Genitourinary Alterations PEDS

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Sejune
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Genitourinary Alterations PEDS
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2010-11-05 15:31:56
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Genitourinary Alterations PEDS
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Genitourinary Alterations PEDS
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  1. Lower urinary tract infections
    Cystitis, urethritis
  2. Upper UTI
    Pyelonephritis
  3. Creates risk for UTI's
    • Congenital anomalies
    • Stasis
    • Calculi
    • Residual urin
    • Reflux along GU tract
    • Sexual abuse
    • Females
    • Synthetic, tight underwear
    • Wet bathing suits
    • Bubble bat
    • Hot tube
    • Tampons
  4. S/S of UTI
    • Fever 103+
    • Urine frequency
    • Nocturia
    • Dysuria
    • Hematuria
    • Bladder spasm
    • Reddened perinium
    • Discharge
    • Poor feeding
    • Foul urin
    • vomiting
    • diarrhea
    • poor feeding in infants
  5. Bactrim/Septra
    TX for UIT
  6. Amoxicillin (a cephalosporin)
    Tx for UTI
  7. Nitrofurantoin (Macrobid)
    Tx UTI
  8. Cefaclor
    Tx UTI
  9. Analgesics for UTI
    Pyridium
  10. teaching about pyridium
    analgesic, turns urin orange
  11. Keep hydrated
    tx for UTI
  12. Important to change wet diaper to prevent
    UTI
  13. Involuntary voiding
    Enuresis
  14. Neurological developmental delay can cause
    Enuresis
  15. UTI can cause
    Enuresis
  16. Obstruction or small bladder capacity can cause
    Enuresis
  17. Small bladder capacity can cause
    Enuresis
  18. Chronic renal failure can cause
    Enuresis
  19. Polyuria can cause
    Enuresis
  20. Constipation can cause
    Enuresis
  21. Inorganic causes of enuresis
    • Sleeping
    • Sleep disorders (apnea, enlarged tonsils)
    • Elarged tonsils
    • Stress
    • Inappropriate toilet training
  22. Coditioning therapy (bed wetting alarm)
    Tx for enuresis
  23. Ditropan
    Tx for enuresis
  24. Anticholinergic used for enuresis
    Ditropan
  25. Adverse reactions to ditropan
    • dry mouth
    • flushing
    • constipation
    • heat intolerance
    • insomnia
    • blurred vision
  26. Tofranil used for
    treatment of enuresis
  27. Antidepressant used for enuresis
    Tofranil
  28. Decreases dept of sleep during later part of night
    Tofranil
  29. Dry mouth
    Nervousness
    Insomnia
    Changes in personality
    Tofranil
  30. Desmopressin (DDAVP) is used for
    tx of enuresis
  31. ncreases water retention and urine concentration in the renal tubules
    Desmopressin
  32. S/E of desmopressin
    • Headaches
    • Nausea
    • Nasal conestion
    • Nose bleeds
  33. Very importantt to determin organic vs inorganic with
    Enuresis
  34. Backflow of urin from bladder to ureter to kidey due to uretovesical/vesicuretal junction
    Vesicoureteral Refulx
  35. Most common defect of GU tract
    Besicoureteral reflux
  36. Evaluate with repeated UTIs, enuresis, flank and or abdominal pain
    Versicoureteral Reflux
  37. Diagnosis/Treatment for VUR
    • Cystogram or voiding cystourethrogram
    • LT antibiotics
    • Anticholindergics (Ditropan)
    • Prevent UTI
    • Surgery (reimplantation of ureter)
  38. Anti-cholinergic used for treatmetn of VUR
    Ditropan
  39. Tx of Hypospadias
    • Urethral stent or foley
    • Surgery
  40. When should hypospadias be corrected
    @ 18 mo, prior to toilet training and gender ident
  41. Should the child be catheterized with hypospadias?
    Yes, to prevent obstructive flow due to edema
  42. Tx of hypospadias
    • Encourage fluids
    • Analgesics (tylenol)
    • Anticholinergic (ditropan)
    • Antibiotics
    • NO CIRCUCISION
  43. Should hypospadias clients have a circumsion?
    No
  44. Anticholinergic for hypospadia
    Ditropan
  45. Circumcision for epispadias?
    NO
  46. Who usually dectes cryptochoridism?
    by RN or Dr during physical exam
  47. Surgery for cryptochidism
    Orciopexy-surgery to bring testis into scrotum and secure with scrotal fixation without damagin gtesticles
  48. Who has cryptorchidism?
    Premie
  49. Can testes decend on own?
    Yes
  50. Sperm count with cryptochidism
    Decreases
  51. Risk for testic cancer
    increased with cryptorchidism
  52. Surgery to lengthan penis and reconstruction of bladder neck
    Epispadias
  53. Bulging/swelling in scrotum
    Inguinal hernia
  54. May increase in size with crying, straining
    inguinal hernia
  55. Usually not painful
    inguinal hernia
  56. Hernioorhapy
    • Treatment for inguinal hernial
    • Wound covered with protective sealant
  57. Eversion of bladder through abdominal wall
    bladder extrophy
  58. bladder closure
    tx for bladder extrophy
  59. Pelvic bone separation
    tx for bladder extrophy
  60. Inguinal repair
    tx for bladder extrophy
  61. Creation of urethral sphincter
    tx for bladder extrophy
  62. Reconstructive surgery prn
    tx for bladder extrophy
  63. Urethral opening anywhere on perinium
    Genetic male
  64. Collection of peritoneal fluid in crutum, feels tense and not reducible
    Hydrocele
  65. Hydrolcelectomy
    Tx for hydrocele
  66. Hydrocele usually resolves in how long?
    1 year
  67. If hydrocele does not resolve in one year, indicates
    hernia
  68. Easier to tx ambiguous genitalia if a femal even if
    xy
  69. Intrarenal Acute Renal Fialure
    Acute Glomerulonephritis
  70. Primary source of Acute glomerulonephritis is not...
    renal
  71. Viral infection usually seen 2-3 weeks prior to
    Glomerulonephritis
  72. Systemic or chronic disease that affects teh glomeruli as a disease process
    Acute Glomerulonephritis
  73. Cuase of bacterial infection that can be seen 2-3 weeks prior to Acute Glomerulonephritis?
    Group A Beta hemolyitic Strep
  74. Acute Glomerulonephritis usually seen in which sex?
    AGN
  75. Acute Glomerulonephritis usually peaks at
    7 years
  76. With damaged glomeruli, what happens
    Increased permeability
  77. s/s of AGN
    • Proteniuria
    • Edema
    • Hypertension
    • Dependent/periorpital edema
    • Dec UOP
    • Fatigue
    • Increase Sodium, potas, BUN, Creat
  78. Hematuria is ESSENTIAL FOR DX (TEST QUESTION)
    AGN
  79. Serum complement (c3), usually low in
    DX of AGN
  80. Streptozyme test for strep in
    AGN
  81. Culture off primary site of infection for DX of
    AGN
  82. If culture ofprimary site of infection with AGN is negative or not possible, DX made on...
    Renal sx and history of strep
  83. Renal biopsy may be indicated for diagnosis of
    AGN
  84. Treatment of AGN depends on
    kidney damage
  85. Maintain F & E balance in tx of
    AGN
  86. Maintain B/P tx of (Antihypertensives)
    AGN
  87. Diuretics for edema is a treatment for
    AGN
  88. Strect fluids adn restrict Na and K is treatment for
    AGN
  89. Maintain skin integrity important in tx of
    AGN
  90. Family teachin g(diet, fluid restriction, S/S worsening) in treatment of
    AGN
  91. Excellent prognosis but beware of worsening condition
    AGN
  92. Grossly bloody urine (Test question)
    AGN, and PRIMARY DX TOOL!!!
  93. Increased edema
    AGN
  94. Lethargy/Activity intolerance, restlessness
    AGN
  95. Change in respiratory status
    AGN
  96. Threat to immune system and leads to inflammatory response is evoked
    Nephrotic syndrome
  97. Massive proteinuria and hypoalbuminemia
    Nephrotic syndrome
  98. Level for hypoalbuminemia
    <2.5
  99. Edema and hyperlipemia
    Nephrotic syndrom
  100. Increase in serum cholesterol, triglycerides, hematocrit and platelet
    Nephrotic syndrome
  101. Most common type of nephrotic syndrome in kids
    Primary (idiopathic)
  102. Immune response to glomerulal disease or systemic infection alters glomerular structure
    Primary (idiopathic) Nephrotic Syndrome
  103. Renal malfunction due to drugs, systemic disease (cancer, liver, lupus, lead poisoining, toxins, HIVR/1 immune reponse or otherh ds causing stress on kidneys)
    Secondary Nephrotic Syndrome
  104. Reduce proteinuria
    TX of nephrotic syndrome
  105. Controling edema is a tx for
    Nephrotic syndrome
  106. Preventing infection is an important treatment in
    nephrotic syndrome
  107. High dose steroids used as a treamtent of
    Nephrotic syndrome
  108. High dose steroids used in nephrotic syndrome for
    decreaing inflammation and loss of proteins
  109. Side effect of steroids in Nephrotic syndrome
    • Stimulates appetite
    • Weight gain
    • Also increase blood glucose
  110. Use diuretics for severe edema in
    Nephrotic syndrome
  111. If using diuretics for severe edema in nephrotic syndrom watch for
    • Crackles
    • Dyspnea
    • I & O
    • Weight
  112. Monitor lytes in
    Nephrotic syndrome
  113. Report loss of how much fluid during nephrotic syndrome
    < 1 -2 mg/kg/hour
  114. Assess edema, dehydration with
    Nephrotic syndrome
  115. How to prevent fluid overload in treatment of nephrotic syndrome
    Albumin prn followed by furoseminde to prevent fluid overload
  116. Limit salt
    Tx of nephrotic syndrome
  117. Watch for infection! Important in
    Nephrotic syndrome
  118. Small feedings of high biologic protein such as fish, chicken in small feedings in
    Nephrotic syndrome
  119. Family teaching with nephrotic syndrome
    • Performing daily uring dipsticks for protein levels, will sho remission and relaplse
    • Daily weights
    • watch for s/s of infection
  120. Most frequent cause of ARF in children
    Hemolytic Uremic Syndrome
  121. Cused by E-coli food poisoning
    Hemolytic Uremic Syndrome
  122. After viruese and chemicals inavde GI > vomit/diarrhea ? endotoxins damage and occulde blood vessels ? slows blood to kidneys and or any othe rorgan
    Hemolytic uremic syndrome
  123. 85% recover however, potential for development of chronic renal vailure
    Hemolytic Uremic Syndrome
  124. Prodromal means
    initial
  125. Initial symptoms of HUS
    Diarrhea, vomiting, URI, lethargy, irritable and anorexia when hemolytic process begins
  126. Renal failure > dec UOP > clots cause hypertension
    HUS
  127. Throkmbocytopenia (dec. platelests) bleeding, purpural
    HUS
  128. Anemia > pallor
    HUS
  129. Hepatosplenomegaly points to dx of
    HUS
  130. Edema, hypertension, CHF from edema seen in
    HUS
  131. Pain, Pallor, dehydration, lethargy
    HUS
  132. N, V, D, Decreased UOP, Altered LOC
    HUS
  133. Hemo/peritonial dialysis prn if anuric
    Tx of HUS
  134. Kayexalate enema because kidneys can't excrete high K+
    HUS
  135. Dextrose/TPN
    May be hypoglycemic due to increased metabolis; if pacrease affected > hyperglycemia > need insulin

    Tx for HUS
  136. Ca + gluconate or ca+ chloride tx of
    HUS
  137. Albumin hydroxide gel used because phosphorus increased bind tophos

    Tx of
    HUS
  138. Apresoline or Capoten tx for hypertension with
    HUS
  139. Bicarbonate use dto treat metabolic acidosis due to kidneys inabilityh to buffer acids in what disease?
    DUS
  140. CVP (central venous pressure) monitoring with decreased LOC or seizures with what disease?
    DUS
  141. Packed RBC's or plasma products, tx for
    DUS
  142. PO feedings when N & V subsides tx of
    HUS
  143. Increased T wave due to increased Potassium; widened qrs ; block
    DUS
  144. Monitor for increased ICP/LOC in what genitouriniry disease?
    HUS
  145. GI/NG to decompress in what GU disease?
    HUS
  146. Parents usually find something in the abdomen/dressing/bathing of the child
    Wilm's tumor
  147. Grows large without pain
    Wilms Tumor
  148. Mass may have hematuria, hypertiension, malaise, and fever
    Wilm's tumor
  149. Favorable histology: Resmonds to tx and has better prognosis
    Wilm's tumor
  150. Unfavorable - Harder to tx/poor prognosis
    Wilm's Tumor
  151. How to DX Wilm's Tumor
    • CT
    • MRI
    • U/S
    • Angiography -whows vessls that supply tumor
    • Chest Xray - did it spread to lungs?
    • Bone scan - did it spread to bone?
  152. Labs important in Wilm's turmor
    • CBD
    • U/A
    • Liver and Kidney function test
    • Urine for catecholamines (r/o neuroblastoma of adrenal gland)
  153. Avoid palpatation
    Tx of Wilm's tumor...may cause spread of malignant, or repture if encapsulated
  154. Tx depends on histology
    Wilm's Tumor
  155. Surgical removal of tumor by radical nephrectomy followed by radiation
    Wilm's tumor
  156. Acitonomycin D, Vincristine doxorubicin
    Chemotherapy for Wilm's tumor
  157. Radiation may cause scoliosis/spinal defects
    TX of Wilm's Tumor
  158. Teach to avoid truama to remaining kidney (sports)
    Wilm's Tumor
  159. Potential for altered growth with radiation and risk for 2nd tumor
    Wilm's tumor
  160. Recurrance w/in 6 months of nephrectomy
    Unfavorable Wilm's Tumor

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