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Nsg 210 Peds Ch. 50
Genitourinary dysfx
| Question | Answer |
|---|---|
| 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
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