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53 Cards in this Set
- Front
- Back
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List the four medications used of UTI's in Pediatrics
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1. TMP-SMX
2. Amoxicillin 3. Cephalexin 4. Pyridium (OTC) |
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Trimethoprim-Sulfamethoxazole (TMP-SMX)
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Class- anti-infective, antiprotozols (Pharm) folate antagonist, sulfonamides
Rout: PO, IV Action: inhibits metabolism of folic acid in bacteria. Active against both gram +/- Take all, Notify PHC if fever and diarreha develp. Protect agianst sun |
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Amoxicillin
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Class- anti-infective (pharm) aminopenicillins
Action- bind to bacteria cell wall, causing death side effects- rashes, diarrhea, may increase warfarin effectiveness and decrease BC effectiveness Route- PO only (chewable, caps, suspension >3 mo 25-50mg/kg/day divided in 8-12 hr doses < 3 mo 20-30 mg/kg/day Monitor bowel function, may cause false coombs test |
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Cephalexin
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Class: anti-infective
Action: treatment of infection caused by susceptable organism, binds to bacteria and causes cell death. Active against most gram +, selective gram - Route: PO, IM, IV 15mg/kg/day Side effects: N&V, diarrhea, rashes, pain and plebitis at IV site. Caution in renal impairment , GI disease, if taken with loop diuretic or aminoglycosides may increase renal toxicity |
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Pyridium (OTC)
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Class: nonopioid analgesic (pharm) Urinar tract analgesic
Action: provides relief from UT symptoms; pain, burning, itching, urinary frequency Route: PO only (DONT Crush/Break) 4mg/kg 3x daily for 2 days side effects: bright red-orange urine Use caution in hepatitis pts, also interfers with urine tests that are based on color reaction |
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Nephrotic Syndrome management
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Diet: low to moderate protein, Na restriction with large amounts of edema
Steroids: 2 mg/kg divided dose bid (prednisone is the drug of choice) Immunosuppressant therapy (cytoxan) low-dose, Long term antibiotics to prevent relapse Diuretics if severe Possible do renal biopsy |
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Types of Glomerulonephritis
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Most are postinfectious
Pneumococcal, streptococcal, or viral May be distinct entity or May be a manifestation of systemic disorder Systemic lupus erythematosus Sickle cell disease Others |
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Glomerulonephritis Symptoms
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Hematuria
Bleeding in upper urinary tract→smoky urine Proteinuria Increased amount of protein = increased severity of renal disease |
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Investigation of Acute Glomerulonephritis for the Following
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Generalized edema caused by decreased glomerular filtration
Begins with periorbital edema Loss of appetite Decreased urinary output Progresses to lower extremities and then to ascites Cola or tea-colored urine |
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Prognosis of Glomerulonephritis
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Almost all children diagnosed with acute poststreptococcal glomerulonephritis recover completely
Specific immunity is conferred Subsequent recurrences are uncommon Some children have been reported to develop chronic disease |
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Nursing Care Management of Glomulonephritis
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Manage edema
Daily weights Accurate input and output Daily abdominal girth Nutrition Low sodium, low-to-moderate protein Susceptibility to infections Bed rest is not always necessary |
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Wilms’ Tumor
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Also called nephroblastoma
Malignant renal and intraabdominal tumor of childhood Three times more common in African-American children Peak age of diagnosis is 3 years More frequent in males |
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Bladder capasity of newborns and childrens
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NB
30-60 mL Children oz= age (years) +2 for example a two year old would be 2+2= 4 oz |
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Specific gravity
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NB= 1.001- 1.020
Everyone else= 1.001= 1.003 High= dehydration, presence of protien or glucose or presence of medium contrast Low= excessive fluid intake, distal tubal disfunction, insufficient antidiuretic hormone, diuresis |
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pH
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NB= 5-7
everyone else= 4.8-7.8 acid or neutral= associated with metabolic acidosis, suggest tubular acidosis if associated with metabolic alkalosis, suggest potassium deficiency urinary infection alkaline= metabolic alkolosis |
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Glucose level
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should be absent
if present= DM, infusin of glucose containing fluid, Glomerulunephritis, impaired tubular reabsorption |
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Ketones
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should be absent
if present= acute metabolic demand (stress) diabetic ketoacidosis |
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Leukocyte esterase
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should be absent
if present= can identify both lysed and intact WBC via enzyme detection |
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Nitrites
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shout be absent
if present= most species of bacteria convert nitrates to nitrites in the urine |
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WBC count
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Normal = < 1 or 2
> 5= polymorphonuclear- UTI process leukocyte/field |
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RBC count
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normal= < 1 or 2
greater= trauma, stones, glomerular injury, infection, neoplasms |
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Cast
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normal - occassional
granulare cast- tubular or glomerula disorder, advanced renal disease cellular cast- pyelonephritis WBC- glomerulonephritis RBC- protienuria, usually transient hyaline |
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BUN
Blood Urea Nitrogen |
NB= 4-18
infant, child= 5-18 elevated= renal disease, dehydration, hemorrhage, increase protein intake, corticosteroid therapy |
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Creatine
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infant- 0.2-0.4
child - 0.3-0.7 Adolescent- 0.5-1.0 increased= severe renal impairment |
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Cystitis
Pyleonephritis |
Cystitis- inflammation of the bladder
pyelonephritis- inflammation of the upper urinary track and kidneys |
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Types of UTIs
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Recurrent: repeated episodes
Persistent: bacteriuria despite antibiotics Febrile: typically indicates pyelonephritis Urosepsis: bacterial illness; urinary pathogens in blood |
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A variety of organisms are responsible for UTI
what is the most common |
80% Escherichia coli
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How much urine is produced per hr
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NB will produce 1-2 ml/kg/hr; after 1 month, approximately 1 ml/kg/hr
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UTI Clinical Manifestations of neonate
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Poor feeding, vomiting
Failure to gain weight Respiratory distress Frequent urination Screaming on urination Jaundice, dehydration |
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UTI Clinical Manifestations of infants
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Poor feeding, vomiting
Failure to thrive Excessive thirst Frequent urination Foul-smelling urine Pallor, fever Persistent diaper rash |
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UTI Clinical Manifestations of a child
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Poor appetite, vomiting
Growth failure Excessive thirst Enuresis, incontinence Swelling of face, pallor Fatigue, abdominal or back pain Blood in urine |
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Classification of UTI
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Upper tract: involves renal parenchyma, pelvis, and ureters
Typically causes fever, chills, flank pain Lower tract: involves lower urinary tract Usually no systemic manifestations |
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Lower tract
Upper tract |
Lower tract- Cystitis, Urethritis
Upper tract, Pyelonephritis, VUR, Glomerulonephritis |
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Diagnostic Studies of UTI
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Clean-catch is preferred
U-bag for collection from child Specimen obtained by catheterization or suprapubic needle aspiration has more accurate results -May be necessary when clean-catch cannot be obtained |
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Vesicoureteral Reflex
primary vs secondary |
Primary reflux
Congenitally abnormal insertion of the ureters into the bladder Secondary reflux Result of an acquired condition |
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Vesicoureteral Reflux
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Abnormal retrograde flow of bladder urine into the ureters
Reflux often associated with a UTI in which the child has a high fever, vomiting and chills Renal scarring can occur from the reflux and should be prevented. Therapy: low dose daily antibiotic therapy Nursing considerations:Instruct parents to watch for signs and symptoms of UTI. Prevent recurrent infections. Education on diagnostic procedures. |
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Etiology and Pathophysiology of Acute Pyelonephritis
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Inflammation caused by bacteria, fungi, protozoa, or viruses infecting kidneys
Urosepsis: systemic infection from urologic source Can lead to septic shock and death in 15% of cases Preexisting factor (usually) Vesicoureteral reflux Dysfunction of lower urinary tract function -Obstruction- Stricture |
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Clinical Manifestations of Acute Pyelonephritis
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Vary from mild to “classic” and very severe
Presenting symptoms N/V, anorexia, chills, nocturia, frequency, urgency Suprapubic or low back pain, dysuria Fever, hematuria, foul-smelling urine Costovertebral tenderness Symptoms often subside in a few days, even without therapy Bacteriuria and pyuria still persist |
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Diagnostic Studies of Acute Pyelonephritis
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Urinalysis
WBC casts CBC Imaging studies (IVP or CT) Ultrasound |
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Obstructive Uropathy
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Structural or functional abnormalities that obstruct normal flow
Back up of the urine above the obstruction causes hydronephrosis Acquired, unilateral, bilateral, complete or incomplete Early diagnosis and surgical correction is essential |
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Hydronephrosis
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Dilation of the renal pelvis from distention
Obstructions can be congenital or acquired, unilateral or bilateral, complete or incomplete, or acute or chronic. Needs early diagnosis and evaluation |
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Nursing considerations for Hydronephrosis
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Help identify cases
Assist with diagnostic procedures Care for children with complications Emotional support and counseling Education on ureteral drainage systems Some may face challenges with dialysis or transplantation |
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Nephrotic Syndrome
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Most common presentation of glomerular injury in children
Characteristics (key) Proteinuria- loss of protien in urine Hypoalbuminemia- all of albuminem is going out through urine Hyperlipidemia Edema- fluid going from intervascular to interstitual Massive urinary protein loss |
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Types of Nephrotic Syndrome
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Minimal change nephrotic syndrome
AKA Idiopathic nephrosis Childhood nephrosis Minimal lesion nephrosis Secondary nephrotic syndrome Congenital nephrotic syndrome Autosomal recessive disorder Age 2-7, more common in boys |
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Changes in Nephrotic Syndrome
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Glomerular membrane
Normally impermeable to large proteins Becomes permeable to proteins, especially albumin Albumin lost in urine (hyperalbuminuria) Serum albumin decreased (hypoalbuminemia) Fluid shifts from plasma to interstitial spaces |
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Wilms Tumor Clinical Manifestations:
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Abdominal mass; increased abdominal girth
Anorexia and malaise Nausea and vomiting Elevated blood pressure Hematuria (late and grave symptom) Weight loss Fever Alterations r/t metastasis to lungs |
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Defects of the Genitourinary Tract
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Hydrocele-abnormal fluid in scrotum
Phimosis- tight foreskin around the penis Hypospadias- urethra under penis Chordee- curvature to penis Epispadias- urethra above penis Cryptorchidism- fail of testes to descend one or both |
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Phimosis
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Narrowing or stenosis of preputial opening of foreskin
Therapy: manual retraction or circumcision |
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Hypospadias
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Urethral opening located behind glans penis or anywhere along ventral surface of the shaft
Treatment: surgical correction to provide direct stream on voiding Nursing care: Education pre and postop expectations |
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Chordee
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Ventral curvature of penis, often associated with hypospadias
-caused by fibrous bands on the penis that causes the glan penis to be pulled ventrally Treatment: surgical release of fibrous bands |
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Cryptorchidism
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Failure or one or both testes to descend normally through inguinal canal
Treatment: admininstration of HCG or surgical orchiopexy Nursing considerations: Education pre and postop procedures and expectations |
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Epispadias
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Location of the urethral opening on the dorsal surface of the penis
Treatment: surgical procedure- lengthening of penis and urethra and possibly reconstruction of bladder neck |
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Enuresis (aka bedwetting)
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Intentional or involuntary passage of urine into the bed or clothes when passed the age voluntary bladder should have been achieved.
Diagnosed past age 5yrs when involuntary voiding occurs at least twice a week for at least 3 months. More common in boys Nocturnal bedwetting should stop between 6-8 years of age. Management: drugs (DDAVP and Tofranil), bladder training, elimination of evening fluids, waking to void at night, electrical devices to waken the child upon voiding. |
