Genitourinary dysfx
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| The single most important host factor influencing the occurrence of UTI is | urinary stasis
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| Clinical manifestations of UTI in neonate(birth to 1 month) | poor feeding, V, incr resp(acidosis), frequent urination, screaming on urination, jaundice, seizures, dehydration
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| Clinical manifestations of UTI in infant | excessive thirst, foul-smelling urine, pallor, fever, persistent diaper rash
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| Clinical manifestations of UTI in childhood | growth failure, enuresis, incontinence, swlling of face, fatigue, blood in urine, abd/back pain, edema, htn, tetany
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| 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
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| what is normal newborn urine production amt? child? | Inf: approx 1-2ml/kg/h
child: 1ml/kg/h
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| Define UTI | irritation of the lining of the bladder, urethra, ureters, and kidneys
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| an upper tract involves? lower? | upper: renal parenchyma, pelvis, ureters and cause fever, chills, flank pain
low: bladder and urethra causes no s/s
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| 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
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| What is difference in complicated and uncomplicated UTI | comp: stones, obstruction, catheters, DM, recurrent inf
uncomp: occurs in otherwise normal urinary tract
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| 4 types of UTIs | recurrent
persisten
febrile: indicates pyelonephritis
urosepsis: uremia(urine in blood), bacterial
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| If young child/inf come in with fever, what is standard with each assessment | Urine sample from suprapubic aspiration of urine or sterile catheterization
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| 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
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| What is a hydrocele? tx? | fluid in scrotum
tx: surgical repair
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| inguinal hernia? tx? | protrusion of abd contents into scrotum
tx: surgical
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| phimosis? tx? | narrowing/stenosis of preputial opening of foreskin
tx: retract skin/circumcision
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| hypospadias? tx? | urethral opening located behind glans penis or anywhere along ventral surface of penile shaft
tx: sugery
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| Chordee? tx? | ventral curvature of penis from hypospadias
tx: surgical release of fibrous band
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| epispadias? tx? | meatal opening located on dorsal surface of penis
tx: surgical
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| cryptorchidism? tx? | testes fail to descend
tx: surgical, GH for older child
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| exstrophy of bladder? tx? | eversion of bladder thru ant bladder wall, severe defect
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| ambiguous genitalia? | masculinized female
incomplete male
true hermaphrodite
mixed
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| A urine dipstick ids presence of | nitrites, WBCs, leukocyte esterase
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| What is preferred dx study to obtain urine? | clean catch
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| IVP or Abd Ct is good for spotting what | suspected obstruction and reflux
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| Antibiotics for UTI? pain relievers? | bactrim(TMP-SMX), amoxicillin, cephalexin
pyridium:numbs nerves, turns pee orange
urised: turns pee blue
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| describe nephrotic syndrome | massive proteinuria, hypoalbuminemia, hyperlipidemia, edema
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| hypovolemia can occur as the fluid moves out of the vascular stimulates what system | renin-angiotensin system and secretion of ADH and aldosteroneq
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| 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
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| most common type of nephrotic is? other two types? | MCNS: Minimal change nephrotic syndrome
congenitaland secondary
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| 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
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| Nephrotic syndrome diet | low to mod protein
Na restriction with lg edema
no K restriction
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| Define Acute Glomerulonephritis | type of kidney disease with inflammed glomeruli and impair kidney's ability to filter urine.
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| 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
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| s/s of acute glomerulonephritis | oliguria, edema(periorbital and spreads to abd and extremities), htn, hematuria(tea colored), proteinuria
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| severe glomerulonephritis can raise what electrolyte | potassium
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| In children what usually causes acute kidney failure? | dehydration
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| Most frequent cause of acute kidney failure from 6mos-5y, in the summer? | hemolytic-uremic syndrome
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| 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
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| 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
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| 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
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| Best tx for hemolytic-uremic syndrome? | tx: hemodialysis/peritoneal
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| 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
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| 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
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| 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.
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| what is most immediate threat of ARF in child? | hyperkalemia, restrict K from food or give Kaexylate, peritoneal dialysis/hemo
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| 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
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| 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
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| what is preferred dialysis for children? | peritoneal dialysis
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| 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
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| 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
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