The Child with Genitourinary Alteration2019

Bladder exstrophy

congenital bladder is developing the abdominal wall does not fully form, leaving the pubic bones separated and the bladder exposed to the outside skin surface through an opening in the lower abdominal wall. requires reconstructive surgery

Hydroureter

congenital dilation of the ureter(s) and is most often caused by obstruction of urine outflow due to blockage of the ureter(s) by calculi, chronic inflammation, luminal or intramural neoplasia, or accidental ligation during surgery. urinary diversion

vulvovaginitis hygiene

cotton underwear

Dx process for enuresis

hx clinical symptoms labs to rule out diabetes and infection

Horseshoe kidney

hydrophrosis can develop (swelling of kidney due to urine build up) surgical repair

What increases child's risk to develop HUS

treatment of blood diarrhea with antibiotics

what is Hypospadias

urethra is at the bottom of the penis rather than the middle

can children with acute renal failure regain normal function

yes, most will

Acute Poststreptococcal Glomerulonephritis

Reaction to group A beta hemolytic strep can also be caused by -pneumococcal -viral infections

vulvovaginitis irritants

bubble bath

acute renal failure can children regain function? common in what age group s/s diagnostic findings management

children can regain renal function common in age group of 6 month to 5 years s/s -electrolyte and acid/base imbalance -hyponatremia (seizure precautions) -increase in BUN, Cr, and specific gravity -anorexia, vomiting, -lethargy - blood diarrhea diagnostic findings -dehydration -oliguria -htn -edema -resp distress management - correct fluid electrolyte imbalance -fluid restriction -dialysis -parent/child education

amt of normal urine output

1-2 ml/kg/hr

How long antibiotics for pyelonephritis

2 week via IV

Nephrotic Syndrome common in children in what ages

2-6

what age do children have bladder control

4-5

therapeutic management of uti

<2 yrs = 10 days abx > 2 = 5 days abx

The mother of a child with chronic renal failure who is receiving peritoneal dialysis at home asks the nurse what she can do if both inflow and drain times are increased. Which of the following would be the most appropriate for the nurse to include when responding to the mother? Assess the child for constipation. Decrease the amount of dialysate infused for each dwell. Incorporate the increase inflow and drain times into the dialysis schedule. Monitor the child for shoulder pain during inflow and drain times.

Assess the child for constipation.

After emphasizing to an adolescent with renal failure the importance of maintaining a positive self-concept, which of the following behaviors by the adolescent should the nurse identify as an indicator the plan is working? Reports of headaches, abdominal pain, and nausea. Insistence on making diet choices even if the foods chosen are restricted. Verbalization of plan to quit all after-school activities when returning home. Demonstration of desired to do the dressing change and take care of the medications.

Demonstration of desired to do the dressing change and take care of the medications. Demonstration of desire to do the dressing changes and manage medications implies compliance with the medical regimen and acceptance of the condition, thereby indicating a positive self-image . Diffuse somatic symptoms could indicate anxiety or problems with coping, with a negative effect on self-concept. Insistence on choosing restricted foods implies that the adolescent has not accepted the diagnosis and is noncompliant, possibly indicating a negative self-concept. Social withdrawal from activities may indicate depression, possibly negatively

Nephrotic syndrome frequent for which age group s/s pathophys diagnostic findings management

Nephrotic syndrome is output of protein in the urine due to glomerular damage s/s -frothy urine -weight gain -edema -hyperlipidemia -asites -fatigue -decrease volume output -proteinuria -hypoabuminemia -normal bp age group -2-6 yrs old pathophys -glomerular damage (permeable to protein) →proteinuria→proteinenemia→→ hyperlipidemia and decreased oncotic pressure → low blood pressure and edema (weight gain/ascites) diagnostic findings -proteinuria -decreased frothy urine -hypoalbuminemia -elevated chol, triglycerides, plts, -normal electrolytes managemement -prednisone (lowers proteinuria) -penicillin prphylaxis -fluid restriction -25% albumin if needed -no added salt diet -monitor temp -diuretics

A 10-year-old with glomerulonephritis reports a headache and blurred vision. The nurse should immediately: Put the client to bed. Obtain the child's blood pressure. Notify the physician. Administer acetaminophen (Tylenol).

Obtain the child's blood pressure. Reason: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the physician before confirming the cause of the symptoms would not assist the physician in his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering Tylenol for high blood pressure is not recommended.

Hemolytic Uremic Syndrome (HUS) common cause of what? caused by? pathophys s/s

common cause of acute kidney failure (able to regain fucntion) 90% caused by e.coli pathophys -damage of the endothelial lining of glomerular arterioles -becomes swollen and occluded with platelets -RBC become damaged and removed by spleen -platelet aggregation with damaged vessels or removal of platelets (leads to thrombocytopenia) s/s -hemolytic anemia -thrombocytopenia (low count in platelets) -acute renal failure

urethra duplication

congenital 2 urethra leads to -recurrent utis requires -surgical correction

An adolescent with a history of surgical repair for an undescended testis comes to the clinic for a sports physical. Anticipatory guidance for the parents and adolescent should focus on which of the following as most important? The adolescent's sterility. The adolescent's future plans. Technique for monthly testicular self-exam. Need for a lot of psychological support.

Technique for monthly testicular self-exam.

The physician orders a urinalysis for a child who has undergone surgical repair of a hypospadias. Which of the following results should the nurse report to the physician? Urine specific gravity of 1.017. Ten red blood cells per high powered field. Twenty-five white blood cells per high powered field. Urine pH of 6.0

Twenty-five white blood cells per high powered field.

predisposing factors of uti

anatomical differences urinary tract obstructions vesico-ureteral reflux (fluid go up ureters) sexual activity

Acute Poststreptococcal Glomerulonephritis when does it occur?

appears in 8-21 days after strep infection

vulvovaginitis comorbidity

diabetes

causes of 2ndary enuresis

diabetes uti constipation emotional distress sexual abuse

vulvovaginitis cause

e coli

Common cause of UTI

e. coli

Acute Poststreptococcal Glomerulonephritis s/s

edema renal insufficiency hematuria proteinuria

congenital genital malformation

espidadias horse shoe kidney urethral duplication hydroureter bladder exstrophy

common condition for children up to the age of 2

fever

when do you need to intervene for potassium levels?

greater than 6

Acute renal failure is associated with which disease

hemolytic urinary syndrome

Why is ped population at risk for urinary tract issues

immaturity of system size of structure

vulvovaginitis etiology

immune disorder

what is vulvovaginitis

inflammation or infection of the vulva and vagina.

what is enuresis

involuntary urination, esp at night

what is the allergy risk hypospadia

latex

Interventions for UTI

maintain hydration monitor for infection med admin parent education

can young infant kidney concentrate urine

no

Can you use interventions for primary enuresis

no, must outgrow

hypospadias dx

physical exam

primary vs secondary enuresis

primary - child bedwets when no potty training secondary - child bed wets after potty training successfully of 3 months

Vesicostomy

procedure in which a small opening is made in the lower abdomen (usually just below the belly button) to allow urine to drain out from a child's bladder. This usually is done when an infant or young child has problems emptying their bladder placed in children with GU structural challenges

Nephrotic Syndrome s/s

proteinuria hypoabuminemia hyperlipidemia edema weight gain bp normal

interventions for enuresis

reassure child limit fluids after supper voide before bed time imagery child record dry adn wet nights reward behavioral conditioning meds

what happens to kidney functions when under stress

reduced function

significance of the spleen

removes broken red blood cells (this scenario is related to HUS)

intervention for severe versicoureteral reflux

surgery

hypospadias interventions

surgical -single surgery -done before toilet training -should not have circumcision for reconstruction -may have temp urinary diversion/stent