Ch. 24 Flashcards

Question

when is bladder capacity close to that of an adults?

Answer 1

USG: 1.005-1.020 in-hospital hydration status; normal intake status

Answer 2

clear, pale, yellow/gold should be transparent straw color with minimal odor

Answer 3

avg. 6 (5-8) - want the urine to be closer to 5 (more acidic to prevent infection) acid base balance

Answer 4

presence of: - protein - glucose (diabetes) - ketones - leukocyte esterase - nitrites - WBCs (< 1-2 is normal- irritation) - RBCs (< 1-2 is normal- irritation) - Bacteria - Casts

Answer 5

- can be difficult to examine (restraint) - urine collection is complicated by age and determination of child - conflict is created btwn parental teaching r/t exposed "private parts" and the need to perform exams, lab specimen collection, and nursing interventions

Answer 6

action: antidiuretic hormone effect; causes renal tubule to increase H2O absorption leading to decreased volume of urine indication: nighttime enuresis

Answer 7

- nasal spray may cause irritation, nausea, flushing, or headache - administer at bedtime alternating nostrils - PO is preferred at bedtime

Answer 8

action: inhibits reabsorption of sodium/chloride; leads to increased excretion of H2O and lytes indication: nephrotic syndrome

Answer 9

- give with food/milk - monitor BP, renal function, lytes (esp. K+)

Answer 10

action: results in fluid shift from interstitial to intravascular space indication: nephrotic syndrome

Answer 11

- use filter on IV tubing - rapid infusion can cause vascular overload - monitor VS - observe for cardiac failure and pulmonary edema

Answer 12

not always appropriate for use in children - some are, some aren't

Answer 13

indication: nephrotic syndrome action: induces remission and promotes diuresis ie. prednisone

Answer 14

another 6 weeks at lower doses

Answer 15

medication used for nephrotic syndrome

Answer 16

- UA - Urine C&S - BUN - uric acid - creatinine - KUB - IVP - VCG/VCUG - renal scan - cystogram - retrograde pyelogram - ultrasound - CT scan - MRI - renal arteriogram - renal biopsy

Answer 17

removal of a small piece of the kidney to examine the tissue

Answer 18

can be used on abdominal area or back to get a picture/scan of kidneys, bladder, ureters

Answer 19

- a voiding cystourethrogram uses a small amount of radiation to make images of a person's urinary system - these images help doctors see problems in parts of the urinary system: bladder, urethra, ureters

Answer 20

elevated in renal disease infant: 2-5.5 child: 0.3-0.7 adolescent: 0.5-1

Answer 21

elevated in renal disease 2-5.5

Answer 22

elevated in renal disease newborn: 4-18 infant, child: 2-5.5

Answer 23

urine culture - tests for bacteria - next test after a UA - 48hr results

Answer 24

urinalysis - the urine that is sent off to the lab for analysis (USG, pH, protein, ketones, nitrites, etc.)

Answer 25

- collection bag - wool cotton pads - perez reflex stimulation - catheterization - suprapubic needle aspiration

Answer 26

- on toilet into hat - catheterization - suprapubic needle aspiration

Answer 27

typically clean-catch

Answer 28

- cystitis: contained in bladder - urethritis: irritation; infection; potential for ascending

Answer 29

- pyelonephritis: inflammation of the upper tract; may involve kidneys - VUR: retrograde flow of urine from bladder into upper tract - glomerulonephritis: immunologic disease un kidney proper; did not begin in the bladder and ascend

Answer 30

UTI is complicated by another condition - stones - obstruction - catheters - diabetes or nephrotic disease - recurrent infections

Answer 31

recurrent: repeated episodes in a person whose prior infection was successfully eradicated persistent: bacteria despite antibiotics; occurs because original infection was not adequately eradicated febrile: typically indicates pyelonephritis urosepsis: bacterial illness; urinary pathogens in blood unresolved bacteriuria: bacteria resistant or drug discontinued before bacteria is completely eradicated

Answer 32

- N/V - anorexia - chills - nocturia - urinary frequency - urgency - incontinence - dysuria - suprapubic or low back pain - bladder spasms - dysuria - burning on urination

Answer 33

- fever - hematuria: foul odor; tender, enlarged kidney - + UA: leukocytosis: increase in WBCs; Nitrates, Blood - positive findings of bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP - inconsolable - grimacing, visible signs of pain

Answer 34

- bladder tunnel is too short "leaky valve" - urine flows in both directions

Answer 35

- Prophylaxis antibiotics (bactrim, nitrofurantoin) - Voiding schedule - Hygiene - Routine VCUG - can self resolve

Answer 36

- Same as I and II plus - Surgical intervention (ureteral re-implantation) for severe cases (does not self resolve) - VCUG procedure is upsetting for toilet trained children

Answer 37

IVF at 1 ½ times FMR I & O Foley, suprapubic, and/or ureteral tubes for urine drainage (bloody urine- inform parents this is normal) Pain mgmt. OOB (out of bed- promotes motility, gravity & healing, prevent blood clots & PNA) Abd. assessments Advance diet as tolerated Prophylaxis antibiotics for 1-2 months, small dose/day Follow-up VCUG Psychosocial support

Answer 38

- the patient's bladder is filled with liquid contrast material - X-ray machine sends radiation beams through abdomen and pelvis - images are recorded in special film/computer

Answer 39

a surgery to treat VUR - reimplantation of the ureter(s) - corrects the anatomy at the insertion of the refluxing ureter into the bladder

Answer 40

- inflammatory response in the glomerular system - inflammation of kidney tubules - most common form: (APSGN) acute post-streptococcal glomerulonephritis - most commonly caused from strep throat infection - usually in ages 3-12 years; uncommon in children <3 years

Answer 41

- 1-2 weeks after other type of pneumococcal, streptococcal, and viral infections - 3-6 weeks after skin infections, ie. impetigo

Answer 42

- throat culture: +/- - urine: + bld, + protein, ^ USG, + RBCs, + HGB, + leukocytes, + red casts - serology: electrolytes WNL, ^ BUN, ^ CR, + ASO (anti-streptolysin O) titer, decreased C3&C4 - EKG: heart fx eval if HTN develops - CXR: cardiac enlargement, pulmonary congestion, plural effusion - renal biopsy (only in atypical cases)

Answer 43

- Previously healthy kids are often asymptomatic. - Mild URI (respiratory) s/sx. - Recent history of strep infection.

Answer 44

s/sx: Periorbital Edema (Worse In Am Then Becomes Dependent) Anorexia, Pallor, Irritability, Lethargy Older Children: Headaches, Abdominal Pain, And Dysuria Cola (Smoky Or Tea) Colored Urine Hematuria, Proteinuria (Mild/Moderate), Azotemia (Elevated Nitrogen) Oliguria (decreased UO) Hypertension (Mild To Severe) Weight Fluctuations Hypervolemia Rare: Seizures From Hypertensive Encephalopathy, CHF, Or Hematuria Without HTN Or Edema

Answer 45

s/sx: Increase in UO Decrease in weight (resolution of edema) Increased appetite Normalized BP Normalized Renal function and hypocomplementemia

Answer 46

begins 7-21 days between onset of strep and development of clinical s/sx

Answer 47

begins 1-2 weeks post-strep or 3-6 weeks post skin infection - usually persists 1-3 weeks - encourage rest during this phase

Answer 48

begins with s/sx of improvement - most s/sx resolve within 8 weeks of onset of latent phase

Answer 49

- 95% rapid improvement to complete recovery - 5-15% chronic glomerulonephritis - 1% irreversible damage

Answer 50

Serial VS, weight, and I/O Na (NAS) and H20 restriction Limit potassium with oliguria Protein restriction with azotemia Diuretics with mild renal failure Dialysis (rare) BP q 4 hrs. Antihypertensives Possible anticonvulsants with BP meds ABTs if strep + May test other family members Bedrest-acute phase Restrict strenuous activity until urine is negative

Answer 51

- can be primary or secondary - different types - occurs in all ages but most frequently in preschoolers - swollen eyes*, swollen feet, swollen abdomen - result of increased glomerular basement membrane permeability --> proteinuria (usually albumin)

Answer 52

nephrotic syndrome more common in boys than girls

Answer 53

80% are classified as minimal change nephrotic syndrome

Answer 54

viral URI typically preceded diagnosis but is not the cause of MCNS

Answer 55

- urine: +++ proteinuria, + casts, RBCs, ^ USG - serology: decrease protein, decrease albumin, ^ lipids, ^ cholesterol, ^ PLT (hemoconcentration), H&H (slightly ^), decrease Na, decrease Ca - renal biopsy: will differentiate type and probable course of disease (not always performed)

Answer 56

Child is previously well and begins to develop: **Periorbital edema (worse in am) ***Progresses to swelling generalized edema (anasarca) from abdomen to feet bilaterally **Weight gain greater than expected for age **Urine characteristics: dark white (opal), frothy/bubbles **Skin breakdown ** Gradual or rapid onset. Pallor Fatigue Irritable, easily fatigued, lethargic Hypoalbuminemia → white lines on fingernails Normal BP (or slightly decreased) Edema of the intestinal mucosa results in diarrhea, anorexia, and ↓ intestinal absorption. UO Dull hair Ear cartilage may feel less firm Food intolerances or allergies

Answer 57

VS with close B/P monitoring Daily wt. Monitor for s/sx edema. Assess degree of edema. I & O (strict) Routine vaccinations. No live vaccines until steroids are discontinued Urine dipsticks (inpatient and at home) Heart, lung, and abdomen assessments Skin assessments/skin care

Answer 58

Low Na++ - if edema and steroid therapy Fluid restriction- if renal failure or if hospitalized Low protein foods-if azotemia or renal failure

Answer 59

Corticosteroids (starts at around 60mg/day and slowly taper down) - IV in hospital, po post discharge - Immunosuppressant therapy (some cases) - IV albumin (protein) f/b diuretic (i.e. furosemide) - Antibiotics PRN- for secondary infections

Answer 60

bedrest (edema phase) cluster care

Answer 61

- itching - may harm immunity: immunocompromised - moon face - increased appetite - emotional, very energetic

Answer 62

- chronic condition with relapses - developmental milestones - social isolation: lack of energy, immunosuppression/protection, change in appearance due to edema- self-image

Answer 63

- acute pediatric renal disease - caused by e. coli (diarrhea +) - preceded 1-2 weeks by severe gastroenteritis, UTI, or URI

Answer 64

hemolytic-uremic syndrome (HUS)

Answer 65

- AKI: acute kidney impairment/injury - hemolytic anemia: RBCs are destroyed faster than they are made - thrombocytopenia: low platelets

Answer 66

V/D (Most common) ** Diarrhea (often bloody) Abdominal pain, cramping or bloating Vomiting Fever If URI, UTI, or viral cause will present differently

Answer 67

Symptomatic care Enteral nutrition Parenteral PRN (colitis)

Answer 68

Days to 2 weeks Anorexia Personality changes (irritable, lethargic) *Rapid onset of pallor *Hemorrhagic features (ecchymosis, purpura, rectal bleeding, orifice bleeding) If mild=anemia, thrombocytopenia, azotemia If severe=oliguria or anuria and HTN If CNS involvement=seizures, LOC→ stupor, stroke If cardiac involvement=HF (ex. SOB) If GI involvement: mild jaundice, ascites If renal involvement: ↑ BUN ↑ CR ↓ Hgb ↓ Hct. ↑ retic. count (effects all symptoms)

Answer 69

Focus on controlling complications and managing ARF Calorie intake (foods) Monitor fluid balance Restrict fluids Routine labs Assess for physical s/sx Assess for fluid overload Limit fluid volume with IV meds Keep child calm and afebrile Education on prevention Peritoneal dialysis (PRN)

Answer 70

- enuresis - phimosis - hydrocele - cryptorchidism - hypospadias - epispadias

Answer 71

bed-wetting in children who have never been dry for extended periods of time

Answer 72

the onset of bed-wetting after a period of established urinary continence

Answer 73

- developmental age > 5 years - careful history of baseline information - physical exam

Answer 74

Conditioning therapy Bladder retention training Fluid restriction in evenings Interruption of sleep to void Conditioned reflex response devices Drugs: DDVAP, oxybutynin, imipramine (tofranil)

Answer 75

- steroid cream BID - vitamin E cream

Answer 76

- Not forcing foreskin retraction in newborns - Frequent diaper changes - Washing penis daily with soap and water - Cleansing skin around glans when able to retract skin routinely (infant and older) - Always remembering to replace retracted foreskin (after age 3)

Answer 77

- no straddle toys or strenuous activities x1 month post-op - dressing in place until bathing is allowed - bathing pos-op day 3

Answer 78

- Surgery involves incision to release spermatic cord, pull down of testes, and “tacking in place” - Typically between 9-15 months of age - orchidopexy - Must be corrected before school-age years otherwise

Answer 79

- sterility - high risk for testicular cancer

Answer 80

Predisposing factors: Premies First born males Section babies LBW Hypospadias

Answer 81

testes can be manually descended but migrate out of the scrotum - not problematic *UNLESS no descent is possible OR continues past age 14 yr

Answer 82

Examine the infant in a warm environment. Be sure the infant is calm before the examination. *Warm your hands before touching the infant. *Milk the testis downward from the groin and document its distal point. *Examine the older child in both a sitting and a frog-leg position.

Answer 83

6 months (may take longer for adjusted age infants)

Answer 84

- testes retract if the infant is upset or cold - the cremasteric reflex: testicular retraction in response to tactile stimulation to the front inner thigh

Answer 85

no circumcision- skin is used for reconstructive surgery

Answer 86

- incontinence - infertility - UTIs

Answer 87

Surgery typically between age 6-12 months Urine drainage tube care and maintenance Teaching re: catheter care…..d/c’d home with tube Penis should remain in upright position to reduce incision strain Compression Dressing maintenance; DO NOT CHANGE (removed typically on day 4) ABT’s Pain management (i.e., analgesics, antispasmodics) for bladder spasms Double diapering (inner smaller diaper for stool, outer larger for urine; cut slit in small to pull catheter through (see next slide) Encourage PO intake Assess for s/s UTI/infection Quiet play

Answer 88

used for hypospadias post-op infants - hole in first diaper where catheter goes through - put second diaper over first to keep sanitary (d/t hole in first diaper)

Answer 89

the heart is working harder to pump blood to the kidneys

Answer 90

flat plate the scans the kidneys, ureters and bladder

Answer 91

treated, 3 weeks later repeat culture is clear

Answer 92

children < 2 years old, 2 UTIs with a fever or 1 UTI with renal issues

Answer 93

- bactrim - nitrofutantoin

Ch. 24 Flashcards

(120 cards)