PEDS - GU

S&S of acute renal failure

- N/V - malaise - edema - HTN - disease specific

NIV for nephrotic syndrome:

- corticosteroids - diuretics - NO varicella or MMR vaccine

NIV for post-infectious glomerulonephritis:

- decreased fluids - low protein - low potassium - low sodium - low phosphate - anti HTN meds - diuretics - prevent skin breakdown

symptoms of post-infectious glomerulonephritis

- edema - HTN - hematuria (smoky, blood) - proteinuria (frothy)

NIV for testicular torsion:

- fertility isn't affected d/t involved of one testis - don't lift heavy objects for 4 weeks or strenuous activity for 2 weeks

functions of the nephron

- filtration of metabolic waste - regulate blood flow to keep glomerular filtration even - reabsorption or secretion of water/electrolytes - activates vitamin D - secretes erythropoietin (stimulates bone marrow to produce RBCs) - angiotensin system (blood pressure)

NIV for hemolytic uremic syndrome:

- fluid replacement - dialysis - low protein - low phos - low K+ -low Na+

NIV for vesicoureteral reflux:

- prophylactic ATBcs - surgery

possible complications of vesicoureteral reflux:

- pyelonephritis (UTI involving renal parenchyma) - renal scaring - chronic renal failure - HTN - proteinuria - kidney failure

symptoms of testicular torsion

- severe pain - erythema in scrotum - N/V - abdominal distension - tender testis

serum creatinine levels:

0.2-0.9 mmol/L

the fetus starts to excrete waste by the _____ week of gestation

12th

what is the urinary output measurements for: - infants (ml/kg/hr) - children (ml/kg/hr) - adolescents (ml/hr)

2, 0.5-1, 40-80

the bladder's capacity increases as the child grows. at birth, it holds about _______ mL vs 700mL as an adult

20-50

blood urea nitrogen (BUN) levels:

3.5-7.1 mmol/L

what is the time frame that a child would need surgery (orchiopexy) when they have testicular torsion or they can't get the surgery (necrotic tissue removal)

4-6 hours

Urinalysis (UA): - pH: - specific gravity: - WBC < ___ - RBC < ___ - negative for protein, glucose, bilirubin, ketones, or nitrates

4.5-8 (6 is average), 1.01-1.03, 4, 2

surgery should be initiated for a bladder extrophy within ____ hours

48

how long should you wait to assess a dipstick

60-120 seconds

A 6-year-old child treated for acute glomerulonephritis has improved and is soon to be discharged. What should the nurse plan to offer the parents in preparation for the discharge? A. Samples of no-salt-added diets for the child to continue at home B. Suggestions about activities to keep the child mobile for longer periods C. Instructions about when the child should return for a workup for a kidney transplant D. Phone numbers to reach the nurse on the unit so the parents may call if there are any questions

A

What findings are commonly observed in the child who is in the acute phase of acute glomerulonephritis?

Hematuria and proteinuria

second most common childhood infection

UTIs

The nurse is assessing a toddler with vesicoureteral reflux. which clinical finding would the nurse expect to identify? a. dysuria b. oliguria c. glycosuria d. proteinuria

a

The nurse is reviewing the laboratory report of an adolescent child with nephrotic syndrome. which would the nurse expect analysis of the child's urine to reveal? a. high protein level b. low specific gravity c. numerous red blood cells d. several crystalline particles

a

Which electrolyte, if found on urinalysis, would alert the nurse to the possibility of kidney damage? a. protein b. calcium c. potassium d. phosphate

a

the kidneys grow to an adult size by ________

adolescence

what populations are most at risk for nephrotic syndrome

african american and latino

which is the best indicator of kidney function in a toddler with the diagnosis of nephritic syndrome? a. urine output b. daily weights c. abdominal growth d. improved appetite

b

- protrusion of the bladder through abdominal opening resulting from failure of fusion in utero - bladder tissue exposed in combo with an epispadias - urine leaks from ureters onto skin - surgical repair within 48 hrs

bladder extrophy

A 4-month-old infant is brought to the emergency department after 2 days of diarrhea. The infant is listless and has sunken eyeballs, a depressed anterior fontanel, and poor tissue turgor. The infant's breathing is deep, rapid, and unlabored. The mother states that the infant has had liquid stools and no obvious urine output. What problem does the nurse conclude that the infant is experiencing? a. kidney failure b. mild dehydration c. metabolic acidosis d. respiratory alkalosis

c

A 9-year-old child is admitted to the pediatric unit with a diagnosis of acute glomerulonephritis. What does the nurse expect the admission urinalysis to reveal? a. polyuria b. ketouria c. hematouria d. bacteriuria

c

gradual and progressive loss of kidney function

chronic renal failure

intestine pushes through abdominal wall into inguinal canal; may need surgical correction

inguinal hernia

excessive protein loss in urine glomerular membrane becomes permeable to proteins (fluid shifts from plasma to interstitial spaces) - edema, massive proteinuria, hypoabuminemia, hypoproteinemia - hyperlidipedmia - altered immunity

nephrotic syndrome

- structural or functional abnormalities that interfere with muscle movement (peristasis) of urine from kidneys to bladder - narrowing causes reflux (back into kindyes) - may be acquired, unilateral, bilateral, complete, or incomplete

obstructive uropathy

pain, inflammation, and hanging of the scrotum; scrotum may become immobile in absence of cremasteric reflex

testicular torsion

the testis rotates on spermatic cord and cuts off blood supply - emergency condition - must be reduced in _______ hours - most often before 25 yrs.

testicular torsion, 4-6

how do you decide if something is an inguinal hernia or a hydrocele

transillumination

T/F: children have less bladder control d/t immature nerve development

true

bacterial illness where urinary pathogens invade the bloodstream

urosepsis

elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle

varciocele

- backflow of urine from the bladder into the ureters - commonly mistaken as a UTI - graded as I to IV based on severity of reflux

vesicoureteral reflux

assesses bladder function after fluoroscopy to assess for reflux of urine

voiding cystourethrogram

symptoms of cystitis

- hematuria - urinary frequency - dysuria - bed wetting - strong urine odor - flank pain

diet for nephrotic syndrome

- high calorie - low sodium - ca+ supplements

S&S of hemolytic uremic syndrome:

- irritabiltiy - fever - gastroenteritis (N/V, bloody diarrhea) - abd pain - rash

S&S of chronic renal failure

- low urine output - fatigue - nausea - HA - wt. loss - edema - growth retardation - dry/itchy skin - joint/bone pain

S&S of nephrotic syndrome

- malaise - irritability - decreased output - dark urine (frothy from protein loss) - HTN - tachycardia - thrombosis - anorexia, abd pain - N/V - diarrhea - pallor - edema - respiratory distress

postoperative care for hypospadius/epispadius includes:

- protect surgical site from injury - urine will be blood tinged for several days - double diapering to protect stent - promote adequate hydration (risk of clot from stent)

An adolescent has pain, swelling, and inflammation of the testis; abdominal pain; and occasional immobilization of the scrotum. Which condition does the adolescent likely have? a. varicocele b. epididymitis c. testicular torsion d. testicular cancer

c

which clinical findings are associated with nephrotic syndrome (NS) rather than acute glomerulonephritis (AGN)? select all that apply. a. lethargic and appears unwell b. gross hematuria c. generalized edema d. massive proteinuria e. unchanged blood pressure

c,d,e

- testosterone deficiency - absent/defective testis - narrowing of inguinal canal can all cause

cryptorchidism

failure of one or both testes to descend - often accompanied by inguinal hernia - majority spontaneously descend by 3 months of age

cryptorchidism

UTI involving lower UTI, bladder, & urethra

cystitis

_____ is a UTI treated within 5-7 days of ATB. ____ is a UTI treated within 7-10 days of ATBs, IVs, antipyretics

cystitis, pyelonephritis

A client with recurrent episodes of nausea, vomiting, and abdominal pain arrives at the hospital. Assessments by the primary health care provider reveal that the cremasteric reflex is absent, and emergency surgery is performed. Which is the likely diagnosis? a. variocele b. epididymitis c. penile neoplasia d. testicular torsion

d

To evaluate kidney function, the nurse must accurately measure the hourly urine output of a 1½-year-old toddler weighing 22 lb who has been admitted with extensive burns. What is the minimum safe output per hour for a child this age? a. 61 to 80 mL b. 41 to 60 mL c. 21 to 40 mL d. 10 to 20 mL

d

which is a complication that may develop in the child with hypospadias with chordee? a. renal failure b. testicular cancer c. testicular torsion d. sexual difficulties

d

does an increased BUN show an increased or decreased ability to eliminate waste/concentrated serum

decreased

inflammation of the epididymis as a result of bacterial infection, chemical irritant, or local trauma; no abdominal pain is associated with the testicular pain

epididymitis

urethral discharge, dysuria, fever, and pyuria are signs of

epididymitis

- urethral opening is located on upper surface of penis (dorsal) - in conjunction with bladder extrophy (MILD VERSION)

epispadius

T/F: all of a child's nephrons aren't present at birth

false

T/F: you can still administer potassium if you don't know the renal function

false

what will the urine of a UTI look like

hazy, cloudy

dialysis of the blood to remove toxic substances or metabolic wastes from the bloodstream - H2O restriction - low phos/k+ - painful (cramps, N/V, access) - access: fistula, graft, perm cath - less responsibility, less freedom

hemodialysis

- renal disorder that's most common cause of acute renal failure - no confirmed agent - critical care patients - 6mon-3yrs - 1-7 days manifestation - triad of symptoms: thrombocytopenia, hemolytic anemia, acute renal failure

hemolytic uremia syndrome (HUS)

E. coli, ground beef, and un-pasteurized apple juice, public pools, and alfalfa sprouts are thought to cause

hemolytic uremic syndrome

fluid-filled mass in scrotum.; usually resolve by 1-2 yrs. no surgery req.

hydrocele

abnormal condition of water in the kidney

hydronephrosis

narrowing of the kidneys during obstructive uropathy causes reflux of urine into the kidneys. this often causes ________

hydronephrosis

- urethral opening is on the undersurface of the penis, instead of at its tip (ventral) - in conjunction with chordee (shortage of skin) - interferes with ability to stand/void/sexual function - more severe version

hypospadius

does creatinine increase or decrease with poor renal function/muscle breakdown (trauma, MI)

increase

direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply

intrarental failure

assesses renal structure/blood flow after IV dye is injected

intravenous pyelogram

for specific gravity (1.01-1.03), the lower the specific gravity goes, the less substance you have in it so it's a ______ color in a higher number, it's more concentrated and a _____ color

lighter, darker

types of diet for a child with glomerulonephritis

low-sodium, low-potassium

- dialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood - non-painful (8-10hrs per night) - more responsibility & more freedom - low phos - NO H2O restriction

peritoneal dialysis

renal disorder that occurs 8-14 days after a skin/throat infection - occurs most in males - 2-12 yrs - impetigo/strep throat - 50% asymptomatic - protein and blood loss - immunocompromised

post-infectious glomerulonephritis

sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury

postrenal failure

blood can't get to kidneys (dehydration, shock, hemorrhage)

pre-renal failure

what would you want a urinalysis (UA) to be negative for?

protein, glucose, bilirubin, ketons, nitratres

UTI involving upper ureters, renal pelvis, renal parenchyma

pyelonephritis

how would you obtain a sterile specimen for a urinalysis with C&S?

straight cath or obtain from foley tubing

may or may cause pain, and nodular mass-like structures present in the scrotum

testicular cancer