NURS 629 Exam 2 Questions with 100% Correct Answers | Verified | Updated 2024/2025
3 kinds of UTI
1) Asymptomatic bacteriuria
2) Cystitis
3) Pyelonephritis
Asymptomatic bacteriuria:
bacteria in the urine w/o other symptoms
Cystitis
Infection of the bladder that produces lower tract ...
NURS 629 Exam 2 Questions with 100%
Correct Answers | Verified | Updated
2024/2025
3 kinds of UTI
1) Asymptomatic bacteriuria
2) Cystitis
3) Pyelonephritis
Asymptomatic bacteriuria:
bacteria in the urine w/o other symptoms
Cystitis
Infection of the bladder that produces lower tract symptoms but does not cause fever or renal injury
Pyelonephritis
Severe UTI involving the renal parenchyma or kidneys; potential for irreversible renal damage
S/S - fever, irritability, vomiting in an infant, and urinary symptoms associated w/ a fever, bacteriuria,
vomiting and renal tenderness in older children
Main cause of UTI
E coli (70% of cases)
UTI diagnosis
1. Urine culture to confirm (>100,000 colonies in a clean catch urine; or 10,000 colonies in a single
pathogen and the child is symptomatic) = UTI
2. UA - foul odor, cloudiness, nitrities, leukocytes, alkaline pH, proteinuria, hematuria, pyuria,
bacteriuria
3. CBC, ESR, CRP, BUN, and creatinine for children <1, appears ill or if pyelo is suspected
UTI Prevention
wipe front to back, bathe in clean water, then wash child, and get out; increase water; void after
intercourse; frequent and complete voiding; avoid bubble baths and perfumed soaps; wear cotton
underwear; treat perineal inflammation to prevent UTI; treat constipation; decrease caffeine,
carbonated beverages, chocolate, and citrus, aspartame, alcohol and spicy foods
UTI Treatment in uncomplicated cystitis
Uncomplicated cystitis: children 2-24 months old and febrile children treated for 7-14 days
a. Trimethoprim-sulfamethoxazole (if >2 mo old) 8-12 mg/kg in 2 doses; adolescents - 160mg BID
b. Amoxicillin
c. Amoxicillin clavulanate
d. Cephalexin
e. Cefixime (if >6 mo old)
f. Cefpodoxime proxetil (if >2 mo old)
g. Ciprofloxacin (if >18 years) 500 mg once daily x3 days
h. Nitrofurantoin (if >1 mo)
UTI Treatment in Pyelonephritis
,a. Hospitalization if dehydrated, vomiting, or not drinking
b. If uncomplicated = well hydrated, no vomiting, no abdominal pain = cefixime, ceftibuten, or amox
clav
c. Adolescents w/ uncomplicated = amox clav or ciprofloxacin
Treatment of recurrent UTI
Renal and bladder ultrasound, if not done previously and voiding cystourethrogram (VCUG)
What is GER?
Refers to the passage of gastric contents into the esophagus from the stomach through the LES;
normal physiological process in healthy individuals
What is GERD?
present when the reflux causes troublesome symptoms and/or complications; most common
esophageal disorder in children
GERD etiology
Inappropriate relaxation of LES w/ failure to prevent gastric acid reflux into the esophagus, prolonged
esophageal clearance of the gastric refluxate, and impaired esophageal mucosal barrier function
1. Infants have increased intraabdominal pressure because of their inability to sit upright;
regurgitation is highest in the first month of life and decreases by 50% by the 5th month of life
GER symptoms
1. Infancy = regurgitation; signs of esophagitis (irritability, arching, choking, gagging, feeding
aversion); usually resolves 12-24 months of age
2. Child and adolescent = regurgitation during preschool years, complains of abdominal or chest pain,
neck contortions (arching, turning of head), asthma, sinusitis, laryngitis
3. Symptoms in all children = regurgitation w/ or w/o vomiting; ruminative behavior; heartburn or
chest pain; hematemesis; dysphagia; respiratory disorders (wheezing, stridor, cough, hoarseness,
persistent throat clearing or cough); halitosis
4. Signs in all children = esophagitis, esophageal stricture, barrett esophagus, laryngeal/pharyngeal
inflammation, recurrent pneumonia, anemia, dental erosion, apnea spells, apparent life-threatening
events, weight loss or poor weight gain
GERD diagnosis
By history and physical exam; sometimes an empiric trial of acid suppression w/a PPI x 4 weeks may
be used as a diagnostic test in older children and adolescents, but not recommended in infants and
young children
1. Labs = obtain CBC w/ diff to r/o anemia and infection; UA and urine culture; stool for occult blood;
testing for H. pylori
2. Gold standard to diagnose reflux - esophageal pH monitoring
GERD management
1. H2RA and buffering agents - rapid onset of action, useful in on-demand treatment; result in
tolerance
----H2RA examples: cimetidine, famotidine, nizatidine, ranitidine
2. PPI - superior to H2RAs in relieving symptoms and promoting mucosal healing and do not result in
tolerance as do H2RA
----PPI examples: lansoprazole (prevacid), omeprazole (Prilosec), rabeprazole (aciphex), pantoprazole
(protonix), esomeprazole (nexium)
, 3. Cytoprotective agent - sucralfate (Carafate)
GERD: nutrition
thickening agents for formula in 1 tablespoon rice cereal/ounce formula reduce regurgitation but not
significantly; no evidence to support dietary restrictions to decrease symptoms; avoid eating <2 hours
before bedtime
GERD lifestyle
With GER, position infant in flat prone position after feeding if awake and being observed
Position in flat supine position if sleeping
Semi-sitting position applies abdominal pressure and causes more reflux; positioning infants upright
may worsen reflux;
Burp frequently during feeding
Left-side positioning for older children during sleep or elevation of the head of the bed
What is Celiac disease?
Immune-mediated systemic disorder triggered by dietary exposure to wheat gluten and related
proteins in barley and rye
What is celiac characterized by?
Characterized by the presence of a variable combination of gluten-dependent clinical manifestations,
celiac disease-specific antibodies, HLA-DQ2.5 or HLA-DQ8 haplotypes, and enteropathy
Celiac Disease: history
chronic or intermittent diarrhea, persistent or unexplained GI symptoms (N/V), sudden or unexpected
weight loss or prolonged fatigue
Celiac disease:Physical exam
impaired growth, FTT, unexplained iron deficiency anemia, abdominal distension, bloating or
cramping pain; high suspicion if a child has metabolic bone disease such as rickets or osteomalacia or
low-trauma fractures, or dental enamel defects
Celiac disease: Diagnostic studies
Serologic testing recommended are IgA tissue transglutaminase antibody (tTGA) and IgA endomysial
antibody (EMA); gluten should be eaten in more than 1 meal every day for 6 weeks prior to testing;
If positive = refer for endoscopy w/ biopsy for DEFINITIVE DIAGNOSIS
Celiac disease: management
Gluten free diet for life - (limit of 20 ppm of gluten)
Alternative therapies being explored are enzyme therapy, genetically engineered grains, inhibiting
tTGA in the intestine, and correcting intestinal barrier defects
What is failure to thrive?
Lack of weight gain proportional to age as determined by standardized growth charts
FTT: Diagnostic criteria
1. Weight <80% of median weight for length
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