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Genitourinary #3
| Question | Answer |
|---|---|
| What are the 2 major differences between adult and pediatric renal systems? | Fluid is a larger fraction of pediatric total body weight. Renal system is immature and bladder unable to be controlled until age 2. |
| What is an urinary tract infection (UTI)? | An acquired infection of the urinary system caused by a bacteria, virus, or fungus. |
| What is the most significant risk factor for UTIs? | Any urinary tract abnormality that causes urinary stasis, obstruction, reflux, or dysfunctional voiding. |
| List the factors that contribute to UTIs. | Obstruction, stones, reflux, diabetes mellitus, urine characteristics, gender, age, sexual activity, antibiotic usage. |
| Why does an obstruction contribute to UTIs? | Incomplete emptying of urine creates a medium in which the bacteria can pool and grow. |
| How do stones contribute to UTIs? | Cause obstruction and can irritate mucosal surfaces that will allow invasion of bladder wall by bacteria. |
| How does reflux contribute to UTIs? | Bacteria refluxes from bladder (more bacteria and toxins) into the ureters and kidneys. |
| How does diabetes contribute to UTIs? | Increased glucose provides medium for bacteria growth & nerve damage leads to decreased or incomplete bladder emptying. |
| How do urine characteristics contribute to UTIs? | Alkalotic and concentrated urine promotes bacterial growth. |
| How does gender contribute to UTIs? | More common in males during first year of life, then more common in females d/t anatomy. |
| How does age contribute to UTIs? | Older adults have conditions that lead to obstructions (BPH/prolapse), incomplete bladder emptying (Parkinsons, stroke), poor perineal hygiene (fecal incontinence). Low estrogen increases susceptibility of vagina and urethra. |
| How does sexual activity contribute to UTIs? | Perineal and urethral irritation promotes bacterial migration into urinary tract. Spermicides alter vaginal pH which increases susceptibility. |
| How do antibiotics contribute to UTIs? | They alter the normal protective flora which can lead to bacterial overgrowth and colonization. |
| List common causes of UTIs. | Poor hygiene, bubble baths, or perineal trauma (ex. tampon use or sex) |
| What conditions predispose pts to UTIs? | Constipation, neurogenic bladder, congenital, and voiding dysfunction. |
| What are the types of UTIs? (Hint: there's 3) | Cystitis, urethritis, or pyelonephritis. |
| What is cystitis? | Inflammation of the bladder most commonly caused by E. coli. Immunocompromised pt may have fungal UTI. Trich is most common cause of viral infection. |
| What are the general s/s of UTIs? | Frequency, urgency, dysuria, cloudy/blood-tinged urine, foul smelling urine, incontinence, retention, suprapubic tenderness, fever, n/v, malaise, and flank pain. |
| What are the pediatric s/s of cystitis? | Nonspecific in young child & infants: fever, irritability, poor feedings/appetite. Children: abd or back pain, GI s/s, enuresis, fever, dysuria, frequency, and urgency |
| What are the s/s of cystitis in older adults? | Mental confusion (may be only sign!), falls, new or worsened incontinence, loss of appetite, fever, tachycardia, tachypnea, hypotension, nocturia, or dysuria. |
| List the diagnostic criteria for cystitis. | UA: increased leukocyte esterase and nitrate, 100,000 colonies/mL, or presence of more WBCs with RBCs. Urine culture. CBC with elevated WBCs. Elevated BUN/creatinine. VCUG to dx reflux. IVP to assess anatomy. |
| List therapeutic management for cystitis. | Eliminate current infection (3d course of sephra or bactrum; women > 65 y/o and men on 7-10d course), urinary analgesic (Pyridium), urinary antiseptic (Macro-bid), identify contributing factors, and prevent systemic infection. |
| What is urethritis? | Inflammation of urethra. |
| What are the causes of urethritis? | STDs (most common in men), postmenopausal tissue changes. |
| List the diagnostic criteria for urethritis. | Hx: STDs, painful/difficult urination, discharge, or lower abdominal discomfort. UA: pyuria without large amt of bacteria. Pelvic exam. |
| What is the treatment for urethritis? | ID and tx of STD or estrogen vaginal cream. |
| What is pyelonephritis? | Bacterial infection of kidney and renal pelvis -> inflammation -> scar tissue -> decreased tubular filtration, reabsorption, and secretion -> impaired renal function. |
| What are the s/s of pyelonephritis? | Exaggerated UTI s/s plus high fever & chills, flank/back/loin pain, and constovertebral angle tenderness |
| List the diagnostic criteria for pyelonephritis. | UA: positive leukocyte esterase and nitrite, WBC, and bacteria. Urine culture. Blood studies: CBC & blood culture. Radiologic studies: KUB. Urine antibody-coated bacteria analysis. |
| What is the tx for pyelonephritis? | Antibiotics, urinary antiseptic drugs, blood pressure control, nutrition therapy, and possibly surgery. |
| What is bladder exstrophy? | Urinary bladder outside of the abdominal wall at birth. |
| What is the priority management for bladder exstrophy? | Protection until surgical correction is available. |
| What is the nursing management for bladder exstrophy? | Pre-op: cover with sterile gauze with moist normal saline and nonadhering plastic wrap, supine or side-lying position in isolette, and prevent infection. Post-op: immobilize pelvis (cast/traction), wound care, pain management, and monitor renal function. |
| What is hypospadias? | Congenital anomaly where the urethral meatus is inferior to its normal position. Usually occurs only in males. |
| What is epispadias? | Congenital anomaly where the urethral meatus is superior to its normal position. Occurs in males and females. |
| What is the tx for hypospadias and epispadias? | Surgical correction, preferably before toilet training. Both contraindicate circumcision. |
| What is enuresis? | Intentional or involuntary passage of urine into bed or clothes in children who are beyond the age when voluntary bladder control should normally have been acquired. May occur in adults too. |
| List the diagnostic criteria for enuresis. | Must occur at least 2x/wk for at least 3 mo in a child at least 5 years old. |
| What is the treatment for enuresis? | Limit fluids after supper, void just before bed, behavioral conditioning, and meds: tricyclic antidepressant (Tofranil), antidiuretic (DDAVP), and anticholinergic (oxybutynin) |
| What is acute glomerulonephritis? | Group of kidney disorders characterized by an inflammatory injury to the glomerulus. Acute glomerulonephritis occurs suddenly, is self-limiting, and is caused by inflammation of the glomeruli (tubules of kidney). May lead to renal failure |
| What are the s/s of acute glomerulonephritis? | Gross hematuria, edema (facial, periorbital, extremities), hypertension/headache, and tea-colored urine. |
| List the diagnostic criteria for acute glomerulonephritis. | UA: hematuria & proteinuria. Hx of recent strep infection. Positive ASO titer. Low complement (C3). Elevated BUN and creatinine. Renal biopsy to determine obstruction of capillaries. |
| What is the tx for acute glomerulonephritis? | Symptomatic, dietary (FVE-restrict fluid and sodium; azotemia-restrict protein), antihypertensives, antibiotics, strict I&O, energy conservation, education, and v/s |
| What is hemolytic uremic syndrome? | Bacteria causes injury to endothelial lining of small glomerular arterioles, which causes swelling and occlusion with platelets and fibrin clots. Thought to be result of Shiga's toxin-producing E. coli. |
| What are the s/s of hemolytic uremic syndrome? | Initially gastroenteritis and potential upper resp. infection. Then decreased UOP, pallor, lethargy, anemia, and irritability. |
| List the diagnostic criteria for hemolytic uremic syndrome. | TRIAD: thrombocytopenia (low platelets), anemia, and ARF. Most common cause of ARF in pediatrics!! |
| What is the tx for hemolytic uremic syndrome? | Dialysis, FFP (fresh frozen plasma), transfusions, and dietary: high-calorie and high-carbohydrate with restricted fluids/sodium/potassium/phosphorus and possibly protein. |
| What is phimosis? | The inability to retract prepuce at an appropriate age (~3 yrs). |
| What is the tx for phimosis? | Mild cases: cleaning and gentle retraction. Severe cases: surgical correction enlarging the phimotic ring or circumcision. May also use betamethasone cream. |
| What is cryptorchidism? | Absent, undescended, or hidden testes. Occurs when one or more testes fails to descend through the inguingal canal into the scrotal sac. More common in premature infants. |
| What is the tx for cryptorchidism? | Most spontaneously descend during first year. Orchidopexy is tx of choice (suture teste in descended position). hCG tx available, but limited success. Education important! Increased risk for testicular cancer! |
| What is a hydrocele? | Painless swelling of scrotum caused by fluid accumulation. Often present with hernia. |
| What is the tx for a hydrocele? | Surgery after 1-2 yrs of age if progressively enlarging, non-reducible, present without hernia, or persistant. |
| What is torsion of the testicle? | Rotation of the testicle that decreases blood supply to the teste. Surgical emergency!! More common in teens and infants. |
| What are the s/s of torsion of the testicle? | Sudden onset of severe scrotal pain (usually absent in neonates), redness, and edema. |
| What is Wilm's tumor? | Tumor that originates in kidney. |
| What are the s/s of Wilm's tumor? | A firm, nontender, unilateral abdominal mass. May complain of fatigue and malaise. DO NOT PALPATE MASS -> release of cancer cells and catecholamines |
| List the diagnostic criteria for Wilm's tumor. | History & physical, abd ultrasound, MRI, CT scan, UA, CBC and electrolytes. |
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