TLO 2.5 Renal/Urinary Child Flashcards Preview

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Flashcards in TLO 2.5 Renal/Urinary Child Deck (36)
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1
Q

Anatomy of urinary system of child

A
Stress: reduced kidney function in infants
Shorter urethras
Complete bladder control by age 4-5
Most regain normal function following acute renal failure
Output:
Infants: 2mL/kg/hr
Children: .5-1mL/kg/hr
Adolescents: 40-60 mL/hr
2
Q

Urinary diagnostic tests for children

A

Urinalysis, Culture and sensitivity often included
Serum studies: BUN (5-18 child), creatinine (0.3-0.7 child), osmolality
KUB (kidney, ureters, bladder)
Imaging: CT, VCUG (voiding crystal urethrogram), Renal US
Cystoscopy

3
Q

UTI in children

A

Presence of bacteria in urine caused from outside the urethra getting into bladder and UT

  • fecal bacteria causes most UTI’s
  • bacteria in blood (seeds in kidney) can cause UTI in infants
4
Q

Predisposed r/t

A
Urinary tract obstructions
Urinary stasis r/t voiding dysfunction
Anatomic differences
Susceptibility to infection
Reflux
Toilet training females
Sexually active adolescent girls
5
Q

UTI manifestations INFANTS

A
vague/nonspecific
fever
irritability
crying when voiding
odorous urine
feeding difficulties
6
Q

UTI manifestation CHILDREN

A
ab pain
frequency/urgency
dysuria
fever
enuresis (involuntary urination, especially by children at night.)
7
Q

What is pyelonephritis?

A
Inflammation of the pelvis (acute infection of kidney):
high fever, chills
back pain
costovertebral angle tenderness
N/V
8
Q

UTI therapeutic management

A

oral antibiotics with non complicated UTI

pyelonephritis:
identifying contributing factors to prevent recurrence
prevent system spread of infection
preserve renal function

9
Q

UTI interventions HOSPITALIZED CHILD

A

educate on reason for procedures
keep infant/child’s routine
encourage parents/child be part of care
monitor hydration: encourage fluids, monitor signs of dehydration, I/O, skin turgor

10
Q

UTI interventions NOT HOSPITALIZED CHILD

A
ensure completion of antibiotic
promote comfort
good hydration
keep following up appointments and diagnostic studies
monitor for return of symptoms
11
Q

Cryptorchidism

what is it?

A

Absence of at least one testicle descent from scrotum:

occurs when one or both testes fails to descent
affects about 1-5% of healthy boys at birth
most infants have spontaneous descent by age 6 months

12
Q

Cryptorchidism manifestations

A

Testes no palpable
Testes not easily guided into the scrotum
Previously descended testis that ascends into extrascrotal position
**Children with undescended testes are at increased risk for malignancy and infertility

13
Q

Cryptorchidism therapeutic management

A

Observation of infant up to 6 months
Assess for testicular presence at each well child exam
Persists >6 mo = orchidopexy (done before 12 mo of age reduces risk of adverse consequences

14
Q

Cryptorchidism interventions

A

Educate parents
provide parents with information/resources
Provide post-op care

15
Q

hypospadias

what is it?

A

Opening of urethral meatus is below the normal placement on the glans of the penis

Different degrees: some slightly ventral to glans or as far back as penoscrotal junction

One of the most common congenital anomaly

16
Q

Epispadias

what is it?

A

Dorsal (on top) placement of urethral opening
Congenital anomaly
Less common, extremely rare

17
Q

Hypospadias

Manifestations

A

Occurs from incomplete development in utero
Stenosis of the opening= partial obstruction of urine= altered urine stream
Might interfere with fertility in mature man if left uncorrected
Chordee: downward curvature of penile shaft

18
Q

Hypospadias

Therapeutic management

A

Surgical correction, 6-12 mo before toilet training
Should not be circumcised, foreskin can be used to reconstruction
Urinary diversion
Restricted activity for few days, no hip straddling after surgery
Goal: urinary/sexual function normal and improved cosmetic

19
Q

Epispadias

Manifestation and therapeutic management

A
Manifestation:
Defect on topside of penis
Often associated with bladder exstrophy (bladder outside the ab wall)
Therapeutic:
Surgical reconstruction
20
Q
Misc. anomalies of GU tract
4 types (male)
A

Hydrocele
Phimosis (inability to retract the skin (foreskin or prepuce)
Testicular torsion
Bladder exstrophy (bladder outside of body)

21
Q

Hydrocele

what is it?

A

Painless swelling of scrotum
Caused by collection of fluid
Usually resolves by 12 mo of age

22
Q

Phimosis

what is it?

A

Inability to retract the foreskin at an age is should retractable
Mild cases: cleaning and gentle manual retraction
Severe cases: surgical enlargement of phimotic ring or circumcision

23
Q

Testicular torsion

what is it?

A

Rotation of testicles causing interruption to blood supply
Most be corrected quickly to avoid damage
Sudden onset of severe scrotal pain, erythema, edema

24
Q
Acute glomerulonephritis (AGN)
what is it?
A

Inflammatory injury in the glomerulus
Acute post streptococcal glomerulonephritis is the most common type:
-an immune reaction to group A beta-hemolytic streptococcal infection of throat or skin
-damage is caused by antigen-antibody complex that lodges in glomeruli
-streptococcal infection needs to be verified for dx
Most common in preschool or early school age

25
Q

AGN manifestations

A

Hematuria- cola colored urine
Proteinuria
Edema
HTN

26
Q

AGN lab findings

A

RBC’s, casts, small amount of protein in urine
Decreased or normal Hgb and Hct
Altered electrolytes
Elevated BUN/creatinine
Elevated ASO titer or Streptozyme, decreased complement

27
Q

AGN management

A
Supportive
Antihypertensive
Diuretics
Antibiotics for active strep infection
Low salt diet
Possible fluid restrictions
28
Q

AGN nursing care

A
Prevent fluid excess
Provide adequate rest/quiet play
Maintain skin integrity
Maintain nutritional status
Relieve anxiety
29
Q

AGN patient outcomes

A

Child will remain normal fluid balance
The child will exhibit no signs of skin breakdown
The child will have adequate nutrition

30
Q

Nephrotic Syndrome

what is it?

A

Kidney disorder characterized by proteinuria, hypoalbuminemia, edema
Can occur:
a primary disease known as minimal change nephrotic syndrome
a secondary disorder after glomerular damage
a congenital form that is inherited as an autosomal recessive disorder

31
Q

Nephrotic syndrome

Occurs most frequently in?

A

Toddlers or preschool aged children

32
Q

Nephrotic syndrome

Manifestations

A
Severe proteinuria
Edema
Normotensive
Hypovolemia
Pallor/fatigue
Anorexia
Ab pain
Increased weight
33
Q

Nephrotic syndrome

lab findings

A

Protein in urine
Possible microscopic hematuria
hypoalbuminemia <2.5 g/dL
Elevated cholesterol, triglycerides, Hgb, Hct, platelet levels

34
Q

Nephrotic syndrome management

A
prednisone to initiate remission (remission= less than 1+ urine protein for 3-7 consecutive days)
diuretics
possible albumin admin
prevent infection/skin breakdown
no added salt diet
35
Q

Nephrotic syndrome nursing care

A
Live virus vaccines are contraindicated in children receive steroid therapy
Monitor for s/s infection
Assess fluid status, daily weight, I/O
Monitor labs, CBC, UA
Observe for s/s of dehydration
36
Q

Nephrotic syndrome patient outcomes

A

Child will be free from skin breakdown
Child will maintain adequate fluid volume
Child will not exhibit signs of fluid overload
Parents will be able to explain principles of home management