GU and Renal Conditions

The nurse is caring for a newborn with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response?

"Circumcision is an option, but it cannot be done at this time." surgery may use the foreskin

How to calculate BP in kids

"Normal BP"= 90 + (2x kids age)

normal urine output for kids

1 ml/kg/hr

Renal conditions labs

BUN, Cr, GFR, CMP

GU labs

BUN, Cr, eGFR, CMP, creatinine clearance UA, urine culture, blood culture (if severe) tox screen (for drugs, or ingestion of chemicals)

nephrotic syndrome

Damage to Glomerular basement membrane → loss of protein in urine & accumulation of extravascular fluid Accumulation of fluid in extravascular space: outside vasculature Congenital, secondary (ex: lupus, chemotherapy, etc.), Idiopathic

Urinary tract infection etiology

Gram-negative enteric (Ex: E. Coli) , Gram-positive bacteria (Ex: Staphylococcus) Girls (i.e. vaginas) > Boys (i.e., penises) Urinary retention/ stasis Constipation

HTN in kids and adults

HTN in kids=think kidney issues HTN in adults=think cardiac issues

Acute renal injury labs

Inc BUN, Cr, K dec GFR, Na

nephrotic syndrome labs

Inc BUN, Cr, lipids dec albumin

Which combination of signs is commonly associated with glomerulonephritis?

Mild proteinuria, hematuria, decreased urinary output, and lethargy

A child had a UTI 3 months ago and was treated with an oral antibiotic. A follow-up urinalysis revealed normal results. The child has had no other problems until this visit when the child is complaining of burning with urination. Which is the most appropriate plan? Select apply that apply.

Obtain urinalysis and urine culture Send the patient home with an antibiotic if UA is positive

Glomerularnephritis

Post infection glomerular inflammation → decreased ability to filter -glomerular leakage of proteins -water & sodium retention

Potassium and kidney issues

Potassium high in kidney issues =low or no K in fluids/food/meds

UTI labs

UA, urine culture

How to collect urine

Ubag urine cup (clean catch-clean outer genitalia, or regular collection) straight catheter: sterile, for collection of urine in bladder, go through urethra, in drug tox indwelling catheter/foley: balloon gets inflated once catheter is inside urethra to hold it in place, look at urine output over time, after surgery, cancer treatment *consider patient hx of abuse, restraints make sure another nurse is in the room during catheter insertion

Which is the best way to obtain a urine sample in an 8-month-old being evaluated for a UTI?

Using a straight catheter, obtain the sample, and immediately remove the catheter without waiting for the results of the urine sample

Antidieuretic Hormone (ADH)

a hormone released from the pituitary gland that causes water absorption in the kidneys thus concentrating the urine inc permeability of membrane to retain fluid

GU assessment

anatomic differences urine: color, odor, apparence - amber color, red, brown (kidney injury) -foul smell (infection and STIs) -cloudy (infection) -blood clots/tissue sediment

UTI treatment

broad spectrum antibiotics *depends on culture education on hydration and not holding urine pyelonephritis: IV antibiotics

Obstructive Uropathies

congenital abdominal wall defect-bladder external, urinary tract malformations goal: urinary continence staged surgical corrections wound and skin care: keep moist family support! infection risk is high!

hypospadias

congenital abnormality in which the male urethral opening is on the undersurface (ventral) of the penis, instead of at its tip corrective surgery done around 18 months

Glomerularnephritis late/chronic symptoms

edema: facial, periorbital, peripheral hypertension urine: hematuria, proteinuria, cloudy, foamy

nephrotic syndrome signs

facial, periorbital, peripheral edema, ascites hypo/hypertension urine:proteinuria, dark, frothy

UTI symptoms

fever irritability foul smelling urine painful urination bedwetting/enuresis pyuria (WBC in urine)-may need urine culture pyelonephritis: high fever, flank pain

Role of the kidney

filtration: plasma pushed from glomerulus into Bowmans capsule reabsorption: filtered plasma reabsorbed into circulation secretion: intravascular content from circulation added to filtered content excretion: what is left is after these processes

Glomerularnephritis labs

inc BUN, Cr Positive culture for strep

Why do infants have low GFR?

infants have immature kidneys

Glomerularnephritis management

medications: diuretics, anti-hypertensives fluid restriction: strict I&O possible sodium/potassium restrictions (in food, fluids, meds)

Acute renal injury signs

oliguria (<1 ml/kg/hour) swelling due to fluid retention N/V: metabolic acidosis fatigue, shortness of breath

A 4-week-old infant presents to the clinic with a temperature of 38.5C, fussiness, decreased appetite, and normal physical examination. Which is the next management step? Select all that apply.

perform a urinary catheterization administer acetaminophen

Glomerularnephritis acute/early symptoms

puffiness of face in the morning blood in urine/brown urine urinating less than usual may have shortness of breath/high blood pressure

nephrotic syndrome management

renal biopsy medications: steroids, immunosuppressants sodium restriction relapse potential albumin/furosemide: makes someone pee, reduce edema antihypertensives strict I&O management

GU problems

risk for infection risk for fluid imbalance family adjustment when kid cant use the bathroom child development (can pull catheter out)

Acute renal injury etiology

severe dehydration, recent surgery, trauma (MVA, falls, recent surgery injuring kidney) glomerulonephritis, hemolytic uremic syndrome, high blood sugar, high blood pressure, exposure to toxic solvents or heavy metals, chemo, antivirals though IVs, recent infection tumors (Wilms'), stones is usually reversible

GU interventions

strict I&O catheter care post surgical care

Renal conditions interventions

strict I&O dietary and potential fluid restrictions daily weights blood pressure management

Acute renal injury management

treatment of underlying cause prevent further kidney damage fluid management- I&O dietary: low K, Na, protein hypertension management may need dialysis

Renal conditions nursing assessment

vital signs mental status: confusion, lethargy, appetite fluid balance: edema perfusion: cap refill urine analysis: visual/lab