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65 Cards in this Set
- Front
- Back
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What is expected urine output according to age?
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infant is 2ml/kg/hr
child is 0.5-1ml/kg/hr Adolescents is 40-80 ml/hr |
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What is the normal color of urine and smell?
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normal is pale yellow, clear with ammonia-like smell
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What is normal sg of urine in well hydrated child?
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less than or equal to 1.010
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What is protein level normally in urinalysis?
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protein is absent, ketones absent, bilirubin absent
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What are the three things that should not be in urine and what should be low?
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protein
ketones bilirubin - no, no, no glucose should be less than 130 mg/hour |
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What is the normal pH of urine?
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4.5-8
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What is cause of hypospadias and epispadias?
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failure of the urethral folds to fuse completely over the urethral groove
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What is chordee?
why are we asking? |
a fibrous line of tissue that results in bentral curvature of the penile shaft and can interfere with sexual function
often found with hypospadias |
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Hypospadias vs epispadias
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hypo - hole on bottom
epi - hole on top |
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What are some care things to do for the child with hypospadias repair?
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double diapering
no tub bathe until the stent is removed restrict activity hydration prophylactic abx signs of infection urine will be blood tinged for several days |
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What is VUR?
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backflow of urine from the bladder to the kidneys, which prevents complete emptying of the bladder and creates a resevoir for bacterial growth.
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What is treatment for VUR?
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surgical reimplantment of ureters. prophylatic abx
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What is dx of VUR?
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renal ultrasound and voiding cystourethrogram reveals defect and permits grading the severity of reflux
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What is cryptorchidism?
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undescended testes - when one or more testes fail to descend through the inguinal canal into the scrotum
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Inguinal Hernia. What is definition?
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painless inguinal or scrotal swelling of variable size that occurs when abdominal tissue, such as bowel protrudes into the groin.
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What is cystitis?
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infection of the bladder
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What is pyelonephritis?
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Upper UTI which involves the ureters, renal pelvis and renal parenchyma
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What are the ways you can get a UTI?
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-bacterial entering the GI tract and ascending from the urethra to the bladder
-hematogenous (through bloodstream) -direct extension (through fistula) -lymphatic system |
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What is done after recovery of a UTI?
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follow up urine cultures on a schedule since reoccuring UTIs may be asymptomatic
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What is an important intervention when assessing for/treating a UTI?
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quality, quantity and frequency of voiding
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What type of urine specimen do you collect for UTI?
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clean catch if child can cooperate. If not, then cateterized sample....done in early morning due to its higher concentration
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Along with meds, what is important tx for UTI?
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frequent voids - so force fluids
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What is nephrotic syndrome?
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alteration in kidney function that allows protein to leak at glomerular basement membrane. It is a clinical state, not a disease.
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What are clinical manifestations of nephrotic syndrome?
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edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia and altered immunity
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What is normaly way to state manifestations of nephrotic syndrome?
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swelling
tons of protein and albumin in urine low albumin and protein in blood high fat in blood low immunity |
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Who is normally affected by nephrotic syndrome?
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2-7 year olds
African american heritage |
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What is cause of nephrotic syndrome?
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idiopathic. Damage to glommeruli (considered an immune response)
Usually a URI precedes the onset of edema by 2-3 days |
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What is main presenting symptom of nephrotic syndrome?
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notices shoes and clothes are tight
periorbital edema upon waking that moves to lower after walking |
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What is done after recovery of a UTI?
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follow up urine cultures on a schedule since reoccuring UTIs may be asymptomatic
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What is an important intervention when assessing for/treating a UTI?
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quality, quantity and frequency of voiding
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What type of urine specimen do you collect for UTI?
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clean catch if child can cooperate. If not, then cateterized sample....done in early morning due to its higher concentration
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Along with meds, what is important tx for UTI?
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frequent voids - so force fluids
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What is nephrotic syndrome?
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alteration in kidney function that allows protein to leak at glomerular basement membrane. It is a clinical state, not a disease.
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What leaks out of the glomeruli?
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protein
albumin immunoglobins clotting factors |
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With the losses that happen with nephrotic syndrome, what are the results?
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hyperlipidemia(liver responds and makes lipoproteins)
Increased risk of thrombosis Hypovolemia (blood volume down, so body retains salt and water, leading to EDEMA |
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What is major concern of progression with nephrotic syndrome?
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that they will develop acute nephrotic syndrome
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What is number one intervention when treating child with nephrotic syndrome?
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corticosteroids
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What are other interventions other than steroids for child with NS?
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relieve edema (no added salt diet, diuretics during steroid therapy)
Improve nutrition (regular protein ***NOT ELEVATED) Prevent breakdown Prevent infection/promote rest/provide emotional support |
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Why do you treat with steroids for nephrotic syndrome?
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because the holes in the glomeruli are caused from an immune response, so steroids reduce the immune response
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What usually preceeds an episode of nephrotic syndrome?
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URI - yes upper respiratory infection
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What causes nephrotic syndrome?
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idiopathic, typically they will outgrow it
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Who gets nephrotic syndrome?
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2-7 year olds
african americans |
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What is big main difference to make sure you remember in regard to difference between nephrotic syndrome and acute glomerulonephritis?
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HTN with acute glomerulonephritis
(I know she said it was with both, but it is not.) |
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What is the cause of AGN?
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GABHS - remember, the one with more letters is caused from the acronym with a lot of letters
AGN-GABHS NS-URI,idiopathic,immune response |
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Along with strep infection causing AGN, what is required?
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a genetic predisposition
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Both NS and AGN have leaky glomeruli. Both leak protein, but remember that AGN is more of an __________ ____________.
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acute infection
usually you only get it once NS was more of a remission and relapse chronic thing |
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What is damage situation with AGN vs NS?
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AGN damages the nephrons more than nephrotic syndrome
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What is a big red flag for AGN?
clinical manifestation they would report or you would observe |
hematuria (cola colored urine)
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What is big important thing that is sneaking thru kidneys in AGN?
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RBC
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Why is renal blood flow down with AGN?
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antibody antigen complexes clogging the glomerulus
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Reduced renal blood flow is also causing....
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HTN
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Reduced renal blood flow is also causing....(in addition to HTN)
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oliguria (duh...kidney profusion down, urine production down)
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Discuss edema differences with NS and AGN
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AGN - abrupt onset, mild periorbital or lower extremity
NS - insidious onset, massive edema from shift fluid into interstitial spaces, worsens during day |
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Who gets AGN?
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young school age child 2-12
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Who has proteinuria at 3-4+?
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NS
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Who has elevated ASO titer?
why? |
AGN
because it is caused by GABHS |
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Who has more protein loss, NS or AGN?
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NS
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Who has more blood loss, NS or AGN?
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AGN only. No blood loss in NS
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Who has messed up serum albumin?
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NS
Serum album is normal in AGN (although book says it is low, handout and her lecture state that it is normal. She made a note of the normal serum albumin in AGN) |
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Which one, NS or AGN has administration of antihypertensives?
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AGN - it is the only one with HTN
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Which one, NS or AGN has administration of corticosteroids like Prednisone?
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NS - it is an immune response, so steroids would stop immune response
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In regard to diet on both of these, what is an important change that the kid will probably hate?
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No salt added or low salt diet
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Which one, NS or AGN has a possible administration of albumin?
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NS
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Which one has normal electrolytes, NS or AGN?
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NS
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Which one has higher lipid levels NS or AGN?
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NS - bigger liver response with NS
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