiting, dysuria, frequency, hesitancy, urgency, and pain

42
Q

UTI caused by

A

E. COLI

Treated with Antibiotics

Prevention is most important goal for recurrent UTIs

43
Q

Preventing UTIs in Females

A

Drink enough fluid
Drink cranberry juice to acidify urine
Avoid colas and caffeine which irritate the bladder
Urinate frequently
Avoid bubble baths
Wipe from front to back after voiding
Wear cotton underwear
Avoid wearing tight jeans or pants
Wash the perineal area daily with soap and water
While mensurating change pads frequently to discourage bacteria growth
Void immediately after sexual intercourse

44
Q

Autoimmune disorder where body attacks its own kidneys

A

Nephrotic Syndrome

Triggered by Stress, sickness, smoking, and sun exposure

45
Q

Occurs because of increased glomerular basement membrane permeability, which allows abnormally high protein loss in the urine

A

True

Nephrotic Syndrome

46
Q

Congenital is inherited, rare, Finnish descent, kidney transplant

A

True

47
Q

Secondary Nephrotic Syndrome includes

A

SLE
Henoch Schonleiin purpura, or diabetes

48
Q

Idiopathic Nephrotic Syndrome includes

A

Most common onset by age of 6 years

Complications include Renal Failure and HTN crisis

49
Q

Report key signs of

A

Headache, mental status changes, N/V, oliguria, or low urine output, new, sudden, rapid weight gain

50
Q

Tx of of Nephrotic Syndrome include

A

Corticosteroids, IV albumin, diuretics, Immunosuppressive therapy

51
Q

Glomerulonephritis

A

Inflammation and scarring of the kidney , specifically the glomeruli

52
Q

Streptococcal infection like strep throat can travel down to the

A

Kidneys

53
Q

Condition in which immune processes injure the glomeruli. Immune mechanisms cause inflammation which destroy the little glomeruli causing increased permeability, like poking holes in a coffee filter, now kidneys leak small amount of protein instead of filtering it

A

Acute Glomerulonephritis

54
Q

Symptoms include Periorbital Edema, loss of appetite, tea colored urine, recent strep infection, fever, UA, proteinuria

A

S/S of Glomerulonephritis

Complications include Uremia and renal failure

55
Q

Treatment of glomerulonephritis is aimed at maintaining what

A

Fluid volume and managing HTN

Avoid use of NSAIDs in children with questionable renal function because it may further decrease GFR

56
Q

Defined by 3 features

Hemolytic Anemia
Thrombocytopenia
Acute Renal Failure

A

Hemolytic Uremic Syndrome

57
Q

Other causes include idiopathic, inherited, drug related, malignancies, transplantation and malignant HTN

A

Hemolytic Uremic Syndrome

Typical occurs after diarrheal illness, E. Coli causes majority of cases
- Assessment findings- pallor, toxic appearance, edema, oliguria, or anuria
- Watery diarrhea progresses to hemorrhagic colitis, then to the triad
- Causes microthrombi and ischemic changes within the organs which results in renal failure

58
Q

Therapeutic Management of HUS

A

Maintaining fluid balance, correcting HTN, acidosis, and electrolyte abnormalities, replenishing RBCs, providing dialysis

Proper handwashing is necessary

59
Q

Restoring Fluid and Electrolyte balance include

A

Low sodium, nutrient rich diet, vitamin D and calcium, MVI, erythropoietin injections, growth hormone injections

60
Q

Monitor Vital Signs frequently and assess urine specific gravity
Ensure diet meets required guidelines to support growth
Maintain strict I and Os
- Expected UOP in infant and child is 0.5- 2 ml/ kg/ hour

Administer diuretics as ordered
When urine output is restored, diuresis may be significant

Administer packed RBCs as ordered
Dialysis become necessary

A

Restoring Fluid and Electrolyte Imbalance

61
Q

Condition which the kidneys can’t concentrate urine, conserve electrolytes, or excrete waste products

A

Renal Failure

62
Q

May be acute or chronic, When acute renal failure continues to progress, it becomes chronic, also known as ESRD

A

Renal Failure

63
Q

Treatment Modalities for ESRD

A

Dialysis
- Peritoneal Dialysis- Requires placement of PD catheter, can be performed at home
- Hemodialysis- Requires placement of AV fistula

Kidney Transplantation

64
Q

4-8 hours a day

A

Peritoneal Dialysis

65
Q

Hemodialysis is what time allotted

A

3 hours 2-4 times a week

Assess AV graft with each set of vitals

Auscultate for bruit and palpate for thrill

No BPs on extremity with graft

66
Q

Nursing Goals for the child with ESRD

A

Promoting growth and development
Removing waste products and maintaining fluid balance via dialysis
Minimize complications by maintaining adequate fluid and nutrition
Encouraging psychosocial well-being
Supporting and educating the family

67
Q

Labial Adhesions
Vulvovaginitis
Pelvic Inflammatory Disease
Sexually Transmitted Disease Infections
Menstrual Disorders
- Primary and secondary amenorrhea
- Dysmenorrhea
- Menorrhagia and metrorrhagia

A

Female Reproductive Organ Disorders

68
Q

UTI may result in urinary stasis behind the

A

Labia

If left untreated the vaginal opening may become inaccessible making it difficult to have sexual intercourse.

69
Q

Younger girls up to age of 5 have higher risk of adhesions

A

True

Tx includes estrogen cream 1-2 times a day and petroleum jelly daily x 1 month to prevent reoccurrence

70
Q

Inflammation of the vulva and the vagina

A

Vulvovaginitis

71
Q

Causes include bacterial or yeast overgrowth
Chemical factors such as bubble bath, soaps, and perfumes
Poor hygiene

A

Vulvovaginitis

72
Q

Associated Factors of Vulvovaginitis includes

A

Tight clothing may cause heat rash in the perineal area

Persistent scratching of the irritated area may result in the complication of the superficial skin infection

73
Q

Phimosis and paraphimosis
Cryptorchidism
Hydrocele and varicocele
Testicular torsion
Epididymitis
STIs

A

Male Reproductive Disorders

74
Q

Not priority descend spontaneously by 6 months after birth > 1 year old

A

Cryptorchidism

If not corrected by the time the child is 1 year the male baby can become sterile later on in life meaning they will not be able to have children.

Surgery can be used to fix this condition

75
Q

Irritation, balanitis or UTI may occur if urine is retained within the foreskin after voiding

A

Phimosis

Topical steroid cream BID x1 month

76
Q

Medical Emergency and can quickly result in necrosis of the tip of the penis if left untreated

A

Paraphimosis

Requires reduction of the foreskin or small dorsal incision to release the foreskin

Circumcision may be used to treat phimosis and paraphimosis.

77
Q

Whether to circumcise or not is a personal decision often based on religious beliefs or social norms or cultural

A

True

78
Q

Benefits of Circumcision

A

Decreased Incidence
- UTI
- STI
- HIV infection
- Penile Cancer
- Cervical Cancer in female partners

79
Q

Complications of Circumcision

A

Alterations in urinary meatus
Unintentional removal of the excessive amounts of the foreskin
Damage to the glans penis

80
Q

Fluid in the scrotal sac

A

Hydrocele

usually benign and self limiting and resolves spontaneously by 1 year of age

81
Q

Venous varicosity along the spermatic cord

A

Varicocele

Often noted as swelling of the scrotal sac.

Complications include low sperm count or reduced sperm motility and both require watchful waiting

82
Q

Testicle is abnormally attached to the scrotum and twisted

A

Testicular Torsion

83
Q

Requires immediate surgery because of the ischemia can result if the torsion is left untreated leading to infertility

A

Testicular Torsion

Ensure Surgical Consent on the chart

May occur at any age but most common in boys aged 12-18 years

84
Q

Inflammation of the epididymis

A

Epididymitis

Caused by infection with bacteria

Most common cause of pain the scrotum

Rarely occurs before puberty

85
Q

Therapeutic Management of Epididymitis

A

Eradicate bacteria
If left untreated, a scrotal abscess, testicular infarction, or infertility may occur

ADN005 Pediatrics (21 decks)

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