Genitourinary Alterations (8 questions!)

b) Eyes Periorbital edema may accompany or precede hematuria in children with acute glomerulonephritis. Edema in the ankles, hands and sacrum are not noted in acute glomerulonephritis.

A symptom often seen in acute glomerulonephritis is edema. The most common site the edema is first noted is in which area of the body? a) Sacrum b) Eyes c) Hands d) Ankles

Severe Dehydration (can make kidneys shut down) AGN (Acute glomerulonephritis) (Glo- mara-yu-nuh-fri-tis) HUS (Hemolytic uremic syndrome)

Acute Kidney Injury (AKI) or Acute Renal Failure common causes

3-5 days

How many days of Antibiotics should the child be on for UTI?

Urine Specimen 1. + nitrates 2. + bacteria/ Urine Culture 3. Hematuria 4. WBC in urine

How would you diagnosis UTI?

-SURGERY WITHIN 4-8 HOURS (BEFORE THEY LOSE THEIR TESTICLE) ON THE TEST! -Ultrasound for diagnosis preop -Postoperative care

Intervention/ Testicular Torsion

●Burning ●Urgency ●Odor

Signs of UTI in older child

HUS (hemolytic uremic syndrome)

This occurs because of E coli infection, or viral 0157 h7 a. AGN b. UTI c. HUS d. Testicular torsion

Acute glomerulonephritis (Glo- mara-yu-nuh-fri-tis)

This occurs because of a Group A Beta Hemolytic Strep- 8-21 days after (Strep throat)

-Support parents -Administer medications -Monitor nutritional intake and fluid intake and output -Collaborate with health care team to prevent complications

Treatment/Care Kidney failure/ Injury

-Urinalysis - hematuria/proteinuria -Blood chemistry - usually normal -If renal insufficiency BUN and creatinine will be elevated -ASO titer (antistreptolysis) - elevated -Possible renal biopsy

What are some diagnosis for AGN?

Kidneys, Ureters (upper) Bladder, Urethra (lower)

What do the Genitourinary consist of?

Hematuria ( Bloody urine) Also will have , proteinura, edema, renal insufficieny

What is the first sign a parent will notice in Acute Glomerulonephritis ?

Keep an eye on the kidney function, and blood pressure ●Supportive care/medical management ●May need antibiotics/hospitalization if showing renal failure ●Antihypertensives - limit water and salt ●Excellent prognosis

What is the intervention for AGN?

-Hemodialysis/peritoneal dialysis -Treat with blood products (PRBCs, platelets) -Treat other symptoms

What is the management for HUS?

pyelonephritis (pie-uh-low-nuh-fry-es)

kidney infection. UTI that involves the kidneys

true

vesicoureteral reflux is a reason why a child will have UTI True or false

Fecal bacteria

Which bacteria is most common in UTI.

Outer cortex

-Composed of the glomeruli and convoluted tubules of the nephron and blood vessels

Inner medulla

-Composed of the renal pyramid

concentrate

-Young children cannot_____________________ urine as well as adults

shorter

-Young children have________________ urethras which predispose them to UTI

a) The foreskin is needed for repair. A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement.

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse? a) The foreskin is needed for repair. b) Circumcision is usually performed after 1 year old. c) Circumcision with a hypospadias will cause meatal stenosis. d) The circumcision may predispose the child to renal failure.

Renal Ultrasound VCUG

All males with first UTI and females under 5 years old have to get what kind of test?

NO CIRCUMSION

Can a child have a circumsize if they have epipadias or hypospadias

-Surgical repair; orchiopexy done at age 6 months (better outcomes) -Instruct caregiver to have the child wear loose clothing and use analgesics as ordered -Instruct caregiver to observe for erythema, purulent discharge, fever, and increased pain at the incision site (indicative of infection) -Instruct caregiver to change diapers more frequently and avoid having the older child engage in sports or straddle riding toys that might injure the surgical site

Treatment/ Cryptorchidism (Crip-tor--it-diz-em)

-Surgery (reimplanting the ureter) -Medical management (antibiotics and anticholinergic agents) -Educate the parents about signs and symptoms of UTI and the importance of medication -Postsurgical—manage intake and output, pain control and infection

Treatment/Care Vesicoureteral Reflux (VUR)

●toddler girl undergoing toilet training, sexually active adolescents, uncircumcised males <1

UTI's are more common in who?

●Anemia, thrombocytopenia and renal failure is sufficient for diagnosis ●Oliguria - with proteinuria, hematuria and increased BUN and creatinine -Marked pallor from anemia -Bruising, petechiae, jaundice, bloody diarrhea -CNS symptoms - seizures, coma

What are we noticing in HUS?

-Neonate—scrotum appears dusky colored, a solid mass is palpated, scrotal edema, and minimal pain -Older males—severe and persistent scrotal pain

What are we noticing in a neonate and older male with testicular torsion?

-operation around 12 mo; always before 5 yrs Normally before a child start school and pee in front of others

When should a child get surgery for epipadias or hypospadias?

Vesicoureteral Reflux (VUR)

the backward flow of urine into the ureters from the bladder

Cryptorchidism (Crip-tor--it-diz-em)

undescended testicles. -A retractile testis has descended but retracts with exam and physical stimulation -An ectopic testes is outside of the normal pathway

UTI

●Caused by ascending bacteria from the urethra to the upper urinary tract except in newborns. -Then it is caused by bacteria in the blood which migrated into the kidneys

AGN (Acute glomerulonephritis) (Glo- mara-yu-nuh-fri-tis)

●Inflammation of the glomeruli of the kidney

Epispadias

●opening is above the normal placement

Hypospadias

●opening of the urethral meatus is below the normal placement

a) Recent illness such as strep throat

A child diagnosed acute glomerulonephritis will most likely have a history of which of the following? a) Recent illness such as strep throat b) Hemorrhage or history of bruising easily c) Sibling diagnosed with the same disease d) Hearing loss with impaired speech development

c) Administer the IV fluid slowly If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to replace plasma volume. Administer such fluid slowly, however, to avoid heart failure as extra fluid cannot be removed by the nonfunctioning kidneys.

A 10-year-old girl is experiencing acute renal failure due to dehydration. The nurse is preparing to administer IV fluid. Which of the following interventions should the nurse take in caring for this child? a) Increase oral intake of fluid b) Provide a diet high in protein and sodium c) Administer the IV fluid slowly d) Make sure the IV fluid contains potassium

c) some discomfort at the surgery site. After they are returned to the scrotum, testes may be sutured there to prevent them from returning to the abdominal cavity. This produces a "tugging" or painful sensation. Increased pain indicate infection. Wear loose clothes

A 3-year-old is scheduled for a surgery to correct undescended testes. An important postoperative consideration you would want to prepare his parents for is a) a liquid diet for 3 days. b) the need for maintaining a semi-Fowler's position. c) some discomfort at the surgery site. d) the need for complete bed rest for 10 days.

c) Orchiopexy to correct the condition -Surgical repair; orchiopexy done at age 6 months (better outcomes)

A 6-month-old boy is found to have undescended testes. The parents are concerned. Which of the following should the nurse anticipate as the next step for this client? a) Administer a short course of chorionic gonadotropin hormone for about 5 days b) Wait a year or two to see whether the testes will descend on their own c) Orchiopexy to correct the condition d) Karyotyping to establish the client's gender

a) Creatinine clearance rate

A child is being evaluated for renal and urinary tract disease. Which of the following would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? a) Creatinine clearance rate b) Kidneys, ureter, and bladder x-ray c) Computed tomography scan d) Urinalysis

d) Creatinine clearance

A child needs to collect urine for 24 hours and the nurse explains that this test assesses glomerular filtration rate and how the kidneys are functioning. Which of the following would be indicative of this type of test? a) Microscopic studies for RBC casts b) Urine culture and sensitivity c) Urinalysis for casts and bacteria d) Creatinine clearance

d) This occurs when there is backflow of urine into the bladder and sometimes kidneys. The cause of VUR is a backflow of urine into the bladder and possibly kidneys. This disorder can occur if there is an obstruction, but not always. The way to determine if a child has VUR is typically by a VCUG diagnostic test. There are five different grades to VUR and it is treated according to the cause and degree of VUR.

A nurse is providing education to parents of a child diagnosed with vesicoureteral reflux (VUR). Which of the following would be included in the education? a) This occurs only when there is an obstruction of the ureteropelvic junction. b) This is diagnosed by abdominal x-ray. c) This is typically treated with a kidney transplant. d) This occurs when there is backflow of urine into the bladder and sometimes kidneys.

b) There is a chance the testicles will descend on their own. The AAP recommends surgery at 1 year of age if the testicles have not descended on their own. There is a chance they may descend on their own prior to 1 year old. This problem does not cause pain or swelling.

A parent asks if their newborn's undescended testicles will need surgery to repair. What is the best response by the nurse? a) Surgery is not needed for this type of problem. b) There is a chance the testicles will descend on their own. c) This problem needs to be corrected immediately in the newborn period. d) If the infant is having swelling or pain, then surgery will be performed.

c) The VCUG will rule out VUR.

A voiding cystourethrogram (VCUG) is ordered on a child. What education should be provided to the parents? a) The VCUG will prevent further complications of UTI. b) The VCUG will rule out kidney stones. c) The VCUG will rule out VUR. d) The VCUG will detect if the infection is gone.

-Fever w/o focus -Abd pain -Poor feeding -Irritability

Signs for UTI in an infant/ toddler. Select all that apply a. Fever b. abdominal pain c. polyuria d. urgency e. poor feeding f. irritability

-Fever rash, bloody diarrhea, pallor, vomiting, diarrhea, abdominal pain, hemorrhage, shock (b/c dehydration) anuria, or polyuria

Signs of Acute Kidney injury/ failure

Recurrent UTI Flank Pain Abdominal Pain Enuresis (Bedwetting) (an-u-ree-sis)

Signs of Vesicoureteral Reflux (VUR)

Same as UTI , also , 1. High Fever/ Chills 2. Back pain 3. Nausea/ Vomit 4. Very ill 5. Costovertebral angle tenderness

Signs of pyelonephritis (pie-uh-low-nuh-fry-es) Select all that apply. a. Fever b. oliguria c. back pain d. nausea/vomit e. dehydrated f. Costovertebral angle tenderness

b) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to do which of the following actions? a) Give the child fluids and report back to the nurse in a few hours. b) Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. c) Give the child a diuretic and report back to the nurse in a few hours. d) Weigh the child in the same clothes she had been weighed in the day before and report the two weighs to the nurse while the nurse is on the phone.

c) Acute glomerulonephritis Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also complains of a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100 degrees Fahrenheit. The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have a) Rheumatic fever b) A urinary tract infection c) Acute glomerulonephritis d) Lipoid nephrosis (idiopathic nephrotic syndrome)

d. Hypospadias Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present when the urethral opening is on the dorsal surface of the penis.

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. The nurse documents this finding as which of the following? a) Bladder exstrophy b) Patent urachus c) Epispadias d) Hypospadias

a) Smoky colored urine The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as smoky or bloody.

The nurse is caring for a child admitted with acute glomerulonephritis. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Smoky colored urine b) Jaundiced skin c) Strawberry red tongue d) Loose, dark stools

b) The child recently had an ear infection.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. Which of the following would the nurse likely find in this child's history? a) The child had a congenital heart defect. b) The child recently had an ear infection. c) The child is being treated for asthma. d) The child has a sibling with the same diagnosis.

a) Blood Pressure 136/84 Hypertension appears in 60% to 70% of patients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis.

The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which of the following vital signs would the nurse anticipate with this child's diagnosis? a) Blood Pressure 136/84 b) Respirations 24 per minute c) Pulse rate 112 bpm d) Pulse oximetry 93% on room air

Uretha are much longer

Why are boys unlikely to get a UTI?

b) Dark brown urine Acute glomerulonephritis often presents with glomeruli bleeding, which is revealed as black or brown urine from old blood.

You obtain a history from the mother of a child with glomerulonephritis about how he became ill. Which of the following would you expect her to tell you she noticed? a) Headache, loss of appetite b) Dark brown urine c) Loss of weight, oliguria d) Diuresis and pallor

1.Promoting bed rest Bed rest is required during the acute phase, and activity is gradually increased as the condition improves.

The nurse is creating a plan of care for a 10-year-old child diagnosed with acute glomerulonephritis. What is the priority nursing intervention? 1.Promoting bed rest 2.Restricting oral fluids 3.Allowing the child to play 4.Encouraging visits from friends

1.Encourage limited activity and provide safety measures. Glomerulonephritis is a term that refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus. In glomerulonephritis, activity is limited, and most children, because of fatigue, voluntarily restrict their activities during the active phase of the disease.

The nurse is developing a plan of care for a 6-year-old child diagnosed with acute glomerulonephritis. The nurse should include which priority intervention in the plan of care? 1.Encourage limited activity and provide safety measures. 2.Catheterize the child to monitor intake and output strictly. 3.Encourage the child to talk about feelings related to illness. 4.Encourage classmates to visit and to keep the child informed of school events.

a) Regulate blood pressure Functions of the kidney include regulating blood pressure by making the enzyme renin and also making erythropoietin, which helps stimulate the production of red blood cells. The kidney also excretes excess water and waste products and maintains a balance of electrolytes and acid-base.

The nurse is doing an in-service training with a group of peers on the topic of the genitourinary system. Which of the following is a major function of the kidneys? a) Regulate blood pressure b) Produce white blood cells c) Circulate cerebrospinal fluid d) Remove carbon dixoide

a) Sudden onset of severe scrotal pain with significant hemorrhagic swelling

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate testicular torsion? a) Sudden onset of severe scrotal pain with significant hemorrhagic swelling b) Enlarged inguinal glands and fever c) Fever, scrotal swelling, and urethral discharge d) Hardened and tender epididymitis with edema and erythema of scrotum

c) The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

The nurse knows which of the following is a description of peritoneal dialysis when compared to hemodialysis? a) The child must go into a facility to get peritoneal dialysis. b) There are strict diet and fluid restrictions. c) The child can live a more normal lifestyle. d) Therapy is only 3 to 4 days per week.

4."I'll let him decide when to return to his play activities.

The nurse provided discharge instructions to the parents of a 2-year-old child who had an orchiopexy to correct cryptorchidism. Which statement by the parents indicates the need for further instruction? 1."I'll check his temperature." 2."I'll give him medication so he'll be comfortable." 3."I'll check his voiding to be sure there's no problem." 4."I'll let him decide when to return to his play activities.