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peds urinary
| Question | Answer |
|---|---|
| when does the infant's urinary system function as adult's | by 6 - 12 months old |
| what do premies decrease reabsorption of | glucose, sodium, bicarb, phosphate |
| when is continence achieved | 4 - 5 yo |
| can urinary function be regained after ARF | yes |
| what does a u/a test for | spec. gravity, ph, protein, glucose, keytones, WBCs, bacteria, casts |
| what does incresed WBCs mean | infection or contamination during collection |
| what kind of test is u/a | c&s |
| what to look for in CBC | bun, creatinine, osmolarity |
| what are physical s/s of urinary defect | cloudy, foul smelling urine, particles |
| what kind of radiologic tests done | ct, vcug, dmsa, renal us, ivp, kub |
| what does vcug test for | reflux of urine in bladder |
| what does dmsa test for | blood flow, scarring |
| what does renal us test for | position & size of kidneys, locates masses, stones & obstructions |
| what does ct test for | tumors |
| what does ivp test for | bladder emptying, masses |
| what does kub test for | stones |
| are urodynamic test invasive | yes |
| when should bladder control be expected | 4 - 6 yo |
| what kind of milestone is bladder control | developmental |
| what is enuresis | repeated involuntary voiding |
| what is notcutia | enuresis at night |
| what is diuria | enuresis in the day |
| what is primary enuresis | child has no dry nightsd/t a delay in maturation, small bladder |
| what is intermittent enuresis | child has an occasional dry night d/t |
| what is secondary enuresis | child is dry for 6 mo - 1 yr, then reverts back to bedwetting |
| what causes enuresis | child is hard to rouse from sleep, not aware of bladder signal, unstable bladder contractions, DM or renal insufficiency, spinal bifida, constipation |
| what labs indicate enuresis | u/a positive for e. coli d/t proximity to anus, ultrasound, vcug to view reflux |
| what is the Tx for enuresis | fluid restriction, bladder training, enuresis alarm, meds |
| what meds can be given for enuresis | imiparamine (tricyclic antidepressant), desmopressin (nose spray), oxybutynin chloride (anticholinergic for diuria) |
| what are some nursing Dx for enuresis | situational low self esteem, impaired social interaction, compromised family coping, risk for impaired skin integrity |
| what are some causes of UTIs | organisms (e. coli, staph, enterococcus), obstructions, voiding dysfunctions, anatomical differences, reflux, urinary retention, individual susceptibility, excessive masturbation, sexual abuse |
| what are s/s of UTI of the newborn | unexplained fever, FTT, poor feeding, vomiting & diarhea, strong smelling urine, irritability |
| when should a child have a u/a | any child less than 2 should have a ua with fever of unknown origin |
| what can UTI progress to | polynephritis |
| what tests are done for UTI | u/a for bacteria, c&s, dipstick leukocyte esterase for WBC, nitrate dipstick for bacteria |
| how is urine collected for a u/a | clean catch, sterile cath or supra pubic aspiration |
| what radiologic studies are done for UTIs | renal us & vcug, renal cortical scintigraphy |
| how are UTIs treated | abx for 3-5 days |
| what kind of abx are given for UTIs | sulfamides (Bactrim), nitrofurantoins (Macrodantin) & cephlosporins (rocephin) |
| what should you teach parents about UTI meds | drink lots of water, teach how to administer store |
| what are s/s of children with pyelonephritis | UTI s/s plus high fever & chills, back pain, CVA tenderness, n & v, looks sick |
| what are s/s of a child with a UTI | abd pain, frequent, urgent & painful voiding, fever |
| how do you prevent a UTI | wipe front to back & clean foreskin, don't hold urine, drink fluids to flush bladder, loose cotton underwear, no bubble baths, void b4 & after sex |
| how do you manage a UTI | give all meds, take child to dr for follow up, call dr if s/s worsen |
| what is Tx for pyelonephritis for infants | iv abx & hydration (in hospital), surgery to repair ureters |
| what is Tx for children with pyelonephritis | im abx (outpatient), then po at home, surgery |
| how do you assess for a UTI | vs, i&o, abd palpate & percussion, u/a, c&s, spec gravity |
| what is the most common type of nephrotic syndrome | primary |
| what is primary nephrotic syndrome caused by caused by | a disorder of the glomerulus |
| how can a child acquire secondary nephrotic syndrome | secondary to a systemic disease (lupus, cancer, heavy metal poisoning) |
| what are s/s of nephrotic syndrome | abrupt preorbital or lower extremity edema, wt. gain, HTN, anorexia, hemauria (coca-cola colored urine), decreased output, malaise, frothy urine, respiratory distress, abd pain, malnourished, pale & skinny, prominent veins, brittle hair |
| what labs confirm nephrotic syndrome | *proteinurea of 50 mg/kg/day, serum albumin less than 20, increased BUN or creatinine |
| when does MCNS occur | 2-6 y.o. boys |
| is BP normal or abnormal in child with MCNS | normal |
| what are many children with MCNS misdiagnosed with | allergies d/t periorbital edema & resp problems |
| what labs Dx MCNS | 3-4+ proteinuria, dark & frothy urine, microscopic hematuria, elevated serum cholesterol, triglycerides & h/h, decresed serum albumin |
| what is done for a child not responding to Tx for MCNS | biopsy |
| what is Tx for nephrotic syndrome | 5-7 days of prednisone, iv fluids with albumin, alkylating agents (Cytoxin or Leukeran), oral diuretics, ACE inhibitor, broad spectrum Abx, no live immunizations for 6 mos, normal diet but no added salt if on corticosteroids |
| what are causes of poly cystic kidney disease | genetic disorder, liver abnormalities, dilation of collecting ducts, enlarged kidneys of newborns |
| what are s/s of pckd | r sided HTN, hematuria, frequent urination, poor growth, UTIs, proteinuria, polyurea & polydypsia, uremia |
| what tests detect pckd | renal us, renal biopsy, liver funct. test (normal at first, then abnormal) |
| what is Tx for pckd | teach diet & med, enteral nutrition, peritoneal dyalisis, transfusion |
| what is acute glomerulonephritis | inflammation of the glomeruli |
| what is acute glomerulonephritis caused by | group a beta strep, pneumococcus & coxsackie virus |
| what age group is more susceptible to acute glomerulonephritis | 5-8 y.o. |
| what are s/s of acute glmerulonephritis | lethargy (1st sign), microscopic hematuria, tea colored urine, mild periorbital edma, HTN, feverish, abd pain, headache, CVA tenderness |
| what tests Dx acute glomerulonephritis | BUN & creatinine, elevated K & bicarb, ESR, serum lipids increased & ASO titer, anti DNAse B titer, decreased serum C3, u/a |
| what to look for in u/a to Dx acute glomerulonephritis | decreased Ph, hematuria, proteinuria, tea colored, WBC |
| what is Tx for acute glomerulonephritis | Tx s/s for HTN- antiHTNs (Apresoline), diuretics (Lasix) & diet -fluid & sodium restrictions |
| what are some congenital abnormalities of the GU tract | hypospadius/epispadius & cryptochordism |
| how is hypospadius/epispadius Dx | prenatal US or examination at birth |
| what is Tx for hypospadius/epispadius | surgical repair, pain mngmnt (muscle relaxants for bladder spasms), restrict play & strict I&O |
| what meds are used to Tx hypo/epispadius | pain- tylenol, Abx- til stent falls out, anticholinergis- ditropan, levbid |
| what is cryptochodism | undescended testicle |
| what does cryptochodism result in | testosterone deficiency |
| what should be done for a child with ESRD | renal transplant |
| what needs to be done before a renal transplant | dialysis |
| where do donors for renal transplant come from | relatives or cadavers |
| what is a requirement for renal transplant | must be ABO compatible |
| which has a higher rate of survival, a donor from a relative or cadaver | relative |
| wht improves the survival of a graft | human leukocyte antigen |
| when should children waiting for a renal transplant get dialysis | severe FVO, CHF secondary to FVO, pulmonary edema, severe HTN, metabilic acidosis or hyperkalemia not ersponsive to meds & BUN more than 120 |
| Whats the most common complication of renal transplants | rejection |
| what msut patient do if they reject the new kidney | take antirejection drugs for the rest of their life |
| what antirejection drugs can be given | Neoral, azathioprine, prograg, mycophenolate mofetil, prednisone |
| what are some complications of renal transplants | opportunistic infections, lymphomas, skin cancer, HTN, non-compliance (teenagers, unstable family, low self esteem) |
| how to you manage care of a renal transplant pt. | teach pre & post op procedures (TCDB, IS), meds, follow up appts., health promotion(stay out of bad weather, crowds), s/s acute rejection & infection, how to contact MD |
Created by:
jclrn2010
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