UNIT 3 GU Flashcards

Question

Kids with VUR have frequent ___1___ infections

Answer 1

1. Kidney infections (pylonephritis)

Answer 2

VCUG Images taken of the kidneys before during and after voiding to visulize the possible urine reflux...using contrast medium that is injected into the bladder through a catheter Kids may have to be sedated for this exam. If they are awake reassure them its okay to have an accident on the exam table... Ask allergies to shelfish and iodine... post hydration is important in riding kidneys of die.

Answer 3

Primary thing to know is that grade 1 is the least and 5 is the worst. **Grade 1**: Reflux is only into the ureter **Grade 2: ** Reflux into the renal pelvis **Grade 3: ** Reflux into the renal pelvis w/mild hydropnephrosis **Grade 4:** Reflux into the renal pelvis with moderate hydronephrosis **Grade 5: ** Severe hydronephrosis and can cause ureter to twist and cause obstruction.

Answer 4

1. Daily low dose antibiotic therapy-prophylactic 2. Liberal fluids 3. Regular voiding and double voiding 4. Routine urine culture (every 2-3 months or anytime they have a fever) 5. annual VCUG

Answer 5

1. Prevent any bacteria from reaching kidneys

Answer 6

Typically as the child grows the bladder stretches up making the ureters more on top so less reflux.

Answer 7

1. Ureteral reimplantation

Answer 8

1. Severe forms of VUR 2. Significant anatomic abnormaltiy 3. Noncompliance with medical therapy 4. antibiotic intolerance 5. Infrequent access to health care system Severe forms of VUR are at risk for damaging the kidney permentaly... usually doesnt resolve on its own like grade 1-3. This put them at risk for renal scaring

Answer 9

Structural or functional abnormality of the urinary system that obstructs the normal flow of urine, producing renal disorders. Obstruction can occur at any level of the urinary tract Can be unilateral or bilateral, congenital or acquired and is more prevalant in boys.

Answer 10

1. Obstruction--> 2. Damage to the distal nephrones (UTI)--> 3. altered ability to concentrate urine ---> 4. increased urine flow---> 5. decreased excretion of acid--> 6. Urine pools---> 7. Hydronephrosis ---> 8. UTI which goes back to #2 Understand that urine backs up which damages the kidney causing hydronephrosis

Answer 11

Protrusion of abdominal contents through inguinal canal into the scrotum Usually seen on a sonogram... fairly common seen more often in preterm infants Typically painless unless their is some kind of strangulation of content

Answer 12

Fluid in the scrotom

Answer 13

1. Typically self-resolving 2. Surgical repair if not resolved in 1 year (hydrocelectomy)

Answer 14

Basically we candle the bottom of the scrotum using a penlight. If light is seen then its fluid. If no light passes its a mass

Answer 15

1. Swelling is normal 2. Anythime there is a surgery in the perineal area... kids cannot use straddle toys while healing minimum of 2-4 weeks 3. limit strenous activity, esp in older children

Answer 16

Narrowing or stenosis of the opening of foreskin resulting in the inability to retract forskin Appears like a tight ring or tubber band around tip

Answer 17

1.Resolves as the child grows but can obstruct urine flow... - If urine flow is obstructed parents may report dribbling stream or balloning of fore skin 2. Mild not forcible: manual forskin retraction (NOT FORCIBLE) 3. In Severe cases: Circumcsion or vertical division of foreskin 4. Steroid cream 2x a day for a month... then they will have an option of a circumcison in severe cases.

Answer 18

Urethral opening located below or behind glans penis or anywhere along ventral surface of penile shaft

Answer 19

Surgical correction-- repair usually happens around 6-12 months. Surgery will allow the boy to stand to pee and have a functioning sexual reporducing organ. Sperm wont be able to reach if undreneath

Answer 20

Make sure parents understand that the chld cannot have a circumsision until after surgery because they may need extra the extra skin avoid straddle toys... while healing (2-4 weeks min)

Answer 21

Failure of one or both testes to descend normally through inguinal canal into scrotum

Answer 22

Orchiopexy 1. Surgical release of the undesended testicles into the scrotum... done outpatient 2. If not corrected increased risk for maligency and fertility repairment 3. Might have a button

Answer 23

1. Routine preop/postop care 2. Tub baths are discouraged for a few days up to weeks depending on physicans orders 3. Possibly cath care-- teach parents how to care and teach child not to pull on 4. Activity restriction-- no straddle toys, rough play, pushing, pulling 5. Parental support

Answer 24

Disorder characterized by increased glomerular permeability to plasma protien, which results in massive urinary protien loss Typically membranes in the glomeruli are not permable but in this process they become more permable esp. to albumin which leads to massive protien loss in the urine

Answer 25

1. 80% of the time it is idiopathic -- aka idiopathic nephrosis, childhood nephrosis or MCNS (minimal change nephrotic syndrome) 2. Can be caused by clinical manifestations - If there is glomeular damage then thats going to be the presumed cause esp. in systemic diseases like lupus - Other causes can be toxins... drugs or other toxins that damage the kidney.. these are referred to as secodnary disorders 3. Congenital (inherited autosomal defect)-rare

Answer 26

1.Glomerular membrane becomes more permeable to protiens, esp albumin 2.Protiens are lost in the urine---> hypoprotienemia and massive protienuria 3.Serum albumin level decreases---> Hypoalbuminemia 4.Osmotic pressure in capillaries decrease 5.Vascular pressure exceeds the pull of osmotic pressure 6.Fluid accumulates in the intersitial spaces---> Edema 7.Shift of fluids from plasama to intersitiual spaces reduces vascular volume ---> Hypovolemia 8.Renin-angiotensin system is stimulated 9.ADH & Aldosterone are secreted 10.Reabsorption of sodium & water in an attempt to increase intravascular volume

Answer 27

1. Weight gain in a healthy child "puffy apperance" 2. Edema 3. Massive protienuria 4. Hypoalbuminemia 5. Hyperlipemia--liver rapidly manufactureing lipids to replace protiens 6. Anorexia 7. Irritability 8. decreased activity 9. Increaed infection due to the lose of immunoglobulins which are important to immune response

Answer 28

Edema - Pattern: gerneralized esp. in periorbital and facial area. Worse in the morning but goes down during the day. - May be gaining weight but losing true body weight - ascites - pleural effusion-- fluid in lungs may present with fever, chest pain, syspnea, & non productive cought.

Answer 29

1. Decreaed volume - Dark and frothy in apperance 2. Massive protienuia - Greater than 2+ 3. May have a few RBC's

Answer 30

1. Based on history 2. Clinical manifestations 3. Massive protienuria in urine

Answer 31

1. 1st line: corticosteriods - Prednisone 2mg/kg/day x6 weeks, then 1.5 mg/kg every other day x6 weeks. High dose and long term. 2. Cyclophosphamide or cyclosporine - For chidren who cannot tolerate prednisone or who have repeated relapses 3. Possibly furosemide-- only going to provide temporary relief from edema. The patient is still going to lose protiens so they will continue to swell - to provide temporary relief from edema 4. Possibly 25% albumin - Decrease edema (hopefully) - Increases plama volume

Answer 32

1. Reduce urinary protien 2. Reduce fluid retention 3. Preventing infection 4. Minimize complication r/t tx and therapy

Answer 33

1. Relapses can be triggered by allergies, immunizations viral or bacterial infection up to 2/3 of children with this syndrome will have a replase

Answer 34

1. dx early parents are tught to do @ home dipsticks that look for protient (2+ protien in urine is not good) 2. Relapse tx w/ repeate & shorter doses of high steriords

Answer 35

1. Strict I&O plus daily weight 2. VS-lung heart sounds (watch for chest edema) 3. Prevention of infectoin 4. Thermoregulation 5. Assessment of edema - Measure abdominal circumference - Level/location of swelling - degree of pitting 6. Loss of appetitie/diet 7. Long-term steriod use 8. Home care for relapse 9. Sodium restricted diet/short term fluid restrictions 10. Long term corticosteriods s/s- insomnia, male hair growth, growth retardation, hypertention, gi bleed, bone malformation, infection risk, increased blood sugar.

Answer 36

Make sure parents know not to trash diaper or flush urine. Daily urine protien check are going to happen. We will use the cotton ball method if child is not potty trained

Answer 37

Sticky bag method-- risk of skin breakdown is high due to edema.. infection risk if skin breakdown occurs

Answer 38

1. Group of kidney disorders characterized by inflammatory injury in the glomerulus , most caused by an immunological reaction

Answer 39

Strep in the winter/spring Impetigo in the fall and summer can also be a autoimmune disease response

Answer 40

1. Immunological/autoimmune disease 2. Following strep infection of pharynx or skin - Acute: 2-3 days after infecton - Chronic: after the acute phase or slowly over time History of pharyngitis or tonsillitis 2-3 weeks before symptoms b

Answer 41

1. Immune complexes deposited in glomerular basement membrane 2. Increased glomerular basement membrane permability to RBC's & Protiens---> Hematuria protienuria 3. Glomeruli become edematous & infiltrated with leukocytes 4. Capillary lumen becomes occluded 5. Decreased capillary flow & decrease in plasma filtration 6. Excessive accumulation of waer & retention of sodium 7. Interstital fluid & plasma volumes expand 8. Circulatory congestsion ---> Edema & HTN

Answer 42

We see the trigger from the strep infection 10-21 days post infection... throat culture would be negative since antibiotics have already been given

Answer 43

1.Non-specific complaints-- headache,tired, irritable, decreased appetite? 2.Edema- especially periorbital 3.Urine: - Cloudy, tea/cola-colored - Parallell, protienuria & hematuria....2+protienuria =2+ hematuria 4. Azotemia will show increased BUN & CR (this doesnt happen in nephrotic syndrome) 5. ASO titer - If strep is believed to be the reason... this will measure against the antibodies. So if strep was present antibodies that the infection would still be present

Answer 44

1. Dietary restrictions - Moderate sodium restrictions (regular diet with no added salt) - Possible fluid restriction - Restrictions of foods with substantial potassium during periods of oliguria - fluid volume overload s/s 2. Antihypertensives & diuretics

Answer 45

If the kidneys are not filtering k+ out then we are retaining k+ in the blood. We do not want to add more and they become hyperkalemic which we know would affect the heart

Answer 46

Usually good w/complete recovery but there are some cases in which the child will go into acture renal failure

Answer 47

1. VS, strict I&O, daily weight - blood pressure monitoring will be important 2. Monitor for dehydration in fluid-restricted pts 3. Offer appealing meal choices - Will not be hungry but try to offer them choices within their appropriate dietary needs 4. Allow for frequent rest periods - Typically done on their own will due to not feeling well. - Restricted contact sports

Answer 48

If they are normotensive and have normal urine output... they can be treated at home... If they start to have increased bp or urine output they will have to be admitted.

Answer 49

1. frequent ua and vp monitoring for signs of progression of the disease 2. 1st sign of renal failure is decreased urine output... report decreased urine output

Answer 50

Nephrotic syndrome

Answer 51

Acute glomerulonephritis: Follow streptococcal infection Nephrotic syndrome: Idiopathic in most cases

Answer 52

Acute glomerulonephritis: Anorexia, lethargy, headache Nephrotic syndrome: Fatigue, susceptible to infection

Answer 53

Acute glomerulonephritis: Mild to moderate, Primarly periorbital Nephrotic syndrome: Severe, facial and generalized, ascites

Answer 54

Acute glomerulonephritis: Mild to severe HTN Nephrotic syndrome: Generally normotensive

Answer 55

Acute glomerulonephritis: Cloudy, tea/cola-colored Nephrotic syndrome: dark and frothy

Answer 56

Acute glomerulonephritis: Generally mild to moderate; parallels hematuria Nephrotic syndrome: Massive protienuria (3+ and higher)

Answer 57

Acute glomerulonephritis: Up to gross amounts Nephrotic syndrome: Few RBCs

Answer 58

Acute glomerulonephritis: Positive Nephrotic syndrome: Negative (if tested)

Answer 59

Acute glomerulonephritis: Supportive, moderate dietary restrictions, antihypertensives & Diuretics pRN, Abx to treat caustive agent Nephrotic syndrome: Corticosteriods, dietary restrictions, possibly diuretics & albumin

Answer 60

Intentional or involuntary passage of urine into bed (usually at night) in children who are beyound the age when voluntary bladder control should be normally acquired More common in boys than girls

Answer 61

1. Small bladder 2. Persistent UTI 3. Severe Stress 4. Developmental delay that interferes w/toliet training

Answer 62

1. Primary: Bedwetting in children who have never been dry for an extended period 2. Secondary: The onset of wetting after a period of established urinary continence-- may be caused by stress

Answer 63

Behavioral 1st 1. 1st must rule out organic cause(s) 2. Restrict or eliminate fluids after dinner 3. Avoidance of caffeine & sugar-containing drink after 1600 4. Purposeful interruption of slee to void 5. Motivation therapy(bribery) 6. Bed alarm This continues until there is 14 days of no bed wetting.

Answer 64

Imipramine (tofranil) and desmopressin are most commonly used Trycyclic antidepressants/anticholenergic meds... remember these are going to dry mouth, headache, cause constipation, and trycyclic antidepressants can become cardiac toxic if there is an overdose.

Answer 65

Uncommon, acute renal disease that occurs primarily in infants and small children between the ages of 6 months and 5 years

Answer 66

Bacterial toxins, viruses & chemicals... typically e.coli, bad meat, juice or dairy products, swimming in pools and lakes contaminated with feces

Answer 67

Hemolytic anemia Thromboytopenia Renal Injury

Answer 68

1. Toxin damages endothelial lining of glomerular arterioles 2. Glomerular arterioles become swollen & occluded with depositis of platelets & fibrin clots 3. RBCs are damaged as they attmpt to move through partially occluded vessels---> acute hemolytic anemia 4. Damaged cells are removed by the spleen ---> thrombocytopenia

Answer 69

1. Preceded by illness - Gastroenteritis - Upper resp. infection 2. Vomiting 3. irritability 4. lethargy 5. pallor r/t low rbc anemia 6. hemorrhagic manifestation r/t thrombocytopenia 7. oliguria or anuria 8. CNS involvment 9. high bp 10. swelling of hands, face or entire body

Answer 70

1. Goals of therapy are early diagnosis & agressive care of renal failure & hemolytic anemia 2. **Most consistently effective treatment is dialysis** - any child anuric x 24 hours or oliguric w/uremia or HTN & seizures - FFP, plasmapheresis - PRBC

Answer 71

1. Strict I&Os 2. Management of dialysis in PICU 3. Thermoregulation 4. reduction of anxiety 5. Closely monitor for fluid overload

Answer 72

1. 95% of the time that a child goes into acute remal failure they will make a full recovery 2. 10-50% chance they will have residual renal impairment & will live the rest of their life without healthy kidneys

UNIT 3 GU Flashcards

(104 cards)