Exam 3 Genitourinary Disorders

Question 1

Genitourinary Disorders (4)

Answer 1

UTI
Acute Glomerulonephritis
Nephrotic Syndrome
Wilm’s Tumor

Question 2

Urinary Tract Infection

1) Lower Urinary Tract (2)
2) Upper Urinary Tract (4)

Answer 2

1) Urethra, Bladder

2) Ureters, Renal Pelvis, Calyces, Renal Parenchyma

Question 3

Upper UTI - AKA _____ _____ can lead to (3)

Answer 3

Acute Pyelonephritis

1) Renal Scarring
2) HTN
3) End-Stage Renal Disease

Question 4

Bacterial causes of UTI’s (6)

Answer 4

• E. coli (80%)
• Proteus pseudomonas
• Klebsiella
• Staph. Aureus
• Haemophilus
• Coagulase-negative staphylococcus

Question 5

Single Most Important Contributing factor to UTI =

So we want to tell toddlers to do what?

Why are females more at risk?

Answer 5

= Urinary stasis (incomplete emptying of bladder)

= Double Void

= have a SHORTER URETHRA

Question 6

UTI structural/functional causes

1) ____ (bladder urine into ureters)
2) ______ abnormalities
3) _____ of ____ ______
4) Bladder ______

Answer 6

1) Reflux
2) Anatomic
3) Dysfunction of Voiding Mechanism
4) Compression

Question 7

Clinical Manifestations of UTI in infancy 
P 
P 
P 
F
F
F
F
V

Answer 7

• Poor feeding
• Pallor
• Persistent diaper rash
• Fever
• Foul-smelling urine
• Frequent urination
• Failure to thrive
• Vomiting

Question 8

Clinical Manifestations of UTI in Childhood

1) Where is the pain located?
- ____/____ of urination, D____, H____, E____, I_____
- ____ appetite, v____, excessive ____
- G____ failure, Facial _____
- P___, F____

Answer 8

1) Suprapubic (lower abdominal pain)
- frequency, urgency of urination, dysuria, hematuria, enuresis (bedwetting), incontinence
- Poor appetite, vomiting, excessive thirst
- Growth failure, Facial Swelling
- Pallor, Fatigue

Question 9

Diagnostics of UTI

1) Urine Culture (3)
2) Urinalysis (3)
3) May need (2)

Answer 9

1) (sterile)
- Clean catch (not sterile) 1st choice bc least invasive
- Sterile catheterization
- Suprapubic aspiration (lidocaine to site first)

2) Leukocytes, Nitrates, Blood
3) Renal Ultrasound, or VCUG (Voiding cystourethrogram)

Question 10

Tx for UTI =

• If < 2 yo what needs to happen? Risk for (2)
• If VUR = __________ may need?

Answer 10

= PO Antibiotics

• Hospitalization + IV antibiotics, Risk for bacteremia, sepsis
• Vesicoureteral Reflux, may need surgical correction bc indicates anatomical obstruction

Question 11

Nephrotic Syndrome =

Answer 11

= most common presentation of glomerular injury in children

Question 12

Causes of Nephrotic Syndrome (3)

Answer 12

1) Idiopathic
2) Congenital/Genetic
3) Secondary to Lupus

Question 13

Characteristics of Nephrotic Syndrome (4)*

Answer 13

1) Proteinuria
2) Frothy and Foamy urine
3) Hypoalbuminemia
4) Hyperlipidemia

Question 14

Nephrotic Syndrome

• ______* especially when?
• Weight ____ (___)
• Abdominal _____
• D______ (bc?)
• A______
• Easily ______
• _____ urine volume

Answer 14

• Facial edema (especially seen when you wake up, will go away once start walking for a bit)
• Gain (edema)
• Swelling
• Diarrhea - dt edema in intestinal mucosa
• Anorexia
• Fatigued (dt fluid overload)
• Decreased urine volume

Question 15

Diagnostics for Nephrotic Syndrome

1) Urinalysis will show __+ of what?
2) 24 hour urine protein = > ___mg/kg/day = consistent with nephrotic syndrome
3) Serum albumin will be high or low?
4) Serum protein will be high or low?
5) Renal ____

Answer 15

1) 3+
2) > 50 mg/kg/day
3) low
4) low
5) Biopsy

Question 16

Tx for Nephrotic Syndrome Goals

1) Reduce =
2) Reduce =
3) Keep child as ____ as they are comfortable with

Answer 16

1) Excretion of urinary protein
2) Fluid retention
3) active

Question 17

Nephrotic Syndrome Dietary Restriction =

• ____ Restrictions = w ____ in severe cases

Answer 17

= Low Salt Intake

• Fluid, diuretics

Question 18

Medication for Nephrotic Syndrome*

Dosage

• __ mg/kg/day for __ weeks followed by
• __ mg/kg/day for ___ weeks

SE (7) for long term steroid tx

Answer 18

Corticosteroids*

• 2 mg, 6 wks
• 1.5 mg, 4 wks

Weight gain, Infection, Growth Retardation, Increased Appetite, Rounding of Face, Hypertension, Hyperglycemia

Question 19

Nursing Management for Nephrotic Syndrome

1) Monitor for ___ retention and excretion, strict ___’s
2) ____ examination for ___ via __ _____
3) Daily ____, measurement of ____ girth
4) Monitor ____ ___ (dt increased risk for infection)

Answer 19

1) Fluid, I/O’s
2) Urine, protein, UA dipstick
3) Weights, abdominal
4) Vital Signs

Question 20

Parent Education for Nephrotic Syndrome

1) ___/___ children will relapse -> ___ ___ minimizes damage to kidney
2) __/__ of nephrotic syndrome
3) urine ____ at home

Answer 20

1) 2/3, early detection
2) S/S
3) dipsticks

Question 21

Acute Glomerulonephritis Causes- Post infection dt (3)

Most common type in children is?

Answer 21

1) Streptococcal*
2) Pneumococcal
3) Viral

Acute Post Streptococcal Glomerulonephritis (APSGN)

Question 22

Acute Post Streptococcal Glomerulonephritis

Occurs __-__ days after strep infection/dental work in certain strains that cause __-___ to deposit in glomerular ___ membrane -> glomeruli become ____, ___ the c___ l___

Peak Age = __-__ y
Uncommon in < ___ y
What seasons?

Answer 22

• 10-21, immune complexes, basement, edematous, occludes the capillary lumen

6-7 yo
< 2 y uncommon
More common in winter and spring

Question 23

Clinical Manifestations of AG

1) ______*** __+, due to?
2) E____ due to? How does it progress?
3) L____
4) D____
5) H_____
6) P_____

How do you know the severity of renal disease?

Answer 23

1) HEMATURIA** 3+ dt bleeding in upper urinary tract -> smokey, cola/tea colored urine
2) Edema - generalized edema dt decreased GFR, Begins w periorbita edema -> LE -> ascites
3) Loss of Appetite
4) Decreased Urine Output
5) Hypertension
6) Proteinuria

Severity increases with increased amount of protein

Question 24

Dietary Restrictions for AG

- Moderate ____, fluid _____

Answer 24

• moderate salt, fluid restriction

Question 25

Regular Measurements to assess progression of AG disease | - ___ signs, body ____, __/__'s

Answer 25

- vital, weight, I/O's

Question 26

Teaching for AG - Do children die from this often? - Specific ____ is acquired -> reoccurances are ___

Answer 26

- almost all children w APSGN recover completely | - immunity, uncommon

Question 27

Wilm's Tumor = - ___ common renal malignancy in children - Peak age of diagnosis is ___ yo - more frequent in females or males? - Associated with GU a_____ and s____

Answer 27

= AKA nephroblastoma - malignant renal and intra-abdominal tumor of childhood - Most - 3 yo - males - anomalies, syndromes

Question 28

Clinical Manifestations of Wilm's Tumor 1) ____ abdominal girth 2) Abdominal ___/___ is ___ and ___ tender on ___ side* 3) H____* 4) H_____ 5) F____ 6) Weight _____

Answer 28

1) Increased 2) swelling/mass is firm and non tender on one side 3) Hypertension 4) Hematuria 5) Fatigue 6) Loss

Question 29

Tx for Wilm's Tumor =

Answer 29

= Surgical removal followed by chemotherapy +/- radiation

Question 30

NEVER ____ Wilm's Tumor, why?

Answer 30

- PALPATE, bc manipulation of tumor may cause spread of cancer cells to adjacent sites

Question 31

Pre/Post op Wilm's tumor, Monitor what? why?

Answer 31

BP closely! bc at increased risk for HTN

Question 32

Child and Family Teaching for Wilm's Tumor - How soon is surgery performed after diagnosis? - ____ is started immediately after surgery

Answer 32

- 24-48 hours | - chemotherapy