GU system Peds exam 2

daily average urine output at birth

15-50 mL

how to maintain adequate output for children

-possible medications - 1-2mL/kg/hr

what does antistreptolysin titer mean?

increased shows recent strep infection

vulvovaginitis

inflammation of the vulva and vagina, pain, odor, pruritus

tx. of AGN

- Goal= preserve renal integrity - may need to be hospitalized - *antibiotics*= tx. infection - *strict I/O* - daily wt. - monitor BP (HTN) - regular diet (possible K and Na restriction - *Diuresis shows improvement* (mobilzing fluid)

Hemolytic Uremic Syndrome (HUS)

- abnormal response to virus/illness/food contaminate *E. Coli* that causes *acute renal failure*

tx. of nephrotic syndrome

- corticosteroids to reduce edema quickly= *prednisone* and within 7-21 days (will reduce proteinuria) - may need up to 1 yr^ - diuretics= massive edema - antibiotics -immunosuppressant tx= to reduce relapse + long term remission ( can be given up to 2-3 mons) *cytoxan and cyclosporine*

tx. of HUS treatment and recovery

- dialysis - blood product transfusion - *maintain normal electrolyte balance, CBC, and output* - most recover completely (if found early/no secondary problems were present)

What does increased ESR lab mean?

- erythrocyte sedimentation rate shows recent strep infection

s/s of AGN

- hematuria, *periorbital* edema> progresses to generalized edema> ascites/ wt. gain./anorexia (lack of appetite) - oliguria, fever

careplan for GU

- monitor intake/output (weighing diapers) - maintain adequate output= medications, catheters, stents( renal or urtheral to keep open) dialysis (last step) - replace electrolytes as necessary

4 main characteristics of nephrotic syndrome

- proteinuria= losing protein in urine r/t increased *glomeruli permeability* -hypoalbuminemia= low in blood due to protein loss -hyperlipemia= increased serum lipids to compensate for protein loss -edema= first sign r/t to decreased protein in blood; *decreased osmotic pressure* causes fluid shift from blood stream to interstitial tissue

presentation of HUS

-hx of gastro or URI with sudden onset of or unexplained *bleeding/bruising* and renal failure

what is GFR rate in infants

30-50% during the first year of life and increases during childhood.

daily average urine output at 2 months

400mL

treatment for cryptorchidism

= *Orchidopexy* sx. bringing down testes into the scrotum sac -sewing of inguinal canal

acute glomerulonephritis (AGN)

= *immune complex dx. * in response to a *previous infection* - usually *group A beta-hemolytic strep* can be staph/pneumococcal - infection is usually an *URI* or *skin* (impetigo)

cryptorchidism

= *undescended testicle(s)* - can result in decreased function of testes> eventually atrophy of gonad> leads to sterility

Hydrocele

= peritoneal fluid in the inguinal canal that cannot be reduced (around testicles/scrotum) - bulge in inguinal/scrotal area - edema worsens by end of day > *gravity filling* - if not reabsorbed= surgery to close defect to prevent further collection of fluid

what is an inguinal hernia?

= protrusion of portion of bowel into the inguinal ring -common in infants due to canal -portion of bowel needs to be fixed tx= surgery

testicular torsion

= testicle is being strangulated> *MEDICAL EMERGENCY* -usually onset /sudden trauma to testicles

what is mittelschmerz

a dull, aching abdominal pain at ovulation means= "midcycle"

The nurse is caring for an infant boy with grade IV vesicoureteral reflux. Which finding would lead the nurse to suspect that hydronephrosis is present?

abdominal mass

diagnosis of HUS

anemia, thrombocytopenia, renal failure ( elevated BUN/Cr/proteinuria/hematuria - plt count will be LOW

Nephrotic Syndrome= Nephrosis

can be caused from AGN cause = *unknown* but can occur with - lupus - DM - allergic response - glomerulonephritis this is a chronic disease (remissions/exacerbations)

dialysis

can be temporary> from possible chemo, etc. to manage electrolyte and fluid status

tx. about corticosteroids

can stunt growth, lead to wt. gain, GI problems, moon face, etc

What does decreased H & H labs mean?

caused from hematuria

What are infants at high risk for ?

electrolyte/volume issues due to immature kidneys - cannot drink water in large quantities can lead to *dehydration*

tx. for testicular torsion

emergency surgery

The nurse is caring for a 5-month-old boy with an undescended left testis. What would the nurse identify as indicative of true cryptorchidism?

testis cannot be "milked" down inguinal canal

vesicoureteral reflux (VUR)

the backward flow of urine into the ureters from the bladder usually due to impairment of the valve between the ureter and bladder or obstruction in the ureter

Candidias discharge

thick, white cheese like discharge

kidney function is not fully mature untul 1-2 years of age

true

Hypospadias and Epispadias

= urethral meatus is *somewhere other than* tip of penis Hypospadias: defect occurs on the ventral aspect of the penis (corpus spongiosum) Hypospadias may be associated with inguinal hernias and undescended testes Epispadias: defect occurs on the dorsal aspect of the penis urethra opens as a groove on the dorsum of the penis

Labs for GU problems

Urine analysis, ^ BUN/Cr/ uric acid Increased ESR and ASO (antistreptolysin titer) decreased H & H

causes of vulvovaginitis

Vulvovaginitis can result from an overgrowth of bacteria or yeast or from chemical factors. Chemical factors include bubble baths, and soaps or perfumes in personal care items like cleansing towelettes

what lab is used to test GFR

creatinine clearance rate

The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which set of assessment findings most likely led the nurse to this conclusion?

hemolytic anemia, thrombocytopenia, and acute kidney injury

urine specimen for 3 y/o

obtaining a clean catch voided urine

what is a good recommendation fluid for infants/toddlers?

pedialyte

Which assessment finding is clinically significant for early nephrotic syndrome?

periorbital edema

Tx for Hypospadias/Epispadias?

pre op= *delay circumcision* so foreskin can be used as tissue Post-op= dressing may be in place for several days - teach about *anti-spasmodic* drugs - possible stent placement

s/s of testicular torsion

severe pain, N/V; sudden onset of pain to groin area

what does increased labs of BUN/Cr/ and uric acid mean?

signs of renal insufficiency

medication for end-stage kidney disease

sodium bicarbonate tablets for correction of acidosis

The nurse is taking a health history of a 12-year-old boy presenting with scrotal pain. Which assessment finding would indicate *testicular torsion*?

sudden onset of severe scrotal pain with significant hemorrhagic swelling