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85 terms

ch 29 genitourinary condition

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cystitis
Urinary bladder inflammation
nephron
microscopic functional units of the kidney, comprised of kidney cells and capillaries, each capable of forming urine more than 1 million in each kidney
kidneys
two bean-shaped organs located on each side of the vertebral column on the posterior wall of the abdominal cavity behind the parietal peritoneum. Their function is to remove waste products from the blood and to aid in maintaining water and electrolyte balances.
ears and kidneys develop
low set ears in newborn and urinary tract anomalies
low set ears in newborn =
urinary tract anomalies
fluid is really important in infants and small children because
makes up a larger fraction of there body weight
glomerular filtration and absorption are relatively low until 1 to 2 years of age
Infants are more prone to fluid volume excess and dehydration
kidney function is immature until
after 2 years of age
most newborn urinate within
24 hours of life -must be reported the presence or absence
Urological diagnostic procedures
Urinalysis
Ultrasonography
Intravenous pyelogram
Computed tomographic scan
Renal biopsy
Cytoscopy
Cytoscopy
Direct visualization, specimen collection, and/or treatment of the interior of the bladder lining and is inserted into the urethra.
micturition
Process of emptying the bladder; urination; voiding
cystometrogram
record that measures urinary volume, bladder pressure, and capacity to evaluate urinary dysfunction such as incontinence
minimum urine output for infants and toddlers is
2 to 3 ml/kg/hr
minimum urine output for young school-age and preschool is
1 to 2 ml/kg/hr
minimum urine output for school-aged and adolescence is
0.5 to 1 ml / kg/hr
dysuria
difficulty urinating
frequency
urinating in frequent intervals
urgency
Feeling the need to void immediately despite inability to do so
nocturia
Frequent urination at night
enuresis
Involuntary urination; most often used to refer to a child who involuntarily urinates during the night
polyuria
condition of excessive urination
oliguria
Decreased urine output
BUN newborn
3-12mg/dL
BUN Child
child 5-18mg/dl
Uric acid child
Nitrogenous waste formed when proteins are used in cells. It is excreted by the kidneys in urine. 2-5 mg/dl
Creatinine
Nitrogen-containing waste product of muscle metabolism; excreted by the kidney in urine.
Creatinine
Infant 0.2-0.4 mg/dl
child 0.3-0.7 mg/dl
adolescent 0.5-1.0 mg/dl
phimosis
narrowing of the opening of the foreskin so it cannot be retracted or pulled back to expose the glans penis
normal goes away by 3 years of age of circumcision
paraphimosis
retraction of the skin of the prepuce causing a painful swelling of the glans penis that prevents the penis from being retracted; the penis is extruded from the prepuce and can't be returned to its normal position immediately call Dr.
hypospadias
a congenital abnormality of the urethral opening where in the male the urethral opening is on the under surface of the penis, and in the female the urethral opening is into the vagina
epispadias
a congenital abnormality in males in which the urethra is on the upper surface of the penis
chordee
A ventral curvature of the penis that results from the replacement of normal skin with a fibrous band of tissue and usually accompanies more severe forms of hypospadias. Causes constriction of penis.
exstrophy of the bladder
A congenital deformity resulting from failure of the pelvic structures to fuse so that the bladder opens on the surface of the lower abdomen. occurs 1 and 40,000 mostly boys
exstrophy of the bladder s/s
fetal sonogram
can be a small fistula in the abdominal wall complete exstrophy urine leaks continually
exstrophy of the bladder treatment
bladder is covered with a plastic shield and allows for draining
placed on back or side so urine can drain
diaper is placed under the infant not around
antibiotics for infection
surgery is usually done in first 48 hours
polycystic kidney
a hereditary condition in which the kidneys are enlarges and contain many cysts. this can lead to the inability of the kidney to concentrate urine
resulting in metabolic acidosis
obstructive uropathy
condition in which the structure or function of the urinary system is altered, resulting in obstruction of urine flow. Altered structure or function of the urinary system. Can be congenital (polycystic kidney) or Acquired uropathy (tumor, stones or crystal formation)
bladder capacity of a child can be approxiamated by
Age in years + 2 = Ounces of bladder volume
acute urinary tract infection
common in children girls more than boys
75 to 90 are caused by E-coli followed Klebsiella Proteus
urethritis
inflammation of the urethra
bacteriuria
presence of bacteria in the urine
pyelonephritis
inflammation of the renal pelvis and the kidney
ureteritis
Infection of the ureters
vesicoureteral reflux
Backward flow of urine into the ureters after you void = so urinary stasis occurs that allows growth of bacteria leading to UTI.
UTI s/s infant
pyelonephritis, fevers, vomiting,chills
UTI diagnosis infant
urine culture , specimens must be processed promptly or refrigerated to prevent contamination.
Urine specimens should not be collected from the diaper because the chemicals and gels alter
UTI treatment
infants under 1 year of age are usually hospitalized
low dose antimicrobial to keep urine sterile and prevent kidney infection
Prevent UTI infant
cleanse perineum with each diaper change
wipe front-back
clean dry underwear white cotton
no bubble baths
have child urinate right after bath
loose fitting pants
drink plenty of water
nephrotic syndrome
( nephrosis)
Kidney condition a syndrome characterized by edema and large amounts of protein in the urine and usually hypoalbumin decrease of protein in blood which enters the urine.
hypoalbumin
decrease in the plasma protein albumin
nephrosis
The four characteristic symptoms of nephrotic syndrome are proteinuria, edema, hypoalbuminemia (low serum albumin level), and hyperlipidemia (increased blood lipid level). Proteinuria occurs because increased glomerular permeability leads to protein loss in the urine and, subsequently, hypoalbuminemia.
nephrotic syndrome treatment (nephrosis)
minimize edema
preventing infection
reducing the loss of protein in the urine
preventing the toxicity from the medicine prescribed
LONG TERM ORAL STEROIDS, IF STEROIDS INEFFECTIVE, IMMUNE SUPPRESSION MEDS, DIURETICS IF EDEMA SEVERE, DIET- LOW SALT AND POSSIBLE FLUID RESTRICTIONS DURING ACUTE PHASE, ANTIBIOTICS FOR INFECTIONS, POSSIBLE ALBUMIN INFUSIONS
neutropenia
Lack of neutrophils. Neutrophil count less than 1000/mm3. Most often suppressed in differential WBC.
granulocyte
White blood cell with numerous dark-staining granules: eosinophil, neutrophil, and basophil.
nephrotic syndrome nursing care (nephrosis)
supportive care to parents and child
parents keep daily record of childs weight,
urinary protein levels and meds. + I & O's
positioning- turn frequently to prevent respiratory tract infections , head is elevated from time to time during day to reduce edema of eyelids , warm compresses on eyelids

* subtract dry diaper weight from weight of wet diaper.
* give juices maintain adicidy of urine
nephrotic syndrome nursing care most important
nurse should monitor fluids: intake and output for patients with renal disease.
nephrosis no
vaccines or immunizations should be administered
acute glomerulonephritis
allergic reaction to group A beta hemolytic Strep infection after scarlet fever or skin infection mostly in boys 3 to 7
Both kidneys are affected nephron is the working unit of the kidney there are millions in the capillaries
hypospadias treatment
surgery before 18 months some times in stages
Routine circumcision is avoided (not done) because the foreskin maybe useful in the repair
girls get UTI 's more than boys
because female urethra is short and anus is close ,wearing close fitting nylon underwear, bubble baths, retention of urine and vaginitis
incest or sexual abuse if repeated infections in young girls
Nephrosis cause
unknown, may be Thymus T-cell dysfunction
Nephrosis edema
Massive edema
Anasarca; whole body edema
Ascites; fluid in the abdominal
Nephrosis blood pressure
usually normal
Nephrosis Urine test
Proteinuria
Traces of blood
Nephrosis Pallor
Degree of pallor is greater than expected in relation to degree of anemia
Acute Glomerulonephritis cause
strepococal infections such as strep throat, scarlet fever, or rheumatic fever
Acute Glomerulonephritis edema
Puffiness of eyes
Acute Glomerulonephritis blood pressure
moderately elevated, hyperkalemia may produce cardiac toxicity
Acute Glomerulonephritis Urine test
Trace of protein
Hematuria blood in urine resolves in 1 month
Acute Glomerulonephritis Pallor
related to anemia
surgical repair of exstrophy of bladder
is done in the first 2 days of life
Acute Glomerulonephritis treatment
- May hospitalize if severe, often until no more hematuria
- PCN
- Daily weights!
- Monitor BP and watch for HA, decreased LOC, blurry vision, seizures. If BP goes up often disease progresses to a chronic condition with eventual renal
failure. Monitor for cerebral complications.
- Antihypertensives as needed
- Symptomatic treatment of CHF
- Rest, but not necessary to be on bedrest
- Dietary: possible mod. sodium restriction, may restrict potassium during oliguria;
may be on fluid restrictions.
- Hemodialysis if renal failure
- Prevention with strep screens
Wilms tumor
a malignant tumor of the kidney that occurs in young children 3 year old associated with congenital anomalies -genetic basis .
Wilms tumor
when a pt has __________ you must never palpate the abdomen.
Wilm's tumor s/s
S & S: child may be asymptomatic. Parents commonly palpate an abdominal mass while bathing the child. May be unilateral or bilateral; is usually firm & contains several lobes. Hematuria, hypertension & abdominal pain MAY be present.
Wilm's tumor treatment
- Surgery (to stage and remove tumor/affected kidney)
- Radiation (done in stages II-IV)
- Chemotherapy (for all stages)
Hydrocele
excessive amount of fluid in your ball sac causing the scrotum to swell
usually corrects itself by age 1
Hydrocele treatment
-surgical repair if indicated if spontaneous resolution not accomplished in 1 year
cryptorchidism
failure of one or both testes to move into the scrotum as the male fetus develops they make be stuck in the abdomen or inguinal canal --low birth weight infants 30 % have this. Usually one teste does not fall.
this causes the testes to heat up and make you sterile if both testes are affected.
cryptorchidism treatment
Hormonal management before surgery hGC - to induce descent, Orchiopexy performed if above unsuccessful by age 2
nurses should tell the child his penis will not be involved in the surgery
How do the signs and symptoms of urinary tract infections differ between infants and the older child?
symptoms of infants often include fever, frequent urination, foul-smelling urine, and persistent diaper rash.
In the older child, urinary frequency, pain during micturition, onset of bedwetting in a previously "dry" child, and abdominal pain may be present.
What are the goals of treatment for nephrosis
treatment include minimizing edema, preventing infection, reducing protein in the urine, and preventing toxicity from the medication prescribed.
Compare the signs and symptoms of nephrosis with acute glomerulonephritis.
Nephrosis: cause unknown, massive edema, blood pressure usually normal, trace of blood in urine and proteinuria, and degree of pallor is greater than expected in relation to degree of anemia.
Acute glomerulonephritis: caused by a response to group A beta-hemolytic streptococci, periorbital edema (puff eyes), blood pressure usually moderately elevated, trace red blood cells or protein in urine, hematuria, and pallor related to edema.
Orchiopexy
endoscopic surgery to move an undescended testicle into its normal position in the scrotum