Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
111 Cards in this Set
- Front
- Back
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.
|
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.
|
|
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.
|
growth
skeletal hypertension lesions immune |
|
True or False: A child in an acute phase of nephrotic syndrome is always hospitalized.
|
True
|
|
True or False: Kidney function is increased when the infant is under stress.
|
False, function is reduced
|
|
True or False: By 6 to 12 months of age, kidney function is nearly that of an adult.
|
True
|
|
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.
|
acidosis
|
|
Younger children have shorter/longer urethras, which predispose them to UTIs
|
shorter
|
|
By what age do children usually achieve complete bladder control?
|
4 to 5 years
|
|
True or False: Unlike adults, most children with acute renal failure regain normal function.
|
True
|
|
What is the most common serious bacterial infection in infants and children?
|
UTI
|
|
The presence of ______ in urine is often the first indication of renal disease.
|
protein
|
|
Nitrites are present in urine produced by _______ and often indicate infection.
|
bacteria
|
|
The serum study ____ is the end product of protein metabolism and is the gross indicator of renal function
|
BUN
|
|
True or False: BUN is decreased in renal insufficiency.
|
False, BUN is increased in renal insufficiency.
|
|
Serum ______ is the measurement of the concentration of blood and is determined by solute in blood. It is an indication of ____ and ____ balance.
|
osmolality
fluid & electrolyte balance |
|
What is the normal pH of urine?
|
4.8 - 8.0
|
|
_________ is the byproduct of muscle metabolism and is constant as long as muscle mass remains constant.
|
creatinine
|
|
True or False: Creatinine increases in renal insufficiency.
|
True
|
|
______ needs to be assessed before giving nephrotoxic chemotherapeutic agents.
|
creatinine
|
|
Does pH increase or decrease in urinary infections? What can it be affected by?
|
increases
diet |
|
_____ is a type of abdominal radiograph that visualizes abdominal structures. It diagnoses renal stones and is done before renal studies.
|
KUB (Kidney, Ureter Bladder flat plate scout film)
|
|
True or False: KUB is very painful and is must be done under general anesthesia.
|
False, it causes no discomfort.
|
|
A _______ is an exam of the bladder and urethra with a tubular, lighted, telescopic lens called a _______.
|
cystoscopy
cystoscope |
|
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.
|
fluids
void |
|
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.
|
CT scan
|
|
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?
|
supine
prone |
|
What does VCUG stand for? What does it detect?
|
Voiding CystoUrethroGram
detects reflux of urine into ureters and its severity detects bladder emptying problems detects urethral problems |
|
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.
|
radiation
Yes it is invasive diversional |
|
______ studies are invasive tests that are indicated to assess voiding dysfunction or an abnormal urinary tract.
|
urodynamic
|
|
Children with difficulties in urinary control are defined as having _______.
|
enuresis
|
|
______ enuresis occurs at night during sleep and _____ enuresis occurs during waking hours.
|
nocturnal
diurnal |
|
What is the difference between primary and secondary enuresis?
|
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.
|
|
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?
|
UA, culture
UTI, Diabetes Mellitus |
|
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.
|
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.
|
|
Emotional factors related to increased stress can contribute to ______ enuresis. ______ abuse must be considered in assessing for this type of enuresis.
|
secondary
sexual |
|
The primary cause of diurnal enuresis is an unstable _______, a condition in which the child experiences bladder spasms or increased urgency.
|
bladder
|
|
True or False: Primary Enuresis often resolves spontaneously.
|
True
|
|
Control of urination is related to maturity of what body system? This system may be delayed in children who have primary nocturnal enuresis.
|
CNS
|
|
Nocturnal enuresis is not a matter of excessive concern unless the child is older than ___ years or has markedly decreased ___-_____.
|
6
self-esteem |
|
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.
|
cystitis
pyelonephritis |
|
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 "___ _____"
|
fluids
voiding imagery "wee alert" |
|
Some causes of UTI's in children can be caused by anatomic _______ and incomplete emptying of the bladder, known as a ______ bladder.
|
abnormalities
neurogenic |
|
In older children, infrequent/frequent voiding and incomplete ______ of the bladder, as well as c_________ can contribute to UTIs
|
infrequent
emptying constipation |
|
True or False: Older children are sometimes just to busy to go, and need to be reminded about potty breaks.
|
True
|
|
In teens, sexual intercourse can lead to UTIs because of friction ____.
|
trauma
|
|
Are UTIs more common in females or males? Why?
|
females
short urethra improper breathing nylon underwear (need cotton to breathe) bubble baths (chemicals irritate urethra) |
|
True or False: UTIs are more common in circumcised males.
|
False
More common in uncircumcised males |
|
To prevent UTIs in uncircumcised males, proper _____ instruction is important.
|
cleaning
|
|
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.
|
VCUG
hydronephrosis polycystic kidneys |
|
Hydronephrosis is an _____ at the uretropelvic junction or other parts of the ureter that cause ______ of the kidney. It can be associated with ___.
|
obstruction
dilation VUR |
|
_____ the most common life-threatening genetic disease and is a cystic genetic disorder of the kidneys
|
polycystic kidney disease or PCK/PCKD
|
|
_______ in the urine is needed to diagnose a UTI.
|
bacteria
|
|
Symptoms of UTI in the absence of ______ can include perineal inflammation, vaginitis, pinworms, or chemical irritation from bubble baths.
|
bacteria
|
|
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 _________.
|
tourniquet
circumcision |
|
Signs and Symptoms of UTI in the neonate include .... (5)
|
jaunice
vomiting fever failure to thrive feeding diffuclty |
|
Signs and Symptoms of UTI in the infant include...(5)
|
irritability
poor feeding vomiting diarrhea strong odor to urine |
|
Signs and Symptoms of UTI in the child include.... (8)
|
vomiting
diarrhea abdominal/flank pain fever enuresis urgency frequency strong odor to urine |
|
______ is WBC in urine may be seen in the UA for a UTI along with h______, which is RBCs in urine.
|
pyuria
hematuria |
|
______ is when blood culture and urine culture grow the same organism.
|
Urosepsis
(this is where the infection in the blood has spread to the urinary system) |
|
In _________ you will likely see an elevated WBC count and elevated C-reactive protein and erythrocyte sedimentation rate.
|
pyelonephritis
|
|
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.
|
intravenous pyelogram (IVP)
|
|
Usually the tx for UTI involves _______ therapy, either IV or PO, over a course of ____ to ____ days. _______ can be used for pain.
|
antibiotics
7 to 10 acetaminophen |
|
What are the most common antibiotics used in treating UTIs?
|
amoxicillin
Cefazol Bactrim Sepra |
|
_______ is the most common organism that causes UTI's.
|
E. coli
|
|
______ is a condition caused by the backflow of urine from the bladder into the ureters and sometimes into the kidneys.
|
Vesicoureteral Reflux (VUR)
|
|
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 ________.
|
urine
scarring HTN |
|
________ is undescended testicle(s). There is a high incidence among ______ infants. The goals of treatment include... (2)
|
cryptorchidism
premature Goals: preserve testicular function and promote a normal scrotal appearance |
|
True or False: Cryptorchism usually resolves on its own, in that they spontanously descend on their own.
|
True
|
|
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?
|
6 to 12 months
orchiopexy |
|
In treating cryptorchism, hormone replacement therapy is used, which one? If cryptorchism is untreated, there is a slightly higher risk of ____ _____.
|
HCG
testicular cancer |
|
________ a congenital anomaly in which opening of urethral meatus is below normal placement on penis.
|
hypospadius
|
|
_____ or downward curvature of the penile shaft, can accompany hypospadias
|
chordee
|
|
Which is more common, epispadias or hypospadias?
|
hypospadias
|
|
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?
|
Age 6- 12 months
|
|
_________ inability to retract the prepuce at an age when it should be retractable, usually should retract around age ____
|
phimosis
3 |
|
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 ____.
|
inflammation
A skin |
|
s/s of acute poststreptococcal glomerulonephritis develop 1-2 weeks after streptococcal pharyngitis or ___ to ___ weeks after a streptococcal pyodema infection.
|
3-6
|
|
Incidence of acute poststreptococcal glomerulonephritis is most common in _____-age children, ages ___ to ____ years old.
|
school age
5-12 |
|
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: ________.
|
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.
|
|
Complications from S/S of acute poststreptococcal glomerulonephritis include what 2?
|
HTN
pulmonary edema |
|
Lab studies for S/S of acute poststreptococcal glomerulonephritis (6)
|
UA
CBC chem panel ASO (antistreptolysin titer) cultures of throat /skin lesions renal biopsy (CUP CAR) |
|
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.
|
rest
sodium protein antihypertensives diuretics antibiotics creatinine |
|
Describe some symptoms of acute poststreptococcal glomerulonephritis .
|
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) |
|
Clinical condition cause by damage to the glomerular structure of the kidneys describes ______ syndrome
|
nephrotic
|
|
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?
|
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. |
|
Glomerulonephritis has a ______ onset while nephrotic syndrome has a ______ onset.
|
abrupt
slow (insidious) |
|
Clinical manifestations of nephrotic syndrome are similar to glomerulonephritis. What are the main symptoms present in nephrotic syndrome only?
|
dark frothy urine
weight gain massive edema (especially day) normal BP |
|
What are some lab findings you will see for nephrotic syndrome?
|
marked proteinuria (3+ or 4+)
hyperlipidemia (↑ cholesterol & triglycerides) ↑ HGB & HCT hypoalbuminemia (hypoproteinemia) |
|
Tx for nephrotic syndrome involves medications like ____ and _____ as well as prophylactic _____ . Then if severe, _____ is given IV.
|
corticosterioids (esp. prednisone)
diuretics antibiotics albumin |
|
Diet restrictions for nephrotic syndrome
|
low salt, low saturated fat, low cholesterol
may be fluid restrictions |
|
Ensure that the child with nephrotic syndrome changes ______ often to decrease pressure on body parts and relieve edema in dependent areas.
|
position
|
|
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.
|
gravity
|
|
True or False: Promote physical activity for the child with nephrotic syndrome as tolerated by providing developmentally appropriate play activities.
|
True
increased activity helps promote circulation |
|
Diuretics can increase excretion of _____.
|
potassium
|
|
When the kidneys are suddenly unable to regulate volume and composition of urine appropriately, this is known as what?
|
acute renal failure.
|
|
What is the most common cause of acute renal failure in children?
|
HUS- hemolytic uremic syndrome followed by dehydration
It is the result of decreased perfusion of the kidney. |
|
Clinical manifestations of acute renal failure include:
|
REALIE!
-Respiratory distress r/t fluid overload -Elevated BP -Acid-base imbalance -Lethargy -Increased BUN & Creatinine -Edema |
|
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 _______.
|
fluids, electrolytes, acid base balance
potassium and sodium infection |
|
Chronic Renal Failure is when the kidneys are unable to function at least _____
|
50 %
|
|
Chronic Renal Failure is caused by congenital _________ or related to ____, ____ or _____
|
anomalies
AGN HUS pyelonephritis |
|
The pathophysiology of chronic renal failure .....
|
early or advanced renal disease that can progress to end stage renal disease
|
|
Clinical manifestations of chronic renal failure
|
HTN
Anemia Imbalance of fluid & electrolyte /acid base Rickets Fatigue Anorexia Nausea/ vomiting Growth problems (short stature failure to thrive) |
|
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)
|
low salt
very low protein fluid restrictions diuretics antihypertensives |
|
A diagnosis of ESRD is made when the GFR decreases to about _____. What tx are needed?
|
peritoneal dialysis
hemodialysis kidney transplant |
|
Explain the difference between peritoneal dialysis and hemodialysis
|
just tell me and I'll go with it.
|
|
characterized by muscle weakness, leg cramps and ileus
|
hypokalemia
|
|
abdominal cramping, tachycardia, cold clammy skin
|
hyponatremia
|
|
tetany , positive Chvostek's sign, and hypotension
|
hypocalcemia
|
|
itching, weakness, bradycardia
|
hypercalcemia
|
|
flaccid paralysis and cardiac and respiratory arrest
|
hyperkalemia
|
|
thirst, peripheral edema, and seizures
|
hypernatremia
|