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Mat-Child4
Maternal Child Test 4
| Question | Answer |
|---|---|
| When do the kidneys begin to develop? | 1st week of embryonic life |
| When does kidney function mature? | The end of the 1st year of life |
| When does the Glomerular filtration and absorption rates reach adult values? | 1-2 years of age |
| When does concentration/dilution of urine reach an adults ability? | 3 months of age |
| Define a Urinary Tract Infection (UTI)? | AN infection that involves the urethra, bladder, and/or urters, renal pelvis, calyces, renal parenchyma |
| What are the clinical manifestations of a UTI in a child under 2 years old? | Poor feeding, vomiting/diarrhea, jaundice, failure to thrive, frequent urination, poor urine stream, tachypnea, respiratory distress, seizures, fever, persistent diaper rash |
| What are the clinical manifestations of a UTI in a child over 2 years old? | poor appetite, vomiting, failure to thrive, frequent urination, enuresis/incontinence in a toilet trained child, abdominal/back (flank) pain, hematuria, seizure, excessive thirst, fatigue |
| What are the clinical manifestations of a UTI in an adilescent? | frequent and painful urination, hematuria, Fever, Chills, Flank Pain |
| What diagnostic evaluations are performed to diagnosis a UTI? | Physical exam, health history, Urinalysis & Culture, Radiographic studies, Blood culture |
| What are the characteristics of urine in a patient with a UTI? | Cloudy, hazy color, noticeable strands of mucous & pus, unpleasant, fishy smell |
| What are the nursing considerations for a child with a UTI? | Teach parents signs and symptoms of UTI, teaqch proper cleaning technique, obtain accurate history, use appopriate collection techniques, encourage fluids |
| How can a UTI be prevented? | Perineal hygiene, avoid tight clothing or diapers, wear cotten panties, check for vaginitis or pin worms, avoid holding urine, empty bladder at every void, avoid straining at stool, encourage generous fluid intake, acidfy urine with juices. |
| What is Vesicoureteral Reflux? | Retrograde flow of bladder urine into the ureters |
| What is the pathophysiology of Vesicoureteral Reflux? | Urine is swept up in the ureters with each void and then empties into bladder after voiding. Residual urine remains in bladder until next void. |
| What is the cause of Primary Vesicoureteral reflux (congenital)? | Results from congenital anomaly affecting the appropriate implantation of urters at vesicoureteral junction. |
| What is the cause of Secondary Vesicoureteral reflux (infection)? | Results from an acquired condition and effects the vesicoureteral junction. |
| What is the therapeutic management for Vesicoureteral Reflux? | conservative non-operative therapy (effective in most cases), continuous low-dose antibacterial therapy, frequent urine cultures, surgical intervention |
| What are the nursing considerations of Vesicoureteral reflux? | Encourage compliance, hygiene, frequent voiding schedule |
| What is Nephrotic Syndrome? | A group of symptoms that defines glomeruli injury in children. |
| What are the three classifications of Nephrotic Syndrome? | Primary - restricted to glomeruli injury, Secondary - result of systemic illness, Congenital - autosomal recessive |
| What is the cause of nephrotic syndrome? | cause unknown, but usually preceded by 4-8 days by viral respiratory infection |
| What is the pathophysiology of Nephrotic sysndrome? | glomerular membrane becomes permeable to proteins, proteins lost in urine and serum albumin level decreases, decreased colloidal osmotic pressure in capillaries, fluid shift to interstitial spaces and body cavities |
| What are the clinical manifestations of nephrotic syndrome? | insidious onset, weight gain, puffiness in face, esp. eyes, abdominal and lower extremity edema, labial or scrotal swelling, diarrhea/anorexia, decreased urine volume, urine dark & frothy, pallor, nail changes, susceptible to skin breakdown & infection |
| What diagnostic test are used to diagnosis nephrotic syndrome? | History/Clinical manifestations, urinalysis, blood analysis, renal biopsy |
| What will the urinalysis findings be in a patient with nephrotic syndrome? | Massive proteinuria, casts, microscopic to no hematuria, increased specific gravity |
| What will the blood analysis findings be in a patient with nephrotic syndrome? | Hypoalbuminemia, hypercholesterolemia, Hgb/Hct normal to elevated, increased platelet count, decreased Na+ |
| What does a renal biopsy show in a patient with nephrotic syndrome? | Tells about glomerular status and type of nephrotic syndrome. |
| What is the therapeutic management for nephrotic syndrome? | Corticosteroid therapy/Prednisone drug of choice, bedrest during edematous phase, appropriate antibiotics for infections, Na+ restrictions during massive edema periods, immunosuppresant therapy, diuretics |
| What is Hemolytic-Uremic syndrome? | Characterized by a triad of manifestations: Acute renal failure, hemolytic anemia, thrombocytopenia in children ages 6 months - 3 years. |
| What is the clinical manifestations of hemolytic-uremic syndrome? | Prodromal illness (gasroenteritis or URI) 1-15 days after the illenss, the patient will experience for 2-3 days: abdominal pain, bloddy diarrhea, vomiting, bruising, petechiae, jaundice, bloddy diarrhea, olguria/anuria, generalized edema, hypertension |
| What is the diagnostic evaluation of hemolytic-uremic syndrome? | Based on presence of TRIAD or: renal failure, anemia, thrombocytopenia, Urinalysis: proteinuria, hematuria, urinary cast; Hematology: Increased BUN, Creatine, reticulocyte, decreased Hgb & Hct |
| What is the therapeutic management of hemolytic-uremic syndrome? | Fluid replacement, treat hypertension, correct acidosis & electrolyte imbalances, hemodialysis/peritoneal dialysis, blood transfusions, enteral/parenteral nutrition. |
| What are the long-term complications of hemolytic-uremic syndrome? | Chronic renal failure & hypertension |
| What is nocturnal enuresis? | Urinary incontinence during the night. |
| What is the diagnostic criteria for nocturnal enuresis? | voiding must occur at least twice a week for at least 3 months or else cause significant stress or impairment, child must have reached age where continence is expected (at least 5 years) |
| What is the therapuetic management of nocturnal enuresis? | Behavior modification, Pharmacological, Bladder retention training (most effective), withholding of fluids after dinner, sleep interruption. |
| What behavior modification technique is used to control nocturnal enuresis? | Alarm to wake up child when urine touches underclothing ort pajamas, conditions child to sensation of bladder filling |
| What drugs are used for nocturnal enuresis? | Tofranil (antidepressant) or Ditropan (anticholinergic): inhibits urination through decrease in bladder muscle contractions, lightens sleep but does not cause wakefulness, Desmopressin (antidiuretic hormone): decreases urine output at night |
| What is cryptorchidism? | Failure of one or both testes to descend normally through the inguinal canal into scrotom |
| What are the three types of cryptorchidism? | Ture undescended, Retractile, & Absence |
| What is a true undescended cryptorchidism? | Abdominal: located proximal to the internal inguinal ring, canalicular: located between the internal and external inguinal rings, Ectopic: located outside the normal pathways of descent between abdominal cavity & the scrotum |
| What is a retractile cryptorchidism? | normally descended testes that are pulled back up into the inguinal canal as a result of a hyperactive cremasteric reflex |
| What is an absence cryptorchidism? | True absence of testes |
| What are the clinical manifestations of cryptorchidism? | One side of scrotum may appear smaller & incompletely developed, no discomfort |
| What is the therapuetic management for retractile cryptorchidism? | Testicle manipulated into scrotum and eventually assume satisfactory position in the scrotal sac. |
| What is the therapuetic management for true undescended cryptotchidism? | 75% will descend on their own by age 1; surgical repair (orchiopexy) between 1st & 2nd year |
| Why is surgery necessary to repair a cryptorchidism? | Prevent prolonged testicular exposure to increased body heat, decreased incidence of tumor formation, avoid trauma & torsion, close processus vaginalis, and cosmetic & psychological |
| What are the therapeutic modalities for children? | Therapeutic Play, Art Therapy, Children's Games, Bibliotherapy, Storytelling, Autogenic Storytelling, and Enacting plays |
| What is Therapeutic play? | Play without specific direction, allows expression of feelings, fun & effective tool, use age appropriate imaginative toys |
| What is Art Therapy? | uses drawing to describe an event or express feelings, can provide information about behavior & development maturity |
| What is children's games therapy? | Motor control, increased concentration, frustration tolerance |
| What is bibliotherapy? | Use of literature to identify & express feelings, provides a safe structure to explore feelings, can identify with the characters, gain insight into own life |
| What is storytelling therapy? | Nurse creates a story to teach new coping skills |
| What is Autogenic storytelling? | Child participates in creating the story |
| What is enacting plays therapy? | Provides opportunity to practice new behavior |
| What are pervasive developmental disorders? | Characterized by severe impairment across multiple domains of development |
| What are the pervasive developmental disorders? | Autistic Disorders, Rhett's Disorder, and Asperger's Disorder |
| What is classic autism? | Onset before age 3, moderate mental retardation in 75% of cases and impaired communication & social interaction |
| What is the etiology of Autism? | Genetics/Family, increased serum serotonin |
| What are the signs & symptoms of autism? | Poor eye contact, fails to develop peer relationships, no shared enjoyment with others, no social/emotional reciprocity, lack of verbal communication, abnormal intonation, mixing of pronouns, echolalia, hand flapping, rocking, insistence of sameness |
| What other behavioral problems are associated with autism? | Hyperactivity, Aggressive, Self-Injurious, Unusual sensitivity to sensory stimuli, and abnormal mood/affect |
| What is Rhett's Disorder? | Delay in normal development after normal period (5 months of age or older) |
| What are the signs & symptoms of Rhett's Disorder? | Decreased head growth, loss of acquired skills, loss of social engaqement, poor coordination, severely impaired language development |
| What are the stages of Rhett's Disorder? | Early Onset (6-18 Months), Rapid Deterioration (1-4 Years), Plateu (2-10 years) and Late Motor Deterioration (After 10 years of age) |
| What is the definition of Hypertension? | A systeolic blood pressure greater than140 mm Hg or a siasolic |
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