Nursing 2Nd Semester: Peds Exam 1: Unit 4

Front 1

The kidneys maintain fluid and chemical balance through glomerular ________, tubular ________, and secretion. The kidneys are also involved with hormonal production: the production of renin, which regulates _____ _______; production of erythropoietin, which stimulates ___ production by the ____ ______, and metabolism of Vitamin ___ to its active form, which is important in calcium metabolism.

Back 1

The kidneys maintain fluid and chemical balance through glomerular FILTRATION, tubular REABSORPTION, and secretion. The kidneys are also involved with hormonal production: the production of renin, which regulates blood pressure; production of erythropoietin, which stimulates RBC production by the bone marrow, and metabolism of Vitamin D to its active form, which is important in calcium metabolism.

Front 2

When assessing a child for possible genitourinary dysfunction, it is important to consider nonspecific assessment data such as altered g_____, s______ anomalies, h_________, skin l_____, and i______ dysfunctions.

Back 2

growth
skeletal
hypertension
lesions
immune

Front 3

True or False: A child in an acute phase of nephrotic syndrome is always hospitalized.

Back 3

True

Front 4

True or False: Kidney function is increased when the infant is under stress.

Back 4

False, function is reduced

Front 5

True or False: By 6 to 12 months of age, kidney function is nearly that of an adult.

Back 5

True

Front 6

After the first few weeks of life, the kidneys' acidifying ability reaches the adult level. With ____, however, there is only a small increase in acid secretion and susceptibility to acidemia rises.

Back 6

acidosis

Front 7

Younger children have shorter/longer urethras, which predispose them to UTIs

Back 7

shorter

Front 8

By what age do children usually achieve complete bladder control?

Back 8

4 to 5 years

Front 9

True or False: Unlike adults, most children with acute renal failure regain normal function.

Back 9

True

Front 10

What is the most common serious bacterial infection in infants and children?

Back 10

UTI

Front 11

The presence of ______ in urine is often the first indication of renal disease.

Back 11

protein

Front 12

Nitrites are present in urine produced by _______ and often indicate infection.

Back 12

bacteria

Front 13

The serum study ____ is the end product of protein metabolism and is the gross indicator of renal function

Back 13

BUN

Front 14

True or False: BUN is decreased in renal insufficiency.

Back 14

False, BUN is increased in renal insufficiency.

Front 15

Serum ______ is the measurement of the concentration of blood and is determined by solute in blood. It is an indication of ____ and ____ balance.

Back 15

osmolality
fluid & electrolyte balance

Front 16

What is the normal pH of urine?

Back 16

4.8 - 8.0

Front 17

_________ is the byproduct of muscle metabolism and is constant as long as muscle mass remains constant.

Back 17

creatinine

Front 18

True or False: Creatinine increases in renal insufficiency.

Back 18

True

Front 19

______ needs to be assessed before giving nephrotoxic chemotherapeutic agents.

Back 19

creatinine

Front 20

Does pH increase or decrease in urinary infections? What can it be affected by?

Back 20

increases

diet

Front 21

_____ is a type of abdominal radiograph that visualizes abdominal structures. It diagnoses renal stones and is done before renal studies.

Back 21

KUB (Kidney, Ureter Bladder flat plate scout film)

Front 22

True or False: KUB is very painful and is must be done under general anesthesia.

Back 22

False, it causes no discomfort.

Front 23

A _______ is an exam of the bladder and urethra with a tubular, lighted, telescopic lens called a _______.

Back 23

cystoscopy
cystoscope

Front 24

A cystoscopy is performed with child under general anesthesia, little pain is involved. ______s are encouraged and it is important to assess the ability to ____ after the procedure.

Back 24

fluids
void

Front 25

During a ___ _____, the child lies on back and should remain still, oral contrast material may be administered, the child is usually NPO because of sedation or oral contrast material. It can be used to visualize renal tumors.

Back 25

CT scan

Front 26

During a renal US for transplantaion, how is the child positioned? How is the child positioned if purpose is only to assess kidneys, ureters, bladder?

Back 26

supine

prone

Front 27

What does VCUG stand for? What does it detect?

Back 27

Voiding CystoUrethroGram

detects reflux of urine into ureters and its severity
detects bladder emptying problems
detects urethral problems

Front 28

A VCUG can be done in nuclear medicine department to decrease ____ exposure. Is the procedure invasive? It is important to provide _______ activities an provide support for the child.

Back 28

radiation
Yes it is invasive
diversional

Front 29

______ studies are invasive tests that are indicated to assess voiding dysfunction or an abnormal urinary tract.

Back 29

urodynamic

Front 30

Children with difficulties in urinary control are defined as having _______.

Back 30

enuresis

Front 31

______ enuresis occurs at night during sleep and _____ enuresis occurs during waking hours.

Back 31

nocturnal
diurnal

Front 32

What is the difference between primary and secondary enuresis?

Back 32

Primary enuresis is defined as a child never having experienced a period of dryness whereas secondary enuresis occurs when a 6 to 12 month period of dryness has followed with the onset of wetting.

Front 33

Diurnal enuresis is characterized by urgency, frequency, and inappropriate wetting. They just can't get to the bathroom fast enough. What is used to diagnose enuresis? What first needs to be ruled out?

Back 33

UA, culture

UTI, Diabetes Mellitus

Front 34

There is no single cause for enuresis. Some risk factors include decreased bladder ______, underlying urinary _____ abnormalities, ______ alterations, obstructive sleep _____, constipation, UTI, _______ infestation, diabetes mellitus, and _____ dysfunction.

Back 34

There is no known cause for enuresis. Some risk factors include decreased bladder CAPACITY, underlying urinary TRACT abnormalities, NEUROLOGIC alterations, obstructive sleep APNEA, constipation, UTI, PINWORM infestation, diabetes mellitus, and VOIDING dysfunction.

Front 35

Emotional factors related to increased stress can contribute to ______ enuresis. ______ abuse must be considered in assessing for this type of enuresis.

Back 35

secondary

sexual

Front 36

The primary cause of diurnal enuresis is an unstable _______, a condition in which the child experiences bladder spasms or increased urgency.

Back 36

bladder

Front 37

True or False: Primary Enuresis often resolves spontaneously.

Back 37

True

Front 38

Control of urination is related to maturity of what body system? This system may be delayed in children who have primary nocturnal enuresis.

Back 38

CNS

Front 39

Nocturnal enuresis is not a matter of excessive concern unless the child is older than ___ years or has markedly decreased ___-_____.

Back 39

6
self-esteem

Front 40

UTI is the presence of infection of the upper or lower portion of the urinary tract. ______ is an infection of the bladder, while ________ is an infection of the kidney.

Back 40

cystitis
pyelonephritis

Front 41

Approaches to treating primary nocturnal enuresis include limiting _____ after dinner and _____ just before bedtime. The use of a mental image known as _____ can be helpful, as can the use of an alarm system, such as a "___ _____"

Back 41

fluids
voiding
imagery
"wee alert"

Front 42

Some causes of UTI's in children can be caused by anatomic _______ and incomplete emptying of the bladder, known as a ______ bladder.

Back 42

abnormalities
neurogenic

Front 43

In older children, infrequent/frequent voiding and incomplete ______ of the bladder, as well as c_________ can contribute to UTIs

Back 43

infrequent
emptying
constipation

Front 44

True or False: Older children are sometimes just to busy to go, and need to be reminded about potty breaks.

Back 44

True

Front 45

In teens, sexual intercourse can lead to UTIs because of friction ____.

Back 45

trauma

Front 46

Are UTIs more common in females or males? Why?

Back 46

females

short urethra
improper breathing
nylon underwear (need cotton to breathe)
bubble baths (chemicals irritate urethra)

Front 47

True or False: UTIs are more common in circumcised males.

Back 47

False
More common in uncircumcised males

Front 48

To prevent UTIs in uncircumcised males, proper _____ instruction is important.

Back 48

cleaning

Front 49

UTI's should be further investigated in children to find the underlying cause. Investigations such as ____ assess ureteral reflux and an US of the kidneys can rule out ________ or ____ kidneys.

Back 49

VCUG
hydronephrosis
polycystic kidneys

Front 50

Hydronephrosis is an _____ at the uretropelvic junction or other parts of the ureter that cause ______ of the kidney. It can be associated with ___.

Back 50

obstruction
dilation
VUR

Front 51

_____ the most common life-threatening genetic disease and is a cystic genetic disorder of the kidneys

Back 51

polycystic kidney disease or PCK/PCKD

Front 52

_______ in the urine is needed to diagnose a UTI.

Back 52

bacteria

Front 53

Symptoms of UTI in the absence of ______ can include perineal inflammation, vaginitis, pinworms, or chemical irritation from bubble baths.

Back 53

bacteria

Front 54

In instructing uncircumcised males (or their parents) on proper cleansing, instruct to gently retract the foreskin for cleansing but do not force. Do not leave foreskin retracted or it may act as a _______ and obstruct the head of the penis, resulting in an emergency _________.

Back 54

tourniquet
circumcision

Front 55

Signs and Symptoms of UTI in the neonate include .... (5)

Back 55

jaunice
vomiting
fever
failure to thrive
feeding diffuclty

Front 56

Signs and Symptoms of UTI in the infant include...(5)

Back 56

irritability
poor feeding
vomiting
diarrhea
strong odor to urine

Front 57

Signs and Symptoms of UTI in the child include.... (8)

Back 57

vomiting
diarrhea
abdominal/flank pain
fever
enuresis
urgency
frequency
strong odor to urine

Front 58

______ is WBC in urine may be seen in the UA for a UTI along with h______, which is RBCs in urine.

Back 58

pyuria
hematuria

Front 59

______ is when blood culture and urine culture grow the same organism.

Back 59

Urosepsis

(this is where the infection in the blood has spread to the urinary system)

Front 60

In _________ you will likely see an elevated WBC count and elevated C-reactive protein and erythrocyte sedimentation rate.

Back 60

pyelonephritis

Front 61

A _______, is a renal diagnostic test that involves an IV injection of a contrast material (dye) and looks at the bladder's ability to empty completely, provides information about the anatomy of the kidneys, ureters, and bladder, and identifies masses that compress the urinary system.

Back 61

intravenous pyelogram (IVP)

Front 62

Usually the tx for UTI involves _______ therapy, either IV or PO, over a course of ____ to ____ days. _______ can be used for pain.

Back 62

antibiotics
7 to 10

acetaminophen

Front 63

What are the most common antibiotics used in treating UTIs?

Back 63

amoxicillin
Cefazol
Bactrim
Sepra

Front 64

_______ is the most common organism that causes UTI's.

Back 64

E. coli

Front 65

______ is a condition caused by the backflow of urine from the bladder into the ureters and sometimes into the kidneys.

Back 65

Vesicoureteral Reflux (VUR)

Front 66

In VUR, if the reflux goes into the bladder, _____ is the medium for bacteria. If the reflux goes into the kidney, renal damage and _____ can occur, which can lead to ________.

Back 66

urine
scarring
HTN

Front 67

________ is undescended testicle(s). There is a high incidence among ______ infants. The goals of treatment include... (2)

Back 67

cryptorchidism
premature
Goals: preserve testicular function and promote a normal scrotal appearance

Front 68

True or False: Cryptorchism usually resolves on its own, in that they spontanously descend on their own.

Back 68

True

Front 69

In treating cryptorchism, surgery is necessary if the testicles do not descend into the scrotal sac by what age range? What is the name of this surgery?

Back 69

6 to 12 months
orchiopexy

Front 70

In treating cryptorchism, hormone replacement therapy is used, which one? If cryptorchism is untreated, there is a slightly higher risk of ____ _____.

Back 70

HCG
testicular cancer

Front 71

________ a congenital anomaly in which opening of urethral meatus is below normal placement on penis.

Back 71

hypospadius

Front 72

_____ or downward curvature of the penile shaft, can accompany hypospadias

Back 72

chordee

Front 73

Which is more common, epispadias or hypospadias?

Back 73

hypospadias

Front 74

True or False: The surgical procedure to correct hypospadias should be done before the age of toilet training because the location of the meatus may make it difficult for the child to urinate standing up. What age should the surgery be done?

Back 74

Age 6- 12 months

Front 75

_________ inability to retract the prepuce at an age when it should be retractable, usually should retract around age ____

Back 75

phimosis
3

Front 76

AGN is acute poststreptococcal glomerulonephritis , an acute __________ of the glomeruli of the kidneys that follows a Group __ beta-hemolytic streptococcal infection of the throat or ____.

Back 76

inflammation
A
skin

Front 77

s/s of acute poststreptococcal glomerulonephritis develop 1-2 weeks after streptococcal pharyngitis or ___ to ___ weeks after a streptococcal pyodema infection.

Back 77

3-6

Front 78

Incidence of acute poststreptococcal glomerulonephritis is most common in _____-age children, ages ___ to ____ years old.

Back 78

school age
5-12

Front 79

S/S of acute poststreptococcal glomerulonephritis include our favorite word: _________. Also: poor appetite, ______ pain, h________, which causes ___ or ___ colored urine. Other symptoms p______, edema primarily in the ______ time, especially around ____ and _____. There is often a BP problem known as: ________.

Back 79

S/S of acute poststreptococcal glomerulonephritis include our favorite word: lethargy. Also: poor appetite, abdominal pain, hematuria, which causes tea or cola colored urine. Other symptoms proteinuria, edema primarily in the morning time, especially around eyes and ankles.

Front 80

Complications from S/S of acute poststreptococcal glomerulonephritis include what 2?

Back 80

HTN
pulmonary edema

Front 81

Lab studies for S/S of acute poststreptococcal glomerulonephritis (6)

Back 81

UA
CBC
chem panel
ASO (antistreptolysin titer)
cultures of throat /skin lesions
renal biopsy
(CUP CAR)

Front 82

Therapeutic management for sacute poststreptococcal glomerulonephritis includes _____ for fatigue, low ____ and ____ diet, _____ may be restricted, drugs like anti_________, d______, and ____ for 10 days if positive throat or blood culture. We also do a 24 hour urine for ________ clearance.

Back 82

rest
sodium
protein
antihypertensives
diuretics
antibiotics
creatinine

Front 83

Describe some symptoms of acute poststreptococcal glomerulonephritis .

Back 83

cola /tea color urine( hematuria)
HTN
edema (periorbital, ankle)
abdominal pain
pallor
decreased urine output
irritability
anorexia
lethargy

( When you have AGN you spend all your money at the doctor's so you buy CHEAP DIAL soap.. spells out s/s)

Front 84

Clinical condition cause by damage to the glomerular structure of the kidneys describes ______ syndrome

Back 84

nephrotic

Front 85

The cause of nephrotic syndrome is unknown, but is believed to be the result of an a_______ of the glomerular m_______, making it permeable to ______ proteins especially _______. Nephrotic syndrome is more common in males/females?

Back 85

The cause of nephrotic syndrome is unknown, but is believed to be the result of an alteration of the glomerular membrane, making it permeable to plasma proteins especially albumin.
More common in males.

Front 86

Glomerulonephritis has a ______ onset while nephrotic syndrome has a ______ onset.

Back 86

abrupt
slow (insidious)

Front 87

Clinical manifestations of nephrotic syndrome are similar to glomerulonephritis. What are the main symptoms present in nephrotic syndrome only?

Back 87

dark frothy urine
weight gain
massive edema (especially day)
normal BP

Front 88

What are some lab findings you will see for nephrotic syndrome?

Back 88

marked proteinuria (3+ or 4+)
hyperlipidemia (↑ cholesterol & triglycerides)
↑ HGB & HCT
hypoalbuminemia (hypoproteinemia)

Front 89

Tx for nephrotic syndrome involves medications like ____ and _____ as well as prophylactic _____ . Then if severe, _____ is given IV.

Back 89

corticosterioids (esp. prednisone)
diuretics
antibiotics
albumin

Front 90

Diet restrictions for nephrotic syndrome

Back 90

low salt, low saturated fat, low cholesterol
may be fluid restrictions

Front 91

Ensure that the child with nephrotic syndrome changes ______ often to decrease pressure on body parts and relieve edema in dependent areas.

Back 91

position

Front 92

Edema is _____ dependent, so we should elevate edematous body parts with pillows while the child is in bed or sitting in a chair. This helps move fluid away from dependent body parts.

Back 92

gravity

Front 93

True or False: Promote physical activity for the child with nephrotic syndrome as tolerated by providing developmentally appropriate play activities.

Back 93

True
increased activity helps promote circulation

Front 94

Diuretics can increase excretion of _____.

Back 94

potassium

Front 95

When the kidneys are suddenly unable to regulate volume and composition of urine appropriately, this is known as what?

Back 95

acute renal failure.

Front 96

What is the most common cause of acute renal failure in children?

Back 96

HUS- hemolytic uremic syndrome followed by dehydration
It is the result of decreased perfusion of the kidney.

Front 97

Clinical manifestations of acute renal failure include:

Back 97

REALIE!
-Respiratory distress r/t fluid overload
-Elevated BP
-Acid-base imbalance
-Lethargy
-Increased BUN & Creatinine
-Edema

Front 98

Therapeutic management for acute renal failure includes the tx of the underlying cause and management of complications. What needs to be monitored? What electrolytes need to be especially monitored? It is very important to prevent _______.

Back 98

fluids, electrolytes, acid base balance

potassium and sodium

infection

Front 99

Chronic Renal Failure is when the kidneys are unable to function at least _____

Back 99

50 %

Front 100

Chronic Renal Failure is caused by congenital _________ or related to ____, ____ or _____

Back 100

anomalies
AGN
HUS
pyelonephritis

Front 101

The pathophysiology of chronic renal failure .....

Back 101

early or advanced renal disease that can progress to end stage renal disease

Front 102

Clinical manifestations of chronic renal failure

Back 102

HTN
Anemia
Imbalance of fluid & electrolyte /acid base
Rickets
Fatigue
Anorexia
Nausea/ vomiting
Growth problems (short stature failure to thrive)

Front 103

Therapeutic management for Chronic Renal Failure includes assisting with diet, assessing fluid and electrolyte imbalance, monitoring skin integrity, and provide family support. What are some diet restrictions? (3) and medications? (2)

Back 103

low salt
very low protein
fluid restrictions

diuretics
antihypertensives

Front 104

A diagnosis of ESRD is made when the GFR decreases to about _____. What tx are needed?

Back 104

peritoneal dialysis
hemodialysis
kidney transplant

Front 105

Explain the difference between peritoneal dialysis and hemodialysis

Back 105

just tell me and I'll go with it.

Front 106

characterized by muscle weakness, leg cramps and ileus

Back 106

hypokalemia

Front 107

abdominal cramping, tachycardia, cold clammy skin

Back 107

hyponatremia

Front 108

tetany , positive Chvostek's sign, and hypotension

Back 108

hypocalcemia

Front 109

itching, weakness, bradycardia

Back 109

hypercalcemia

Front 110

flaccid paralysis and cardiac and respiratory arrest

Back 110

hyperkalemia

Front 111

thirst, peripheral edema, and seizures

Back 111

hypernatremia