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Genitourinary
Maternal Child
| Question | Answer |
|---|---|
| Patho UTI | Recurrent infection can cause incompetence of vesicourethral valve. Scarring and loss of renal tissue |
| S/S UTI <2 yrs | Non specific resembles GI disorider: poor feeding, n/v, jaundice, FTT, frequent urination, poor urine stream, tachypnea, resp distress, fever, seizures |
| R/O Sepsis | culture: blood urine CSF |
| S/S UTI > 2yrs | more classic poor appetite, vomitting, /FTT frequent urination, enuresis, abd pain or flank pain, excessive thirst, fatigue |
| S/S UTI Teen | similar to adult frequent painful urination heamturia. Lower Tract Fever chills flank pain |
| Parent Education r/t UTI | Personal hygiene ie wiping, avoid tight clothing, cotton panties, check for vaginitis or pinworms, avoid holding urine, avoid straining at stool, encourage adequate fluid intake. Finish all abx Acidify urine withh juices or animal protein |
| Vesicourethral reflux | retrograde flow of bladder urineinto ureters. Urine is swept up into ureters w/ each void then empties back into bladder. Residual urine remains in bladder until next void. Often outgrown as child grows and ureter angle becomes more sharp |
| Primary Reflux | results from congenital anomoly affecting the appropriate implantation of ureters @ vesicouretal junction |
| Secondary Reflux | results from an acquired condition UTI, neurogenic bladder |
| Mgt Vesicoureteral Reflux | Grades 1-3 mqay cure itself ; Low dose abx, frequent urine cultures. IV and V surgical reimplantation of ureters 2-3 days hosp post op abx VCUG @ discharge, 3 mos and 1 and 3 yrs post op |
| Nephrotic Syndrome | Glomeruli Injury Primary restricted to injury Secondary result of systemic illness (lupus, drug toxicity) Congenital autosomal recessive. Often preceded by viral resp inf |
| MCNS(Minimal Change Nephotic Syndrome) AKA Childhood Nephrosis | glomerular membrane becomes permeable to proteins. Protein lost in urine leads to dec serum albumin and dec collodial osmotic pressure fluid shifts to intestitial and body cavities |
| S/S Childhood Nephrosis | insidious onset, slow weight gain, puffiness face and eyes,esp am, abdominal and lower extremity edema, labial or scrotal swelling, diarrhea anorexia r/t intestinal edema, dec urine volume concentrated dark and frothy, pallor, nail changes, skin breakdwn |
| Dx evaluation of Childhood Nephrosis | massive proteinuria 2-4 m2, casts, microscopic to 0 hematuria, inc sp gravity, hypoalbuminemia, in cholesterol, hgb, hct normal ot elevated, inc platelets 800,000-6,000,000, dec NA+, Biopsy |
| Corticosteroids and childhood nephrosis | prednisone 2 mg/kg/day |
| IVP | intravenous pyelogram IV contrast and x rays at 5, 10 & 15 min after injection |
| VCUG | Voiding cystourogram contrast via urethral catheter x rays taken before during and after voiding |
| Catherization children | 5-8 french. Child's room is saffe place, do in tx room, 1st mroning sample is best, Do not dilute urine by over ingesting fluids |
| Goals of Care UTI | eliminate infection, detect and correct anatomic abnormality, prevent recurrence, preserve renal function |
| Mgt UTI | ABX PCN and cephalosporins, sulfanomides (Bactrim Septra) 14 days for pyelonephritis IV abx 48 hrs. |
| Nirofurantain | antiseptic (astringent) to inhibit bacteria for nuerogenic bladder or structural problem causing stasis |
| UA/C for UTI | cloudy, hazy, noticable strands of mucous, pus, u npleasant fishy odor. Pyuria >5-8 wbc/ml at least one bacterium in gram stain. Cultures repeated monthly X3 then 6 mos and 9 mos |
| Renal Development and Function | kidneys develop 1st weeks of embryonic life but do not mature until 12 mos. Glomerular filtration and absorption reach adult levels at 1-2 yrs Concentration/Dilution adult ability 3 mos |
| UTI Incidence | girls more than boys r/t shorter utethra young girls 2 cm vs adult 4 cm. Males with early UTI's suspect structural abnormality Peak age 2-6 yrs and again in sexually active teens |
| Contributing Factors UTI | E.Coli, urinary stasis, bowel pressure r/t constipation, vesicouretral reflux, altered urine chemisty, dec fluid intake, alkaline PH r/t fluid inatke |
Created by:
margaretptz
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