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61 Cards in this Set

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The nurse knows that the function of the GU system is to?
regulate the body's fluid and electrolyte status and remove metabolic waste and toxins from the body
The nurse knows that an infant's kidneys and renal system are?
immature & ineffective
At what age is sphincter control attained?
2 yrs of age
Why do infants urinate so much?
they cannot concentrate urine until after 1 yrs of age
A toddler is producing only 300 cc's of urine a day. What should the nurse do?
nothing this is normal
infants= 60cc
toddlers = 285-400cc
schoolage= 840-1000 cc
What metabolic imbalance can take affect in a child under 1 due to inefficient renal function?
hyponatremia due to inefficient reabsorption of sodium
What is a dangerous effect of inefficient renal function in an sick infant under 1 or for anyone with a GU disorder?
inefficient clearance of meds
A 2 yr old is brought to the clinic with pain on urination, blood in the urine and irritation of the penis. He appears to be having problems emptying his bladder, and the urine stream is presenting sideways. The nurse knows the diagnosis of Phimosis to mean?
that the infant is having problems urinating because the opening of the foreskin is narrow, and preventing retraction over the glans penis
The treatment for Phimosis is?
stretching of the foreskin, several times a day and then replacing
A baby boy is brought into the ER with severe high pitched screaming when the mother changed his diaper. The foreskin of the penis will not move and appears to be tight. The nurse expects a diagnosis of?
Paraphimosis which is a medical emergency
An 11 mth old boy is brought into the clinic where the mother questions the nurse on why one testicle of the baby has not descended. What should the nurse tell her?
This is Cryptorchidism and is common- it affects every 3-4 out of a 100 males- that it sometimes spontaneously descends about 1 yr of age or can be surgically corrected with a orchiopexy btw 1-2 yrs of age,
An newborn boy is brought into the clinic where the mother questions the nurse on why the opening of the penis is on the underside and why the penis curves down. What should the nurse tell her?
This is called Hypospadias- it is congenital and common; 1 out of 150 males, runs in families, and may occur with cryptorchidism. This has to be surgically repaired btw 6-18 mths
A mother with a baby with Hypospadias wants the child circumcised. The nurse knows that?
this cannot happen, they may need the foreskin to repair the hypospadias
Why should a child with Hypospadias or Epispadias (meatus on top of penis) risk being operated on?
so the boy can stand and void, have a normal appearance and have the potential for future sexual function
A newborn presents with a spade-shaped penis. The nurse knows this is a sign of?
hypospadias or epispadias
post hypospadias surgery, a nurse assess the penis bound in pressure dressing, secures the catheter and clamps it regularly. What has the nurse done that is dangerous?
Clamped the catheter. Never do this
A child sent home after Hypospadias surgery has discharge instructions of: take a long, hot bath, keep clean, play as usual. Which are wrong instructions?
limit tub bathing, and no rough play, riding toys or straddling, no sand or dirt
A 4 yr old is bed-wetting after being potty trained. The nurse knows this is a sign of? What should she teach the mother?
Enuresis - this is common, do not scold, shame or punish the child, they need support. May be caused by meds or med. condition. Type is secondary Enuresis
If a 4 yr old is still having problems wetting himself this may be a sign of which type of Enuresis?
primary
The nurse expects what test to be performed for a child with Primary Enuresis?
U/A
C & S
radiology to rule out mass/obstruction
What meds does the nurse expect a child with Enuresis to be prescribed?
Ditropan or Tofranil
What are some things the mother can do to help a child with Enuresis?
remind the child to use the toilet every 2 hrs
- decrease the fluids after 5-6 pm
- and give emotional support
A 15yr old comes to the ER after playing football with severe pain in the groin area, N, V, and abd. pain that feels and looks like a frozen spasm. The nurse suspects that the diagnosis will be? She recognizes that this diagnosis will be an?
Testicular Torsion

Surgical Emergency
A 7 yr old boy is brought to the ER 11 days after having strep throat. He is showing s/s of edema, gross hematuria, pallor, and brown urine. The nurse knows these are signs of?
Acute Glomerulonephritis
What causes Acute Glomerulonephritis?
infection with streptococcal organisms (group 1 beta hemolytic) that may be an aftereffect of strep throat and impetigo
What does the infection of streptococcus cause in the glomeruli?
it causes antibody-antigen complexes to become lodged and leads to inflammation and obstruction
When the glomerular membrane is damaged by AGN, what is excreted? what is retained?
RBCs

Sodium and water- leads to edema
Where would the nurse expect to find tenderness in a pt with a suspected case of AGN?
in the costovertebral area
What would the nurse expect to find in a pt who is recovering from AGN?
massive diuresis, decreased Htn and hematuria and the pt feels better
How long can an AGN infection last?
4 days to 3 wks
When a pt with AGN has signs of greatly increased BP, headache, and vomiting, what should the nurse/doctor look for?
Encephaly- should look for ICP (inceased intercranial pressure)
What is a bad cardio complication from AGN?
cardiac decompensation- heart failure from volume overload, increased heart size, and pulmonary edema
What is a bad renal complication from AGN?
acute renal failure- oliguria progresses to anuria- very uncommon
When looking for a diagnosis of AGN the nurse expects to see the Labs to show?
Urinalysis: hematuria, proteinuria at 3-4+, increased SPGR,BUN and CRT. Normal electrolytes,
To test for strep. infection, this test will be ordered?
ASO titer- antistreptolycin titer to detect strep and sed rate-non specific
also expect to see anemia (hemodilution)
What therapies should a pt with AGN expect?
bedrest, fatiqued, HTN control with meds, Diuretics, Corticosteriods, Penicilian, can be treated at home,
What meds does a AGN pt receive?
HTN is Apresoline,
Lasix, Corticosteriouds, Penicillin
If a pt is receiving Apresoline for HTN related to AGN, what intervention should the nurse perform?
check BP at least q 4 hrs
What nutritional nursing interventions should the nurse perform?
limit added salt, k+ restriction, fluid restriction if oliguric, the degree depends upon severity of edema
A ER client's labs show cloudy, smoky brown urine, proteinuria, elevated urine specific gravity, hematuria and decreased urine output. What diagnosis does the nurse suspect?
AGN acute glomeri...
What metabolic/hematologic imbalance should the nurse expect to find in a pt with AGN?
hyperkalemia, anemia, azotemia (retention of metabolic waste), hyperproteinia
What are the nursing interventions for a pt with AGN?
+ BP q 1-2 in acute stage, q4 if stable
+ seizure precautions
+ monitor fluid vol every 1-2 hrs-should be 1-2 ml/kg per hr
+ assess neurological status
+weigh daily- weigh diapers (1 g of diapers = 1 cc of urine)
+assess for edema
+ high carb diet
+ small, frequent meals
+ restrict sodium & protein as ordered
+ change position q 2 hrs
-bathe daily
+ support and elevate edematous extremities
What teaching should the nurse do with the caregiver of a patient with AGN?
- seizure precautions if HTN
- follow-up care VERY IMP
- prevention of infection
- nutritiional restrictions
- may take CA channel blockers, ACE inhibitors, Beta blockers
A client presents to the ER with massive urinary protein loss. What does the nurse expect the diagnosis to be?
Nephrotic Syndrome
The nurse knows that untreated Nephrotic Syndrome can lead to?
Hypoalbuminemia
massive proteinuria
hyperlipidemia
massive edema
altered immunity
What is the most common nephrotic Syndrome?
MCNS - minimal change Nephrotic syndrome
The nurse knows that the cause of MCNS is?
unknown- normal kidney on biopsy
What age and gender does the nurse expect to find a diagnosis of MCNS in?
preschool- rare b4 1 and after 8 yrs of age

more common in males 2:1
What s/s does a pt with NS present with when has proteinuria? what does this lead to?
decreased oncotic pressure
and development of edema

leads to hypoalbuminemia
What happens when a pt has hypoalbuminemia?
the kidneys reabsorb salt and water, edema develops, immunoglobulins are lost, which results in altered immunity.
When a pt has hypoalbumia what happens to the liver?
The liver responds to this by increasing synthesis of lipoprotein
When a pt has MCNS the nurse expects to see?
incidious wgt gain
shifting edema
oliquria, urine dark & frothy
pallor
skin breakdown
Muercke lines on nails
cellulitis or pneumia due to altered immunity (nursing diagnosis)
irritable, easily fatiqued
What are the signs of shifting edema in MCNS?
morning periorbital/sacral shifts to scrotal/labial during day
One distinctive sign of MCNS is?
white horizontal lines on the nail bed indicative of hypoalbumenia - Muercke sign
What does the Lab reports of a pt with MCNS show?
protein (50mg/kg daily)
casts
 SPGR
decreased serum protein
hyperlipidemia
What treatment does the nurse anticipate will be ordered for a pt with MCNS?
-dietary: no added salt
- plasma expanders (albumin)
- immunosuppressants-chemo drugs such as Cyclophosphamide along with Prednisone if child does not respond to steriods
- Sprionolactone with hydrochlorothiazide for edema
- broad-spectrum antimicrobials for infection
What drug is the mainstay of therapy for MCNS?
Prednisone- immunosuppresent- stimulates vascular reabsorption of edema
- dose usually 2 mg/kg/d
Does MCNS have a good prognosis? does it have relaspe?
yes to both
The nurse knows that interventions for edema are?
-skin care
- do not use adhesive tape
- warm soaks
- elevate head of bed
- turn frequently
- scrotal support & padding btw body parts
Other nursing interventions for a patient with MCNS are?
-small, frequent meals
-I & O, V/s, frequent BP monitoring
- bedrest
- infectious precautions
- abd. girth measurements
- diuresis in 1-3 wks & maintain bedrest during this time
- teach home care
- seizure precautions
To sum up the assessment for MCNS expect to find:
- oliguria
- proteinuria
- hematuria
- HTN (sometimes)
- edema of face in morning
- edema of extremities and abd as day progresses
- pallor