Pediatrics > Genitourinary > Flashcards

Genitourinary Flashcards

(49 cards)

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1
Q

Dev diff in GI sys

A
  • nephrons less mature and effecient
  • glomerular filtration and abs rates low bc kidneys of newborns are immature
  • dec ability to conc urine and reabs AAs
  • loop of Henle shorter which dec ability to reabs Na and water making very dilute urine for first 3M of life
  • H+ excretion red; acid secretion dec, bicarb levels are lower–more vulnerable to acidosis
  • bladder in abdomen until 3-4M
  • vulnerable to electrolyte overload
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2
Q

S/s GU disease in newborns

A
  • poor feeding
  • resp distress
  • poor urinary sys
  • jaundice
  • sz
  • dehydration
  • vomiting
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3
Q

s/s GU disease in infants

A
  • poor feeding
  • pallor
  • fever
  • failure to gain wt
  • persistent diaper rash
  • sz
  • dehydration
  • vomit
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4
Q

s/s GU disease in children

A
  • enuresis
  • freq or painful urination
  • smelly urine
  • enlarged bladder or kidneys
  • pallor
  • poor appetite
  • hematuria
  • ab or back pain
  • tetany (common in chronic condx)
  • HTN
  • edema
  • growth failure
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5
Q

NC for GU disease

A
  • accurate measure of BP, wt, I&O
  • prep kids and parents for tests (can be painful like inserting dye into bladder)
  • collection of specimens (maybe wee bag or in/out cath)
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6
Q

Best way to measure urine output in non-potty trained kids besides a catheter

A

Weigh diapers

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7
Q

Desired urinalysis results

A
  • clear and yellow
  • Sp gr 1.01-1.03 (how dilute it is)
  • pH 4.5-8
  • Glucose—negative (pos–GN or DM)
  • Protein—negative
  • Ketone—negative
  • RBCs <1
  • WBCs <1 (higher means infection)
  • casts–moderate clear protein
  • nitrite–negative (positive is nitrates–bacteria in urine (infection))
  • volume 1-2 mL/kg/hr
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8
Q

Normal serum lab values

A
  • uric acid (2-5.5)–kidneys ability to clear products of metabolism
  • BUN (5-18)
  • creatinine (0.3-07)
    BUN and creatinine indicate how well kidneys are working
    ***should draw BUN and creatinine about the same time daily
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9
Q

Diagnostics eval of GU disease

A
  • urine culture and sensitivity
  • IV pyelography
  • voiding cystourethrography (inject dye into bladder to watch urine path)
  • renal ultrasound
  • kidney, ureters, bladder (KUB)–flat image of abdomen
  • cystoscopy
  • renal biopsy–high risk of bleed, NPO, stay flat after
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10
Q

GU physical assessment

A
  • hx (UTIs, etc)
  • fam hx
  • respirations
  • HTN
  • fever
  • growth retardation
  • signs of circ congestion
  • ab distention
  • early signs of uremic encephalopathy (lethargy and confusion)
  • hypospadias or epispadias
  • ear abnormalities since ears and kidneys dev around same time in kids
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11
Q

Hypospadias

A

Urethral opening does not extend to tip of penis
- urethra on underside of penis
- vary in severity
- unknown cause
- may be sign of ambiguous genitalia

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12
Q

Epispadias

A

Urethra goes up instead of to tip of penis
- more common

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13
Q

Hypospadias complications

A
  • inc risk of UTI
  • may interfere with procreation if not fixed
  • body image disturbance
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14
Q

Hypospadias tx goal and management

A
  • surgical repair in stages
  • goals of correction–enable child to void in standing position, fix physical appearance, preserve fxn of sex organ
  • ideal time is 6-18M bc kids don’t realize diff in their body yet
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15
Q

Hypospadias NC

A
  • examine every newborn carefully
  • delay circumcision bc may use foreskin in surg cosmetically
  • psych prep of parent and child
  • postop: pressure dressing (check tip freq, don’t change dressing but check for bleeding), catheter/stent care, double diaper, teach home care
  • avoid tub baths until stent is removed
  • don’t carry baby on hip or ride straddle toy bc don’t want to put pressure on site
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16
Q

Cryptorchidism

A

one or both testicles fail to descend into scrotum

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17
Q

Cryptorchidism types

A
  • undescended - testes somewhere along normal pathway of descent
  • ectopic - testes located outside normal pathway
  • retractile - testes manipulated into scrotum
  • absent - testes is absent
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18
Q

Cryptorchidism therapeutic management

A
  • ultrasonography or surgical exploration to locate testes
  • AAP reccs tx before age 1
  • admin HCG (low success)
  • Orchiopexy b/t 6-24M (avoid pressure on site, watch for bleeding)
  • health teaching–inc risk of testicular cancer in 3rd and 4th decade of life
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19
Q

Obstructive uropathy

A

obstruction at any level of the upper or lower urinary tract
- blockage of urine flow makes dilation of the affected kidney (hydronephrosis)

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20
Q

Obstructive uropathy CM

Study These Flashcards
A
  • recurrent UTI
  • incontinence
  • fever
  • flank or ab pain
  • smelly urine
  • hematuria
  • dysuria
  • polyuria, polydipsia, urgency
  • anemia
  • FTT
  • nocturnal enuresis
21
Q

Obstructive uropathy management

Study These Flashcards
A
  • surgical correct if needed
  • monitor BP
  • may need defect fixed
  • prep for procedure
  • post-op watch
  • protect and care for catheter
  • teach home care (wound and cath care)
22
Q

Vesicoureteral reflux (VUR) and complications

Study These Flashcards
A
  • regurgitation of urine from bladder into ureters and kidneys
  • graded 1-5
  • inc pressure can lead to HTN, renal insufficiency, failure, or scarring
  • primary reflux is familiar and usually outgrown
23
Q

Vesicoureteral reflex types

Study These Flashcards
A
  • Primary reflux–result of incompetent valvular mech at ureterovesical jxn
  • Secondary reflux–from acquired condition like UTI or holding it in
24
Q

signs of VUR

Study These Flashcards
A
  • repetitive UTIs
  • 1 UTI in boys
  • fam hx of VUR (screen early using VCUG)
25
VUR tx
- antibiotics until reflux resolves (long-term course) - grade 4/5 almost always (sometimes 3) get surg; reimplantation of ureter
26
VUR NC, preop
- infx prevention (compliance with abx (best before bed) teach child to empty bladder completely (esp before bed), teach good hygiene - have siblings screened - age appropriate prep for procedures
27
VUR NC post-op
- care for cath and stent - administer analgesics for incision pain and antispasmodics for bladder spasms - teach home care; prophylactic abx for 1-2 post-surg
28
Hernias
Protrusion of a part of organs thru an abnormal opening - danger arises when: protrusion is constricted, circ impaired, interference with fxn or dev of other structures - common herniation areas in kids include (diaphragmatic, ab wall, inguinal canal)
29
Diaphragmatic hernia
Hole in diaphragm that allows ab contents to be sucked up into cavity - severity depends on how early it happened (affects heart more if happens earlier)
30
Congenital diaphragmatic hernia s/s
- s/s often is detected in utero - s/s after birth--resp distress, cyanosis, scaphoid ab, impaired CO
31
Congenital diaphragmatic hernia tx
- intubation - GI decompression - IVF - will need surg ASAP after stabilizing
32
Congenital diaphragmatic hernia surg NC
- monitor resp and fluid, acidosis, thermoreg, cardiac output, sedation, gastric decompression - tube in stomach for decompression - promote bonding and reassurance - postop--continue ventilation (slowly weaned), watch for acidosis, I&O, GI decompression, TPN and liquids, thermoregulation, sedation, pain control, CO
33
Umbilical hernia
Incomplete fusion of the umbilical ring where umbilical vessels exit ab wall - usually ok in 3-5Y - can be fixed in surg but usually not needed (just monitor) - inc in size with cough, bearing down - parents should press down on it and feel air and fluid--go to ER
34
Inguinal hernia
Opening on lower abdominal wall, leaving opening for abdominal contents to poke through - hernia more visible with cry, strain, having BM - need surgery
35
Most important NC for inguinal and umbilical hernia
Press on area and should feel air and fluid; if feel something else, go to ER
36
Urinary tract infection
Bacterial infx including urethritis (urethra), cystitis (bladder), and pyelonephritis (kidneys)
37
UTI epidemiology
- E. coli most causes in females - more common in females bc short urethra - uncircumcised males more likely - very common in kids before age 6
38
UTI risk factors
- constipation - soak in bubble bath (bubbles can irritate urethra) - pinworms - dysfxn voiding; urinary stasis - dec fluid intake - VUR - urologic abnormalities - indwelling catheterizaion - neurogenic bladder (often poor muscle tone, prob with CNS) - sex abuse and intercourse (investigate cause with more than one UTI)
39
UTI CM: infants
- fever - irritable - poor appetite—FTT - wt loss - smelly urine - v/d - cry w/ urination - NOT urgency—can’t discern that
40
UTI CM in kids
- dysuria - freq, urgency, incontinence - foul smelling urine, maybe hematuria - ab pain - fever
41
UTI diagnostics
- urine screening (+ nitrites, + RBCs, + WBCs) - urine culture > 100k colonies of a single bac
42
UTI therapeutics
- cure infx - ID predispose fx (tight underwear, poor wiping, sex activity) - prevent recurrent infx
43
UTI NC
- specimen handling - adequate admin of abx - push fluids - promote comfort - adequate follow-up cultures - teach preventative measures like promote freq bladder emptying, hydration, avoid tight pants, avoid colas and caffeine, chx period products freq
44
Enuresis
involuntary passage of urine by a child over age of 5 - primary or secondary - diurnal or nocturnal
45
Enuresis etiology
Primary - fam tendency - dec bladder capacity (age + 2 in oz) - heavy sleep - nocturnal polyuria theory - dev or maturational lag - sleep dx Secondary - psych fx (divorce, bully) - abuse - UTI - diabetes - sickle cell anemia
46
Enuresis dx/tx
- hx and physical - urine sample (check for UTI) - hx of bed wetting - wait for maturation (most kids outgrow by age 10) - tx the cause - retention/control exercise - drug therapy: oxybutynin, imipramine, DDAVP for special situations like sleepovers ($$$) - moisture alarm--beeps or vibrates - behavior mods--positive reinforcement is key
47
Enuresis NC
- don't punish child - child not lazy or doing on purpose - recc books (Dry ALL night, waking up dry) - limit choc and caffeine - limit fluids after dinner - use bed pads and 2 sets of sheets - use pull ups only on sleepovers--wick moisture away but we want kids to get used to getting up after feeling moisture - void schedule and gradually inc to get kids used to peeing not in bed - teach use of alarms - support and encouragement
48
What is normal urine output
1-2 mL/kg/hr
49
Desired urine pH
4.5-8
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