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Peds GU

Genitourinary dysfunction

UTI definition Bacterial infxn involving UT.
UTI risk factors Urinary stasis, UT anomalies, reflux within UT system, constipation, onset of toilet training, female, synthetic tight underwear, wet bathing suits, sexual activity
UTI s/sx (infants and < 2 y.o.) Irritability/fussiness, crying upon urination, poor feeding, N&V, diarrhea, abdm distension, jaundice. Newborns (fever, hypothermia, sepsis)
UTI s/sx (general) Urinary frequency c. small voiding, urgency, nocturia. Dysuria, bladder cramping, spasms. Discomfort/pain in back or abdm. Urinary incontinence in toilet-trained kid. Fever, diaper rash, perineal redness/itching
UTI testing UA, C&S: sterile cath or suprapubic asprtn most accurate method of obtaining urine for kids < 2 y.o. Clean-catch if kid can cooperate
To prevent falsely low bacteria count, avoid kid doing what? Avoid drinking large amount of PO fluids prior to obtaining urine specimen
UA findings + bacteria/protein, cloudy, foul-smelling, bright red or tea-colored c. pH > 7. Elevated RBC/WBC
Cystoscopy, voiding cystoureterography, IVP, urodynamics tests indicated for ______ and conducted ____ UTI Assessment of anatomic/physical defect. Conducted after UTI resovled
RN considerations for diagnostic procedures: Sedate infants/young kids if needed. Assist older kid to be quiet during exam. Maintain NPO after midnight in prep for cystoscopy/IVP. IVP needs bowel prep too. Cath PRN
UTI RN care: Encourage frequent and complete voiding. Encourage fluids. Monitor urine output. Administer tylenol for pain. Encourage sitz baths PRN.
T or F: cotton underwear not recommended to prevent UTI False. Recommended
T or F: bubbles can increase risk of UTI True
UTI complications; Chronic UTI, renal damage, urosepsis
Peak incidence of UTI not caused by structural abnormalities: 2-6 y.o.
Children c. suspected pyleonephritis and fever given ____ for how long? IV antibiotics, minimum 48h. Blood and urine cultures on admit and after therapy. Urine cult monthly for 3 mo, then q3mo for next 6 mo.
Acute glomerulonephritis (AGN) definition Follows infectious process. Common; pneumococcal, streptococcal, viral. Immune complexes develop an dtrapped in glomerular capillary loop.
Findings associated c. AGN Oliguria, edema, HTN, circulatory congestion, hematuria, proteinuria
Subjective findings c. AGN Recent URI or strep infxn. Lack of specific reports (older kids; abdm discomfort, HA, painful urination, anorexia/nausea)
Glomerulonephritis primarily affects children at what age? School-age (6-7 y.o.). Uncommon in kids < 2
AGN s/sx Decreased GFR, decreased urine output, anorexia, pallor, vague discomfort, dyspnea, orthopnea, distensed neck veins, moist crackles on auscult, periorbital edema, face edema (worse in AM), mild-severe HTN, irritability, lethargy
Lab tests for AGN Throat culture for strep infxn (usu - by time of Dx). UA: proteinuria, smoky/tea-colored urine, hematuria, cell debris, elevated specific gravity. Elevated BUN/Cr. ASO titer +. Decreased C3 serum, increases c. recovery
CXR for AGN indicated for IDing pulmonary complications, pleural effusions, cardiac enlargement
Nursing care for AGN VS, daily wt, I&O.
Tx of AGN Diet = no added Na, occasional fluid restriction. Antibiotics only for pt. c. persistent infxn
T or F if pt. has normal BP and urine output, can be Tx at home for AGN True
AGN complications Acute or chronic renal failure. Hypertensive encephalopathy, acute cardiac decompensation.
Nephrotic syndrome definition Alteration in glomerular membrane allow proteins pass into urine. Massive proteinuria, hypoalbuminemia, hyperlipedemia, edema
Peak incidence of min. change nephrotic syndrome 2-7 y.o.
Nephrotic syndrome s/sx Wt. gain over short period (days-wks), poor appetite, N&V, diarrhea, decreased activity lvl, irritability, periorb/dependt edema (worse in AM), ascites, dark frothy urine, oliguria, norm or slightly elevated BP, extreme pallor, skin brkdwn (severe edema)
Lab tests for nephrotic syndrome UA/24hr collection: proteinuria (> 3-4), hyaline casts, increased specific gravity, color change
T or F: will see elevated Hgb, Hct, platelets in nephrotic syndrome T
Kidney biopsy indicated if ________ Only if nephrotic syndrome unrespsonsive to steroid therapy
Primary goal for nephrotic syndrome Reduce protein excretion, maintain protein-free urine
Nephrotic syndrome care Provide rest, I&O, urine, daily wt., edema, adbm girth, skin Ax, quiet activity during edema phase, unrestricted play during remission
Nephrotic syndrome diet Remission: regular diet. During therapy (steroids): low Na
T or F: good prognosis for min. change nephrotic syndrome, esp. if responsive to steroid therapy T. Tends be self-limiting disease
Hemodialysis preferred for __ Children c. acute conditions such as life-threatening hyperkalemia, for ppl. living close to dialysis center
3 types of hemodialysis access Grafts, fistulas, external access devices
T or F hemodialysis be performed at home T
_____ is preferred type of dialysis for independent children/families who live far away from dialysis center, want fewer diet restrictions, school-age to teens Peritoneal dialysis
Complications of PD Tunneled infxns (d/t cath), peritoneal leaks, ventral hernias
Complications of HD Anemia, peripheral neuropathies, vascular access infxn
Preferred method for ARF Temporary HD, generally for trauma and viral illness
Preferred method for CRF Permanent dialysis (HD or PD)
Ultimate Tx for renal failure Transplantation. Can leave inside while placing new kidneys in. Lasts average 20 yrs.
Created by: choel