Week 3 Chapter 43 Flashcards
Blood flow through the kidneys
GFR
Expected urine output in 0.5ml/kg/hr
Kidney is ____________ relation to the stomach
Large
Prone to injury
Urethra is shorter which means?
Increased UTI- Bacteria entry into the bladder
GFR is______________ in infants which means?
Slower; Dehydration risk
What is the bladder capacity in newborn?
30mL
Adult size by 1 year- 270mL
Immature at birth but mature in adolescence
Reproductive Organs
Past Medical history for GU Disorders
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
S/S of GU Disorders
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
S/S of GU Disorders
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
Common Lab and Diagnostic Testings
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
Common Medications for GU Disorders
Antibiotics
Anticholinergics
Desmopressin
Diuretics
Corticosteroids
ACE Inhibitors and other Anti HTNs
Imipramine
Immunosuppressants
Albumin IV
Common Medical Treatments for GU Disorders
Urinary Diversion
Foley Catheter
Ureteral Stent
Nephrostomy Tube
Suprapubic Tube
Vesicostomy
Appendicovesicotomy
Bladder Augmentation
Dialysis
important to clean urine bag and pat dry
True
If collecting urine culture, be sure to use betadine or cleaning application per policy and apply bag, check bag frequently for urine.
Sterile Urinary Catheterization
Same as adults but size varies
Discuss procedure with parents
6F for ..
Birth to 2 years
6-8 Foley for
2 to 5 Years
8-10 Foley for..
5 to 10 years
10-12 Foley for…
10- 16 years
Urine specimens may be collected using a variety of different methods in infants and children
True
Urine Bag
Sterile Urinary Catheterization
Suprapubic Aspiration
When performing or examining catheterization allow children to sit with their parent to decrease anxiety
True
Use familiar terms such as pee pee or tinkle or potty to explain the child what is needed and to gain cooperation
Structural Disorders
Hypospadias/ epispadias
Obstructive Uropathy
Hydronephrosis
Vesicoureteral Reflux
Urethral Defect in which the opening is on the ventral surface of the penis rather than the end of the penis .
Hypospadias
Urethral defect in which the opening is on the dorsal surface of the penis.
Epispadias
What happens if hypospadias or epispadias is left untreated?
Boy may not be able to urinary stream from standing position
May also result in erectile dysfunction or interfere with depositing sperm during intercourse
Repairs for hypo and epispadias occurs at
12 -18 months
Urinary output is very closely monitored due to a temporary stent or catheter placement.
True
No urinary output=
PRIORITY
Indicates urethra is blocked and must be reported to HCP; circumcision is delayed
Any obstruction along the ureter between the kidney, pelvis, and bladder
Obstructive Uropathy
Common Sites for Obstructive Uropathy
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
Complications of Obstructive Uropathy
Recurrent UTI, renal insufficiency, damage to kidney resulting in kidney failure
Requires surgical intervention
_______________ is withheld from IVF until adequate UOP is established to avoid hyperkalemia should the kidneys fail to function properly
Potassium
Renal Pelvis and calyces are dilated
May occur as congenital defect, because of obstructive uropathy or VUR
Hydronephrosis
Complications include renal insufficiency, HTN, and renal failure
Urine from bladder flows back up to the ureters caused by faulty valve within the bladder
Vesicoureteral Reflux
Occurs during bladder contraction with voiding
If reflex occurs when the urine is infected, the kidney exposed to bacteria which may result in in?
Pyelonephritis
Kidney may appear large on abdominal x ray due to urine back up
True
Vesicoureteral Reflux can lead to
renal scarring, HTN, renal insufficiency or failure
Manage with antibiotic prophylaxis, hygiene
Grade III, IV, V warrant what for Vesi Reflux?
Surgical Intervention
Acquired and Functional Disorders
UTI
Enuresis
Nephrotic Syndrome
Acute Glomerulonephritis
Hemolytic Uremic Syndrome
Renal Failure ( Acute and Chronic)
Infection of the urinary tract and most commonly affecting the bladder
Short Urethra
UTI
Urethra close to vagina and anus
Sexually Active female at higher risk
UTI in Infants presents
Fever, irritability, vomiting, failure to thrive, or jaundice
UTI in Children presents as
Fever, vomiting, dysuria, frequency, hesitancy, urgency, and pain
UTI caused by
E. COLI
Treated with Antibiotics
Prevention is most important goal for recurrent UTIs
Preventing UTIs in Females
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
Autoimmune disorder where body attacks its own kidneys
Nephrotic Syndrome
Triggered by Stress, sickness, smoking, and sun exposure
Occurs because of increased glomerular basement membrane permeability, which allows abnormally high protein loss in the urine
True
Nephrotic Syndrome
Congenital is inherited, rare, Finnish descent, kidney transplant
True
Secondary Nephrotic Syndrome includes
SLE
Henoch Schonleiin purpura, or diabetes
Idiopathic Nephrotic Syndrome includes
Most common onset by age of 6 years
Complications include Renal Failure and HTN crisis
Report key signs of
Headache, mental status changes, N/V, oliguria, or low urine output, new, sudden, rapid weight gain
Tx of of Nephrotic Syndrome include
Corticosteroids, IV albumin, diuretics, Immunosuppressive therapy
Glomerulonephritis
Inflammation and scarring of the kidney , specifically the glomeruli
Streptococcal infection like strep throat can travel down to the
Kidneys
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
Acute Glomerulonephritis
Symptoms include Periorbital Edema, loss of appetite, tea colored urine, recent strep infection, fever, UA, proteinuria
S/S of Glomerulonephritis
Complications include Uremia and renal failure
Treatment of glomerulonephritis is aimed at maintaining what
Fluid volume and managing HTN
Avoid use of NSAIDs in children with questionable renal function because it may further decrease GFR
Defined by 3 features
Hemolytic Anemia
Thrombocytopenia
Acute Renal Failure
Hemolytic Uremic Syndrome
Other causes include idiopathic, inherited, drug related, malignancies, transplantation and malignant HTN
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
Therapeutic Management of HUS
Maintaining fluid balance, correcting HTN, acidosis, and electrolyte abnormalities, replenishing RBCs, providing dialysis
Proper handwashing is necessary
Restoring Fluid and Electrolyte balance include
Low sodium, nutrient rich diet, vitamin D and calcium, MVI, erythropoietin injections, growth hormone injections
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
Restoring Fluid and Electrolyte Imbalance
Condition which the kidneys can’t concentrate urine, conserve electrolytes, or excrete waste products
Renal Failure
May be acute or chronic, When acute renal failure continues to progress, it becomes chronic, also known as ESRD
Renal Failure
Treatment Modalities for ESRD
Dialysis
- Peritoneal Dialysis- Requires placement of PD catheter, can be performed at home
- Hemodialysis- Requires placement of AV fistula
Kidney Transplantation
4-8 hours a day
Peritoneal Dialysis
Hemodialysis is what time allotted
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
Nursing Goals for the child with ESRD
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
Labial Adhesions
Vulvovaginitis
Pelvic Inflammatory Disease
Sexually Transmitted Disease Infections
Menstrual Disorders
- Primary and secondary amenorrhea
- Dysmenorrhea
- Menorrhagia and metrorrhagia
Female Reproductive Organ Disorders
UTI may result in urinary stasis behind the
Labia
If left untreated the vaginal opening may become inaccessible making it difficult to have sexual intercourse.
Younger girls up to age of 5 have higher risk of adhesions
True
Tx includes estrogen cream 1-2 times a day and petroleum jelly daily x 1 month to prevent reoccurrence
Inflammation of the vulva and the vagina
Vulvovaginitis
Causes include bacterial or yeast overgrowth
Chemical factors such as bubble bath, soaps, and perfumes
Poor hygiene
Vulvovaginitis
Associated Factors of Vulvovaginitis includes
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
Phimosis and paraphimosis
Cryptorchidism
Hydrocele and varicocele
Testicular torsion
Epididymitis
STIs
Male Reproductive Disorders
Not priority descend spontaneously by 6 months after birth > 1 year old
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
Irritation, balanitis or UTI may occur if urine is retained within the foreskin after voiding
Phimosis
Topical steroid cream BID x1 month
Medical Emergency and can quickly result in necrosis of the tip of the penis if left untreated
Paraphimosis
Requires reduction of the foreskin or small dorsal incision to release the foreskin
Circumcision may be used to treat phimosis and paraphimosis.
Whether to circumcise or not is a personal decision often based on religious beliefs or social norms or cultural
True
Benefits of Circumcision
Decreased Incidence
- UTI
- STI
- HIV infection
- Penile Cancer
- Cervical Cancer in female partners
Complications of Circumcision
Alterations in urinary meatus
Unintentional removal of the excessive amounts of the foreskin
Damage to the glans penis
Fluid in the scrotal sac
Hydrocele
usually benign and self limiting and resolves spontaneously by 1 year of age
Venous varicosity along the spermatic cord
Varicocele
Often noted as swelling of the scrotal sac.
Complications include low sperm count or reduced sperm motility and both require watchful waiting
Testicle is abnormally attached to the scrotum and twisted
Testicular Torsion
Requires immediate surgery because of the ischemia can result if the torsion is left untreated leading to infertility
Testicular Torsion
Ensure Surgical Consent on the chart
May occur at any age but most common in boys aged 12-18 years
Inflammation of the epididymis
Epididymitis
Caused by infection with bacteria
Most common cause of pain the scrotum
Rarely occurs before puberty
Therapeutic Management of Epididymitis
Eradicate bacteria
If left untreated, a scrotal abscess, testicular infarction, or infertility may occur
