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Peds GU
Genitourinary dysfunction
| Question | Answer |
|---|---|
| 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
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