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Nsg 210 Peds Ch. 50

Genitourinary dysfx

The single most important host factor influencing the occurrence of UTI is urinary stasis
Clinical manifestations of UTI in neonate(birth to 1 month) poor feeding, V, incr resp(acidosis), frequent urination, screaming on urination, jaundice, seizures, dehydration
Clinical manifestations of UTI in infant excessive thirst, foul-smelling urine, pallor, fever, persistent diaper rash
Clinical manifestations of UTI in childhood growth failure, enuresis, incontinence, swlling of face, fatigue, blood in urine, abd/back pain, edema, htn, tetany
Infants and young child may show no s/s of UTI except fever, V, decr appetitie/activity, fatigue, but with infant what do you want to rule out? UTI, pneumonia and meningitis
what is normal newborn urine production amt? child? Inf: approx 1-2ml/kg/h child: 1ml/kg/h
Define UTI irritation of the lining of the bladder, urethra, ureters, and kidneys
an upper tract involves? lower? upper: renal parenchyma, pelvis, ureters and cause fever, chills, flank pain low: bladder and urethra causes no s/s
vesicoureteral reflux refers to what? More likely associated with recurring what infections? abnormal regtrograde flow of bladder urine into ureters. Kidney infections(pyelonephritis) rather than bladder infections
What is difference in complicated and uncomplicated UTI comp: stones, obstruction, catheters, DM, recurrent inf uncomp: occurs in otherwise normal urinary tract
4 types of UTIs recurrent persisten febrile: indicates pyelonephritis urosepsis: uremia(urine in blood), bacterial
If young child/inf come in with fever, what is standard with each assessment Urine sample from suprapubic aspiration of urine or sterile catheterization
Ways to avoid UTI hygiene: front to back wiping cotton panties check for pinworms/vaginitis avoid holding empty bladder avoid straining during defecation encourage fluid intake
What is a hydrocele? tx? fluid in scrotum tx: surgical repair
inguinal hernia? tx? protrusion of abd contents into scrotum tx: surgical
phimosis? tx? narrowing/stenosis of preputial opening of foreskin tx: retract skin/circumcision
hypospadias? tx? urethral opening located behind glans penis or anywhere along ventral surface of penile shaft tx: sugery
Chordee? tx? ventral curvature of penis from hypospadias tx: surgical release of fibrous band
epispadias? tx? meatal opening located on dorsal surface of penis tx: surgical
cryptorchidism? tx? testes fail to descend tx: surgical, GH for older child
exstrophy of bladder? tx? eversion of bladder thru ant bladder wall, severe defect
ambiguous genitalia? masculinized female incomplete male true hermaphrodite mixed
A urine dipstick ids presence of nitrites, WBCs, leukocyte esterase
What is preferred dx study to obtain urine? clean catch
IVP or Abd Ct is good for spotting what suspected obstruction and reflux
Antibiotics for UTI? pain relievers? bactrim(TMP-SMX), amoxicillin, cephalexin pyridium:numbs nerves, turns pee orange urised: turns pee blue
describe nephrotic syndrome massive proteinuria, hypoalbuminemia, hyperlipidemia, edema
hypovolemia can occur as the fluid moves out of the vascular stimulates what system renin-angiotensin system and secretion of ADH and aldosteroneq
Nephrotic syndrome is manifested with these s/s in a child wt gain, tight fitting clothes, decr urine output, pallor, fatigue, puffy face, ascites, swelling
most common type of nephrotic is? other two types? MCNS: Minimal change nephrotic syndrome congenitaland secondary
Nephrotic syndrome tx? Nsg intv? steroids to decr immune reaction(2mg BID of Prednisone) Cytoxan(immunosuppressant therapy) diuretics: to compensate abx Nsg: avoid incontinent episodes, hydrate(dilutes, flushes), follow up UA
Nephrotic syndrome diet low to mod protein Na restriction with lg edema no K restriction
Define Acute Glomerulonephritis type of kidney disease with inflammed glomeruli and impair kidney's ability to filter urine.
Acute glomerulonephritis usually stems from strep infection, but can also be pneumoccocal or viral. poststreptococcal: one wk after inf as a reaction from antibody from having strep
s/s of acute glomerulonephritis oliguria, edema(periorbital and spreads to abd and extremities), htn, hematuria(tea colored), proteinuria
severe glomerulonephritis can raise what electrolyte potassium
In children what usually causes acute kidney failure? dehydration
Most frequent cause of acute kidney failure from 6mos-5y, in the summer? hemolytic-uremic syndrome
what is causative agent? s/s? ecoli from contaminated food or water in swimming s/s: abd pain, bloody/watery D, V, oliguria/anuria, petechiae, HTN, seizures, coma
In hemolytic-uremic syndrome, the arterioles are clogged how? toxins destroy RBCs, so low filtration to cause kidney failure. Also spleen destroys RBCs so anemia is common
In dx of hemolytic-uremic syndrome, what is the triad to be seen? What lab levels will be elevated? anemia, thrombocytopenia, renal failure BUN & creatinine with a low H&H
Best tx for hemolytic-uremic syndrome? tx: hemodialysis/peritoneal
Describe ARF(acute renal failure), CRF(chronic), ESRD(end stage renal disease) acute: kidney suddenly stops filtering waste from blood chronic: dev slowly w/ few s/s esrd: failure
What is principle feature of ARF? what is azotemia? Most transcient cause? oliguria, azotemia, metabolic acidosis, electrolyte disturbance azo: waste build up of nitrogenous waste in blood cause: severe dehydration
What is best test to determine chronic renal failure? creatinine level test adn is often first sign of kidney failure occurring even before pt feels sick.
what is most immediate threat of ARF in child? hyperkalemia, restrict K from food or give Kaexylate, peritoneal dialysis/hemo
With chronic renal failure, diet is best way to reduce quantity of materials that need to be excreted, what is goal? sufficient in calories/protein while not over taxing kidney excretory demans, minimize metabolic bone disease, minimize electrolyte/fluid disturbs
When evidence of edema and HTN waht is restricted from diet as well h2o and na and phosphorus, not K and metabolic acidosis is alleviated with Na bicarb
what is preferred dialysis for children? peritoneal dialysis
What are concerns in transplantation as far as complication? hurdle? avoid what meds? encephalopathy is big issue and if adult kidney used, then size can be hurdle in newborn, no aluminum containing meds
what happens in proximal tubule? loop of henle? distal? collecting ducts? prox: reabsorb Na majority Loop: concentrate urine, water reabsorption(desc), Na reabsorbed(ascend) distal: secrete K,urea,H,ammonia coll: reabsorb h2o(adh req.), final concentration
Created by: palmerag