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functions of the kidneys
maintains constant composition & volume; produces erythropoietin; produces renin
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the primary responsibility of the kidneys is to:
maintain the composition/volume of the body fluids in equilibrium
-
functional unit of kidney
nephron
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rate at which blood is filtered into Bowmann's capsule
Glomerular Filtration Rate (GFR)
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drains Bowman's capsule
proximal convoluted tubule
-
urine is concentrated
Loop of Henle
-
relatively impermeable to water
distal convoluted tubule
-
final concentration of urine
collecting duct
-
Low set ears are often associated with ____ abnormalitities
GU abnormalities
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Glomerular filtration and absorption do not reach adult values until ___ to ___ years old
1 to 2
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Urinary tract infection is more common in what gender?
Girls
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Dysuria, frequent urination, urgency, suprapubic discomfort/pressure, abdominal/flank pain are symptoms of what?
Urinary tract infection
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Pediatric manifestations of UTIs
Frequency, fever, odiferous urine, blood in urine
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Nursing assessment of UTI's include assessing for:
nausea, vomiting, anorexia, chills, nocturia, urinary frequency, urgency
Also: suprapubic/lower back pain; bladder spasms, dysuria, buring on urination
-
Objective data for UTIs
fever, hematuria, foul-smelling urine, tender, enlarged kidney; leukocytosis, bacteria, WBCs, RBCs, pyuria, ultrasound, CT scan, IVP
-
ph is normally ___ to ___
5 to 8
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Specific gravity:
1.001 to 1.030
-
Protein should be less than ?
20 mg/dL
-
Urobilinogen up to ?
1 mg/dL
-
newborn production of urine is about ___ to ___ mL/kg/hour
1 to 2
-
Child production is about ___ mL/kg/hr
1
-
___ tract infection involves renal parenchyma, pelvis, ureters; typically causes fever, chills, flank pain
Upper
-
___ tract involves lower urinary tract; usually no systemic manifestations
Lower
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Classification of lower UTI's
Cystitis; urethritis
-
Upper tract classification:
Pyelonephritis, VUR, glomerulonephritis
-
bacteriuria despite antibiotics
persistent UTI
-
indicates pyelonpehritits
febrile UTI
-
bacterial illness; urinary pathogens in blood
urosepsis
-
Nursing considerations for UTIs:
teach use of antibiotics; adequate fluid intake; avoid caffeine; good hygiene; prevention
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Retrograde flow of bladder urine into ureters; increases potention for infection
Vesicoureteral reflux
-
results from a congenital anomaly that affects the ureterovesical junction
primary reflux
-
result of an acquired condition
secondary refulx
-
inflammation caused by bacteria, fungi, protozoa, or viruses infecting kidneys
Acute pyelonephritis
-
Systemic infection from urologic source; can lead to septic shock and death in 15% of cases
Urosepsis
-
N/V, anorexia, chills, nocturia, frequency, urgency, suprapubic/low back pain, dysuria, fever, hematuria, foul-smelling urine are presenting symptoms of:
acute pyelonephritis
-
____ may be used for recurrent acute pyelonephritis
Prophylaxis
-
Symptoms of glomerulonephritis:
Generalized edema, oliguria, HTN due to ECF, hematuria, proteinuria
-
noninfectious renal disease (autoimmune); onset 5 to 12 days after other infection; most commin in children 6 to 7 years old; hemolytic streptococci
Acute Post Streptococcal Glomerulonephritis
-
ASPG will have increased what? (Diagnosic tests)
BUN, creatinine, ASO titers, C-reactive protein
-
manage edema of APSG by:
accurate I&O, daily weights, daily abdominal girth
-
Nutrition for APSG:
low sodium, low to moderate protein
-
Most common presentation of glomerular injury in children
Nephrotic Syndrome
-
5 characteristics of Nephrotic Syndrome:
Proteinuria, hypoalbuminemia, hyperlipidemia, edema, masive urinary protein loss
-
With nephrotic Syndrome, the glomerular membrane becomes:
permeable to proteins, especially albumin
-
Fluid shifts in nephrotic syndrome from plasma to interstitial spaces, causing:
Hypovolemia, ascites
-
Diet for nephrotic syndrome management:
Low to moderate protein, sodium restrictions
-
Drugs used for nephrotic syndrome management
Steroids (prednisone), immunosuprressant therapy (Cytoxan), Lasix, Albumin
-
Some side effects of Cytoxan include:
Leukopenia, severe nausea/vomiting, loss of hair, sterility in males
-
3 major nursing inverventions for nephrotic syndrome:
Prevent infection, ensure adequate fluid intake, discharge to home instructions
-
a protrusion of a portion of an organ through an abnormal opening
Hernia
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80% of hernias are what type?
Inguinal
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Manifestations of inguinal hernia includes:
partial obstruction of intestines, incarceration, strangulation, gangrene
-
Presence of fluid in processus vaginalis
Hydrocele
-
Scrotum appears enlarge, especially after activity in childhood; surgical repair in some cases
Hydrocele
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Narrowing of stenosis of preputial opening of foreskin, preventing retractin of foreskin over the glans
Phimosis
-
Normal in infants/young children, usually disappears as child grows
Phimosis
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Inflammation of foreskin
Balanitis
-
retracted foreskin cannot be replaced to normal position
Paraphimosis
-
Expect natural retraction of foreskin in what age?
5 to 10 years
-
undescended, retractile, abcense of testes (33% in preterm males, 3 to 4% in full-term males)
Cryptorchidism
-
prevents damage to undescended testes; decreases incidense of malignant formations; avoid trauma/torsion
Orchiopexy
-
Urethral opening of male is located below the glans or underneath the penile shaft/ about 1 out of 300 live births
Hypospadias
-
ventral curvature of the penis; foreskin may be absent ventrally; hooded or crooked appearance of penis
Chordee
-
Severe defect with externalization of the bladder and associated tissues
Epispadias exstrophy complex
-
Results from failure of abdominal wall to fuse in utero
epispadias exstrophy complex
-
failure of uretheral canalization
epispadias
-
defect on the dorsal surface of the penis
Glandular Epispadias
-
Therapeutic goals of epispadias management (5)
Preserve renal function, attain urinary control, repair for psychologic benefit, prevent UTIs, preserve optimum external genitalia with continence and sexual function
-
Correction of exstrophy of the bladder, correct pelvic diastasis, correct hernias is stage __ of surgery of epispadias exstrophy complex
1
-
Repair of epispadias and creation of urethral sphincter is stage ___ of surgery of epispadias exstrophy complex
2
-
3 nursing considerations for epispadias exstrophy complex:
Challenging preoperative care, prevent infection, family support for emotional impact of the defect
-
Clinical manifestations of obstructive uropathy: (5)
Depends on location of lesion; may be asymptomatic; may cause UTIs; may have abdominal mass; may produce "renal colic"
-
therapeutic management of obstructive uropathy:
Transient/permanent urinary diversion in some situations; endoscopic procedures; prognosis variable depending on the defect
-
abnormalities of chromosomal complement; defects of embryogenesis; hormonal/biochemical abnormalities
Ambigous Genitialia
-
4 conditions that produce ambigious genitalia in the newborn:
masculinized female; incompletely masculinized male; presence of male and female organs; mixed gonadal dysgensis
-
Most common type of ambiguous genitalia; inherited deficiency of adrenal-cortical hormones, masculinization of external genitalia with normal internal female anatomy, life threatening alteration of adrenal-cortical hormones
Congenital Adrenogenital Hyperplasia (CAH)
-
Potential Causes for masculinized male:
Deficient production of fetal androgen; deficiency of enzymes needed for testosterone biosynthesis; unresponsiveness of genitalia to testosterone
-
Infants are sex chromosome mosaics; genitalia vary greatly; those appearing predominately female but have dysplastic testis may experience masculinization at puberty
Mixed Gonadal Gysgenesis
-
The most significant ongoing assessments in children with renal conditions are accurate measurement/recordings of (4)
Weight, Intake, Output, BP
-
failure of 1 or both testes to descend normall through the inguinal canal into scrotum
cryptochidism
-
Occurs when connection between kidney and ureter is blocked, urine cannot flow out of the kidney, which causes kidney to swell
Hydronephrosis
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